How Physicians Address Patient Obesity

physicians and obesityWe asked our Sermo physicians recently how they address obesity with their patients.  The majority of them recommended diet and exercise but the stats are revealing in other ways.

Here are the obesity poll results …

  • 88% recommend diet changes
  • 86% recommend an exercise program
  • 42% refer to a nutritionist
  • 19% discuss surgery options
  • 15% recommend talk therapy
  • 12% recommend medication

We found it interesting that more physicians were willing to talk surgery options before talk therapy or medication.

Obesity as a risk factor

A recent study from Mount Sinai Hospital in Toronto, Canada aggregated studies from as far back as 1950 and declared, “it’s not possible to be both fat and fit.”  According to Time Magazine, the researchers found, “that metabolically healthy obese participants had a higher risk of dying earlier or having heart-related problems than those who were normal weight and also metabolically healthy.”

This does seem to contradict earlier studies that said it was possible to have a BMI above 25 and still live a healthy, full life.   The article pointed out that being overweight or obese can affect people differently and that genetics, environmental and lifestyle choices all play a part.

Obesity and treatments

While 19% of Sermo physicians mentioned surgery as an option they bring up to patients, the American Medical Association guidelines recommend not performing surgery unless the patient’s BMI is over 40 or if it’s a BMI of 35 with comorbid conditions such as diabetes or cardiovascular disease.

Medication therapy is recommended for patients with a BMI of 30 or higher or overweight patients with a BMI of 27 or higher and other risk factors such as hypertension or dyslipidemia.

Obstacles to treatment

While obesity is a clinical term meaning a BMI greater than 30, to the general public it’s considered derogatory.  Patients prefer to discuss “their weight problem” and can feel chastised by their doctors if their approach is considered to direct.   This can be an obstacle to ensure the patient gets the necessary help.

In addition, one study found that overweight physicians were less likely to discuss weight with their patients and that their patients were less likely to trust their advice.   The study, published in the journal Obesity said, “normal weight physicians were more likely to talk about weight loss with their obese patients (30 percent vs. 18 percent of overweight docs), had more faith that patients would trust their advice (80 percent vs. 69 percent of overweight docs), and had more confidence in their ability to provide diet and exercise advice (53 percent vs. 37 percent of overweight docs).”

As a physician what do you do in your practice with your obese clients?  Do you approach them on a case-by-case basis or do you have a check-list that you regularly go through?  How do you help them lose weight?  If you’re an M.D. or D.O. this is sure to be a hot topic inside the Sermo community, please join us.

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