Being overweight has become an epidemic, with 711 million overweight worldwide. Obesity – having a body mass index (BMI) of 30 or above – has more than doubled since 1980, and according to the World Health Organization “Most of the world’s population live in countries where overweight and obesity kills more people than underweight.” Doctors are responsible for helping patients make healthy choices, and unlike some other deadly conditions, obesity is often preventable.
Complicating the health problems linked to obesity, however, are the host of social issues associated with being overweight that make it a challenging topic to discuss. The delicate balance of outlining health objectives while creating a supportive relationship with patients is one that doctors struggle with. Doctors on SERMO recently discussed this balancing act.
Doctors have different opinions about whether to bring up the topic
“I don’t address obesity directly unless the patient brings it up first.” – Psychiatry
“[I’ve] never met a patient who needs to be told they’re obese.” – Psychiatry
“I disagree with the inference that just because they know that they are overweight, we don’t need to bring it up. I will always bring up the fact that they are overweight and ask them if they want to address it. If they say no, I will drop it. If they say yes, I will attempt to do what I can.” – Pediatrics
“It has to be said and explained directly. We cannot hide their diseases from patients.” – Internal Medicine
“About 5 years past residency I almost stopped telling patients to lose weight, quit smoking etc. due to the futility. Then I read a journal article saying hearing it from their doctor makes a difference ~25% of the time. So I kept it up over time. A couple years ago a patient was in, had lost 30+ pounds quit smoking: really looked much healthier. I asked him how he did [it] so I could encourage others. He said, ‘Because you told me to.’ Patients need to hear it from us” – Family Medicine
Even though most doctors feel they are responsible for having discussions about the medical impact of being overweight, they are aware of the specific social stigma.
“I just try to remind myself that in our society, with all of our body shaming, nobody is obese because they want to be.” – Plastic & Reconstructive Surgery
“People aren’t offended by being called fat, they are offended by [some doctors who are] shaming them along with the rest of the world, treating them like an idiot, and then not giving them any realistic solutions without you actually shouldering any of the blame for not having a realistic solution. When an oncologist tells a patient about stage 4 cancer, they aren’t blaming and shaming the patient. It is like every time a colon cancer patient comes in, if the oncologist starts out by lecturing them on why they didn’t get their colonoscopy.” – Ophthalmology
“We don’t criticize our patients because their potassium or calcium or thyroid is too high or too low. Body mass is just another parameter that is controlled by physiology. It is not character-determined.” – OBGYN
“I try not to judge. Most people know they are overweight.” – Internal Medicine
“Patients need us to be physicians to assist them, not to nag them. Patients do not need us to be parents or paternalistic. We can educate and assist.” – Anesthesiology
“Leave the ‘Sin Talk’ to the three ‘P’s’–Priests, Parents and Politicians.” – Internal Medicine
“I don’t get focused on cosmetics, and do not criticize people. I weigh them, tell them how much they gained or lost, talk about diet options, and cheer them on. I will let them know how weight affects each disease they have or how it increases risk. I keep it positive and non-judgmental.” – Psychiatry
“I often make the point to patients that being overweight says nothing about someone as a person. It’s not a character defect… But patients need to know what’s bad about these problems and what can be done about them.” – OBGYN
Doctors have different opinions about how to approach this question, but are bound by a common desire to help improve patients’ health. Are you a physician? Join SERMO to compare communication tips with other physicians.