I was a precocious child. For example, when I was 5 years old, I changed my name—ever so slightly but enough to make a difference. A couple of years later, I canceled an appointment with my pediatrician. I didn’t want my doctor to talk with me about being overweight. Getting on the scale caused me great anxiety; visiting the doctor made me self-conscious and uncomfortable. Dr. Adelman told me I was too chubby and had to lose weight. Yet he always offered me a lollipop before I left the office. With every subsequent visit, I thought he was going to embarrass me about my weight. The emotional pain became so great that I avoided my appointment rather than be subjected to my doctor’s judgmental comments. Fast-forward 40+ years. I was still avoiding well-care visits. Getting on a scale still conjures up feelings of embarrassment, loss of self-control, and disappointment.
If only I ate in moderation and exercised regularly—but I do not. While I have not recently experienced the judgmental comments or nonverbal communications of my doctors and nurses, I internalized the comments and reactions of my pediatrician. As an adult, I practiced the same unhealthy behavior of many overweight women who have ignored their health due to stigma and shame. For them, that point in a doctor visit—stepping on the scale—is associated with intense negative emotions that keep too many people who are overweight and obese from obtaining proper preventive healthcare.
Treatment includes treating all people with respect
Two points I find interesting on the topic of obesity are that weight counseling in the primary care setting has decreased 1 and that there is a need to educate healthcare providers about treating obese people with respect and dignity.
At a recent conference on obesity, it was reported that physicians have not found weight counseling to be effective—one reason for the reduction in time spent on this intervention. This decrease in counseling time is occurring despite an increase in patient visits for diabetes, hypertension, and other obesity-related issues. A Healthy People 2020 goal has been set to increase the proportion of obese-adult office visits that include counseling and education on losing weight and living a healthy lifestyle. But are physicians and other healthcare providers equipped to counsel these patients? Do they have effective tools and the resources to guide their patients about weight loss?
At the obesity conference, Christopher N. Sciamanna, MD, from the Penn State University College of Medicine, said that physicians must have effective tools, including Web sites and programs, to guide the treatment of obese patients. He added that physicians need education on what to say and do to help obese patients.1 Weight counseling is not adequately addressed with a few quick statements emphasizing that a patient’s diabetes, cardiovascular disease, or arthritis will be further compromised if he or she does not lose weight. In the absence of knowing what to say and in feeling defeated because of the ineffectiveness of what has been offered, has the course of action for physicians been to say and do less?
Caring for patients with obesity
I started writing this blog when I read a statistic about the high number of women who avoid well-care visits because of the embarrassment and shame they feel about their weight. The case study I read mentioned a healthcare provider rolling her eyes when recording the patient’s weight. The article described a patient’s humiliation when the scale stopped at 350 pounds and the dressing gown was too small. I went on to read more about the challenges of treating people with obesity and realized what a learning curve it is. However, a core tenet of caring for any patient is respect; and in the case of obesity, a few basic considerations have been described in an article from the National Institutes of Health and the Weight-control Information Network (WIN). Excerpts from the article are listed below. To read the full article, go to Medical Care for Patients with Obesity.2
· Have suitable equipment and supplies on hand to improve patient access to care.
· Create a positive, open, and comfortable office space.
o Provide reading materials in the waiting room that focus on healthy habits‚ rather than physical looks or being “thin.”
· Use medical devices that can correctly assess patients with obesity.
o Use large adult blood pressure cuffs or thigh cuffs on patients with an upper-arm circumference greater than 34 cm.
· Be respectful when talking about the patient’s weight.
o Weigh patients in a private area and only when medically needed.
o Record weight without comments.
· Offer well-care services.
o Allow enough time during office visits to provide well-care services.
· Promote healthy behaviors.
o Ask patients if they want to talk about weight loss. If they want to talk about losing weight‚ let them know that a weight loss of 5 to 7 percent of body weight may lower their chance of developing diabetes. Work with patients to establish realistic goals.
o Start small. Encourage patients to start with simple goals such as walking for 10 minutes‚ three times a day. Once they achieve this goal‚ they can build on it.
o Offer patients information and referrals to registered dietitians‚ other health providers‚ and support groups‚ as needed.
o Promote self-acceptance and encourage patients to lead full and active lives.
References: 1. Sciamanna C, et al. Decline in U.S. physician lifestyle counseling during the obesity epidemic. OBESITY 2011; ABSTRACT 28-OR. 2. Medical Care for Patients with Obesity. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health. NIH Publication No. 03–5335. February 2003. Updated July 2011.
Ide Mills, LCSW
Senior Vice President, Health Education