Doctors on fat: Don't ask, don't tell

Just because your doctor hasn't talked with you about weight problems, don't assume you're in the healthy range
Just because your doctor hasn't talked with you about weight problems, don't assume you're in the healthy rangeJoe Raedle / Getty Images file

As long as your doctor doesn’t tell you to lose weight, does that mean your weight is in the healthy range? While it may be a tempting assumption, several studies show that physicians don’t discuss weight loss with 25 to 50 percent of their overweight patients. Many people might think their doctors will speak up if their weight becomes a problem, but many physicians assume that if patients want advice, they’ll ask.

Before the 1998 guidelines of the National Institutes of Health, which urged physicians to address the growing obesity problem, studies in the Journal of the American Medical Association and the Archives of Family Medicine showed that 35 to 42 percent of obese patients reported that a health care provider advised them to lose weight. Even among those with weight-related health problems, only slightly over half were advised to lose weight.

In a more recent study, 50 percent of overweight or obese patients with diabetes were counseled about weight loss on routine medical visits. Among those without diabetes, however, physicians counseled only 21 percent about weight loss. Unfortunately, the methods used in this study don’t tell us whether patients who said they received no counseling from their physician counted referrals to a registered dietitian or fitness trainer.

Another new study gives a more positive picture: 80 percent of obese patients said their physician advised them to lose weight, and almost 70 percent received counseling on diet change or exercise.

Attention to weight control as an important part of health may be increasing, but still, you can’t assume there’s no problem just because your doctor hasn’t mentioned your weight.

Similar story for exercise
A similar situation exists for those who are still couch potatoes despite recommendations from the American Institute for Cancer Research and other experts about the health benefits of regular exercise.

In earlier studies, 11 to 34 percent of patients reported being advised to begin or continue exercise, but more current studies suggest that group may have increased to about 60 percent. However, studies show that advice is often saved for middle-aged, more educated people who already have heart disease or diabetes; physicians seem less likely to discuss exercise as a preventive health measure.

Physicians are not totally to blame for this lack of attention to weight control and regular exercise. Only in the past few years have insurance and government groups begun to recognize obesity as a medical problem and a covered medical expense.

Since our medical system is often geared to caring for illness, it makes sense that more attention is given to obesity in people with medical problems affected by weight, such as heart disease and diabetes. Although weight control has been shown to help prevent these illnesses, as well as cancer and high blood pressure, it does not seem to have gained the status of smoking cessation as part of routine medical exams and preventive care.

Physician-patient communication problems may also play a role. “Overweight” and “obese” are medical terms with specific definitions that describe different degrees of excess body fat. A new survey in Obesity Research indicates that many patients medically diagnosed as obese find terms like obesity and fatness hurtful and offensive. According to this survey, “weight” is the preferred term (presumably sounding more objective and less judgmental). The author of this survey commented that obese individuals don’t bring up weight because they are embarrassed, and doctors don’t bring it up for fear of hurting feelings or because they feel weight control efforts are futile.

Nutrition Notes is provided by the in Washington, D.C.