The Elephant in the Room: Discussing Obesity with the Doctor

August 23, 2017
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From the Wall Street Journal (Doctors Should Discuss Obesity With Patients):

Patients told by their physicians they were overweight or obese were more likely to acknowledge a weight problem and try to do something about it, a new study shows.

Researchers… found that getting an honest assessment from a physician appeared to be a key factor in whether or not study participants considered themselves overweight.

According to the article, people in general have gotten fatter over the years, so a patient may not see himself or herself as obese even if they are. If the doctor doesn’t bring it up they may not think there’s a medical issue. The authors think physicians should tell patients they’re overweight or obese, even if that seems self-evident.

I have a few thoughts on this:

  • I definitely understand the point that fat is the new normal. Growing up in suburban Washington, DC I remember the occasional “fat kid” who got teased in school. If I look around a schoolyard now there are many who fit that description. Hopefully they’re not getting teased about it.
  • I didn’t pay the $30 to read the original article, so I don’t know how the authors caveated their findings. However, I wonder how reliable patients are in reporting whether their physician discussed their weight with them. It wouldn’t shock me if a good number of people who said doctors didn’t discuss their weight problem actually had it wrong, and for whatever reason tuned it out.
  • Some commenters to the online article point out that almost no one is able to lose weight and keep it off, and that therefore it’s not surprising that doctors don’t bring things up that patients can’t do much about. There aren’t really good drug treatments for obesity and surgery is a fairly extreme step, so maybe physicians are spending their time discussing things that can make more of an impact. Furthermore, doctors may not know how to counsel about weight loss
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Doctors probably should talk more about weight loss with patients, but if we really want physicians to intervene it’s probably best to put some new tools in their hands that they’re comfortable using. I don’t see a lot of new drugs on the horizon, and most of today’s surgical procedures are expensive and risky.

I’d love to see some innovation from device companies in this area to develop effective, low risk approaches that can be used by a broader spectrum of patients.