I am scheduled to give a Continuing Medical Education presentation on the topic of how doctors can approach their patients who are overweight about their weight. What advice should I give them? Have you been told well? Badly? What made it good for you or bad?
Ummm…what’s wrong with saying “you’re overweight.”? It’s not insulting or derogatory, like “fat” or “heavy-set” mgiht be. It’s just what it says…over their ideal weight for their age, height, and gender.
If that’s no good, then the doctor can say, “you’re health might improve if you lost some weight.”
And if I might add, that anyone who sues a doctor for calling them fat (i remember we had a thread on this a while back (or two or three threads) is a douchebag. I mean…you pay this guy to tell you what’s wrong with you, but you don’t like his answer, so you sue him? What’s next, sueing him because he told you you had a heart attack?
“anyone who sues a doctor for calling them fat (i remember we had a thread on this a while back (or two or three threads) is a douchebag. I mean…you pay this guy to tell you what’s wrong with you, but you don’t like his answer, so you sue him? What’s next, sueing him because he told you you had a heart attack?”
Seriously…how about suing you for telling me I’m female or something? Just be tactful about it and I would think that it shouldn’t be a problem. I might be offended if a doctor put me on the scale and said, “Whoo, are you fat! Seriously, look how fat you are!” But anything along the lines of, “You could probably stand to lose some weight” or “You are overweight, and it will start effecting your health if you don’t do something about it” are not meant to be insulting and are a proper medical diagnosis.
Of course, a good and understanding doctor would also not just say “*You * should do something about it,” but offer some suggestions or sources of help as to how “we” can address the problem. I think tact is the issue here.
Having spent 11 hours in the emergency room Monday after suffering chest pains, I had a heart to heart (so to speak) conversation with my doctor about just this topic.
He said
“You need to follow a consistent program of exercise and maintain a consistent diet. If you can be consistent in both of those for the next six weeks, I’m sure those scores will be back in the normal range when we repeat the tests.”
I understand “consistent” to be “put down the brownies, get off your fat ass and do something before I have to perform angioplasty.”
The doctor could post the BMI index chart on the wall, indicate where the patient’s ideal weight range lies and show them where their current weight is.
I think the goal should be to treat it strictly as a medical problem, and not a problem with them. For instance, doctors should say things like “you’re such-and-such over the ideal weight for a person of your height/build” and “these are the medical problems you may face if you are at this weight, here are some symptoms of these problems you’re experiencing now.” Bring up facts, bring up statistics. Don’t ask them any questions about how it affects their psychological health or self-esteem. Don’t make any judgements about them as a person. The doctor in that linked Pit thread was way out of line. Obesity is enough of a physical problem that you don’t need to bring someone’s mental state or social stigma into it. People do not need life advice from their GP. If someone is offended by real-world statistics, then that is their own fault.
Anyone else thinking of last week’s Family Guy episode? “I have something to tell you, it’s not easy to say, okay here goes… I’m fat.”
I’m still waiting for some douchebag doctor who doesn’t know my medical history to unload on me about my weight. I thought it might happen last night when I went to the ER for a sports injury, but the ER was at the hospital where I had my gastric bypass, so it would have been readily apparent in my records.
My point? I’ve lost 85 lbs since June, and by all accounts, I’m doing nearly everything right, but there’s going to be the egotistical jerk somewhere who will want to berate me for still being fat.
To be blunt, so what? Are you losing weight for them, or for you?
And I should add, congrats on the weight loss, I’m glad it’s working well for you. 
Don’t say “You’re so fat you’re going to end up alone or with a black guy” like the doctor who got sued did.
Be sure the patient is actually obese. I had a doctor who was on me about my weight when I was 5’5" and 130 pounds.
I would imagine that starting out with a question - “How do you feel about your weight?” or “Are you aware of your potential to develop X health problems?” - might be good. It is not news to most fat people that they are fat, so taking the approach that they must not have noticed and should be told is bound to be irritating.
I’m definitely doing it for me. I’m used to dealing with the snide remarks aimed at fat people, and I anticipating someone opening their mouth not realizing that I’m a work in progress.
One thing I would say to doctors; “Don’t mention my weight if it has nothing to do with my medical condition.” I hate it when doctors spend most of the consultation disapproving of my lifestyle (which I accept isn’t perfect), rather than just writing the goddamn prescription.
Brynda - I wouldn’t go into legalities unless you know exactly what the law will allow. That’s shouldn’t be part of your topic. As far as giving the information to patients, I’d advise doctors to keep it medical, not personal. And if the patient’s weight isn’t impacting their health at the time, don’t harp on it. Maybe a comment about potential problems in the future, but if they’ve come to you for a sinus infection, it really isn’t relevant, is it? And if it is relevant to the problem, state it clearly and unequivically, and tell the patient that you can help them if they will accept help. For example - “Mr. Smith, you’re currently about 80 lbs over your ideal weight. That’s part of the cause of the pain in your knees. We need to develop a diet and exercise plan that will allow you to loose weight without causing more pain and damage to your knees.” But stay away from offering legal advise - that’s for lawyers.
StG
StG
Thanks for the advice so far. My plan is to come up with lists of things for doctors to think about and things to say. For example, I like “don’t mention it unless it is germane to the condition” and “don’t blame the person” advice. One thing I had thought of was to advise them to acknowledge that losing weight is difficult and that the person may have tried before.
There will be a doctor speaking with me who will offer them some medical suggestions as to how to lose weight; my job is just to give them some ideas about how to approach it so patients won’t be offended and will listen. My guess is that some doctors don’t mention weight because they don’t know how, so my part is to put them at ease.
St. G, I don’t intend to give legal advice. That was just a (weak) joke about the case mentioned above.
Correct me if I’m missing something here, but what legal issues? The linked story is about complaints to a medical board, which are not the same thing as lawsuits, correct? Does anyone have any links to stories about doctors actually losing lawsuits due to advising patients on their weight?
Because the saying “anyone can sue for anything” didn’t come from nowhere. But perhaps obviously not every lawsuit is decided in favor of the complainant. Lots of lawsuits are dismissed. Agreed, though, they are still to be avoided because they are expensive to deal with in terms of time and money.
However, the Dr. Bennett in the linked story surely should have expected complaints. One complaint alleged he told the woman to “get a pistol to end her life.” For crying out loud! Can any of us in any field tell customers that without someone complaining to the relevant authority?
So I kind of agree with StG, in that you shouldn’t go into legal issues if you don’t understand them. But I would also add, don’t assume there are more legal issues than there are.
**davenportavenger’s ** suggestions seemed totally on target.
It helps if the doctor is not fat. Its going to be difficult to accept advice on losing weight from a person who is hefty themselves, no matter how sensible the instruction. Reason I mention it is that my doctor is fat, and I think she might find it tough dispensing medical advice in this area.
One thing that hasn’t been mentioned is to discuss anything NEW. Someone who has struggled with weight their whole life doesn’t want to be told about the same diet that didn’t work the last nine times, but may want to hear “gastric bypass has had a success rate of XX%” if they are a good candidate. Also offer referrals to nutritionists, if applicable.
All patients, regardless of size, should be shown their height/mass/bmi etc on charts during checkups. Even the skinny ones. Its one of the ways I know I need to lose five pounds - when I creep up to the top of my range. Five pounds is easier to lose than twenty five. If you make showing the chart and the relative position of the patient on the chart just part of your standard practice, it will come naturally regardless of size.
Brynda - Sorry for misunderstanding the legal comment. I can be distressingly literal at times.
StG