Hard to get sued successfully for telliing the truth. Juries understand a BMI of 45 is bigger than average.
I am so sorry I put the joke in about not being sued, because clearly that confused some people. As I said above, this is NOT about being sued. That was a joke, a reference to the court case mentioned above. I will NOT mention suits or anything remotely like that in my presentation.
OK, back to the question. I am a psychologist giving a presentation to doctors about how to effectively talk to patients who are overweight about their weight. I am looking for advice that I can pass on to the doctors, like “do try to empathize that they may have tried to lose weight before.”
I am also looking for stories of how this was handled badly–sort of “don’t do it this way.”
My one experience was when I was a junior high and my doctor gave my mom some pamphlets on dieting. THat was a non-confrontational, though inneffective, way to approach the situation (I was obese then; my BMI is healthy now).
My advice to the doctors would be to not explicitly mention the patient’s weight. They know they’re fat. Perhaps instead they could simply focus on the medical issues that result from it (“You have increased risk of X, so I’d like to test for it/we need to check that more frequently/whatever”) and be prepared to non-confrontationally offer any resources they have available (e.g., “I know an excellent dietition, let me know if you’d like a referal”).
IANA mental health professional (heh 
) but, thinking back to when I was overweight and very sensitive about it, I think that approach would have worked best with me.
But even being sued unsuccessfully is hard on the pocketbook.
Have a list of people to whom the doctor can refer the patient. People like nutritionists, physical therapists, psychologists and psychiatrists who work with disordered eating, whatever. For other medical problems, patients get names and locations (e.g., “See Dr. Smith, she’s a cardiologist, she’s at Memorial Hospital. She’s specializes in this exact problem.”) - for this, it often becomes, “see a nutritionist,” with no info on where the patient might find one or who is a good one to find.
Even if I called a patient “fat” (which I would not), I would not lose sleep about the patient suing me.
We weren’t explicitly told during medical school how to address this problem. Most people who are overweight realize they are heavy and are sensitive about it. Doctors often do need to know the patients weight. Just asking for the height and weight of the patient can allow you to calculate a BMI and lead into a discussion about diet and exercise without mentioning words like “fat”. I wouldn’t be shy about asking patients their weight – but I suppose you could just ask them to step on a scale and sidestep even this.
I wouldn’t make it personal or judgmental. I suppose you could say something along the lines of “Many of my patients are interested in becoming healthier. Would you be interested in some advice on diet and exercise?”, or “I’m afraid you are currently at increased risk for heart disease, diabetes and joint pain. I can give you some advice on diet and exercise to reduce these risks.” If they say no, you could offer to refer them to a nutritionist or physiotherapist. Again, just saying this without mentioning weight or fat specifically is enough… patients get the idea. You are not doing a patient a favour by ignoring the topic, but I’ve heard plenty of patients complain about “other doctors” who told them they had to lose weight.
I don’t think I have ever seen an MD without having to get on a scale first. If they don’t already have my height on the chart, they measure that, too.
I think it would be reasonable to have charts made up where they have the BMI ranges and tell you the number every time, just like they tell you your blood pressure. I can never remember what the blood pressure numbers mean, so I always just nod and smile (my blood pressure has always been on the low side). But to state “your BMI is up from 26 last year to 28, which is now considered obese” or whatever, that could work well for me.
Also, I think my doctor’s health history form usually asks how much I exercise. So if weight is out of the normal range, the doctor could reconfirm the exercise piece, and make an appropriate recommendation: “you’re exercising 5 times a week, which is good, but since you’re still gaining weight, let’s talk about diet” or “you indicate you exercise once a month, let’s talk about ways you can be more active.”
I’d also say mention weight if it is germane to what the patient is being seen for today, or if it is the patient’s annual physical. That’s kind of a “state of the nation” address, so if there’s an issue it should be covered, whether it’s weight or smoking, etc. If the patient is in for something unrelated, like poison ivy, the discussion about weight is probably best at another time.
Just an anecdote about how this worked for my husband. (I’ll note that he is an intelligent man, and has fought weight issues for much of his life.) After experiencing various health issues, I finally convinced him to visit a general practitioner, in April of this year. The doctor did an exam, diagnosed him with high blood pressure, had him do a blood test, and also diagnosed high cholesterol after those results were in. He noted how my husband’s tiredness, blood pressure, and cholesterol could all well be affected by his diet and weight, and quite possibly cured by dietary changes. He did not say it like ‘you are fat, you’re ruining your health’ but posed it as a rather necessary change to help his health and possibly even fix his problems without having to take medication. He gave my husband a copy of the American Heart Association’s low-fat, low-cholesterol dietary plan, plus a prescription for a mild ACE inhibitor to get his BP down right away.
My husband said that for him, at least, the motivation to lose weight clicked when he talked to the doctor; he always knew that he had to but hearing it like that really hit home for him. I also worked hard to try to fit the diet to his eating preferences, and we both worked together to find acceptable snacks and food for meals. Since April he’s lost around 35-40 lbs. He still needs to lose a bit more, but he says he feels much better, and he looks good. I’m very proud of him.
Don’t treat the patient as if he doesn’t know he is overweight. Trust me, overweight people know that they are overweight and it is ruining their health, just as smokers know that cigarettes are dangerous. Don’t patronize.
Personally, I say “You know I need to say something about your weight. I wouldn’t be a good doctor if I didn’t tell you that your bllod pressure (diabetes, sleep apnea, whatever) would be better if your weight was lower. I know it’s hard. Trust me, if it was easy I’d be thinner”. Then I ask what they’ve tried and what has worked. Telling patients to lose weight without a plan or siggestions is useless.
Also, make sure that the doctors know what is available in the area and are up on the latest diet fads and herbal supplements. They should be able to recognize commonly used herbals in weight loss medications (such as cascara, which has a laxative effect, and kavakava, which has a diuretic effect) and be able to explain why these may or may not be useful and how they interact with the patient’s other medications. The doctor should be familiar with programs such as Weight Watchers and Jenny Craig and be able to explain the difference to patients (ie, some people benefit more from programs with prepared foods).
In short, treat the patient as an informed and intelligent person, and have options available for treatment.
Also, for the record IAAFD.
One thing I would recommend is that if the physician isn’t already familiar with the patient they shouldn’t assume that the patient’s current weight is the full story.
I saw a new doctor recently (gynecologist), and after asking my weight she started into a spiel about how my weight was unhealthy. I weighed 240lbs and 5’5" (26yo female) - definitely need to lose weight. However, six months ago I was 270lbs, and I’m still losing weight (currently 230lbs).
So basically, don’t just assume that the patient is overweight and that’s that. Ask about recent weight changes (losses or gains), to get the bigger picture. Knowing about a trend of continuing weight gain, or a pattern of yo-yo dieting, or successful weight loss is more important than simply knowing that at this moment in time they’re XXX lbs overweight.
I think this is a good suggestion. Especially if there were warnings on the chart for those who were underweight AND those who overweight.
Susan
Fat doctor here…the fact that I’m overweight seems to help people understand that I really don’t have a magic bullet for weight loss. In my area, everybody believes that there is a pill for every problem, and that if I’m not giving it to them, it’s because I don’t want to. (This is especially true of weight loss since a few less-than-scrupulous docs around here are using some potentially unsafe and ultimately ineffective diet pills.) One look at me and they know I have no such pill.
Personally, I think I’d have a harder time taking diet advice from the nutritionists at my old hospital, none of whom weighed more than about 90 pounds. I’m sure they ate better than most people, but they were without exception just tiny little people to begin with.
I can usually find a segue into the subject, and I don’t talk about it any more than the patient wants me to; after all, I can talk until I’m blue and it won’t help if the patient isn’t that interested. The important thing is to be specific. Don’t just say “eat less”; try to find something specific that the patient can cut out, or encourage them to learn how to count calories and keep a food diary. Don’t just say “exercise more”; come up with a plan that the patient can do and stick to.
Do you really believe that? Unless the doctor bought food and helped you shovel it into your pie hole, it’s not a “we” problem, it’s a “you” problem. Get off this touchy-feely-nobody-is-to-blame nonsense. Taking responsibility for what’s wrong with your life is the first step to fixing it, whether it’s booze, drugs, overeating, smoking, or anything else.
Blaming the candor of a doc is an attempt to gain victim status and avoid dealing with the root issue, IMO.
I’m not blaming anyone. Just suggesting a way to be tactful. That kind of phrasing could indicate that while the doctor can’t cure the problem as he might cure a sinus infection, he is willing to work with you to find a means of addressing the issue.
Why the hostility, anyway?
My hubby and I scheduled back to back physicals with our doctor (a small, lightweight guy). I’m about 20-30 pounds over my ideal weight, but was exercising regularly and am healthy. This doctor went on and on during my physical that I should drop this weight (duh) and go on Atkins. When I balked at Atkins he suggested Suzanne Somers plan. All the while, I listened dutifully, just knowing my 300lb plus hubby waited in the next room. I was glad this doctor was so concerned with weight and was sure he would berate my husband for his sloth and gluttony. Guess what? Not one friggin’ word was said to him regarding his weight. Way to go Doc.
As for suggestions, I’d recommend they have hand outs or a website to direct their patients that are serious about losing the weight. Doctors should also stress that it’s a lifetime commitment to changing eating habits and moving joyfully more often. Too many doctors are quick to prescribe meds that cause long term damage (fen-phen anyone?) or bowel leakage. It sounds wonderful that a pill could release us from the evils of weight gain, but at what cost? They should also remember that people overeat for many different reasons. It’s not all about the willpower or lack thereof.
I was at the doctor’s a few weeks back to get results for liver tests. He was checking everything out and said to me, “Let’s see what’s happened to your weight since last time I weighed you.” We went to the clinic room and he weighed me. He pointed out that I had gained weight since last time. He jerked his thumb toward his room and said, “Come on, let’s head back Slim.”
Absolutely broke me up.
Mind you he told me once that he had told a female patient, “Not everything can be fixed with medication, what you need is a good fuck 3 times a week.” When she remonstrated with him that he was being unprofessional he told her, “Being unprofessional would be offering to fill the prescription.”
I guess I have to respectfully disagree with everyone when they say don’t raise the issue if it is unrelated to the visit. Many of us only go to the doctor when we have a complaint. I haven’t had a real physical since the early 90’s. My weight has changed alot since then. I’m not saying that a doctor should ignore the complaint and say “your fat” but they should mention the problems associated and suggest that the patient come back for another appointment with their PCP or see a specialist, etc. and point out that whatever their problem, it may be exacerbated by weight (if it may actually be exacerbated by weight, ie, not a hangnail)
What they shouldn’t do is ignore a weight problem. I was told around the time of my last physical that it was OK for me to weight more that 90% of people my age (before BMI was invented) because I always had. Hunh? Fat is OK if you are used to it? WTF?! Fast forward a few years, and make me a healthy weight and then I get a Dr telling me that I might be worrying about my weight too much and that isn’t healthy. My BMI is 21…I’m not exactly starving to death.
I used to have the ‘pleasure’ of accompanying my grandfather to the doctor’s office. He complained about having to take his blood pressure medication and his cholesterol medication and that he was tired and had trouble moving around and etc., etc., etc. Did his doctor suggest that he change his diet or excercise? Nope! Write another Rx and send him out the door! He did send over-photocopied pamphlets home, but my grandfather doesn’t see well enough to read and doesn’t understand all the do’s and don’ts when they are written in medicalese. So, he gets mad and ignores all dietary advise and then wonders why he’s developed Type II Diabetes. My mom is the same way, her doctor just writes her another Rx when she probably weighs 300# for a BMI of well over 40. There are lots of people out there who need it spelled out: eat this for breakfast at 7, this for a snack around 10, this for lunch, this when you get home from work, this for dinner and that’s it. Then go for a walk for 30 minutes 4x per week. Make it sound easy and a person might follow it, make it sound hard and all of the sudden it is impossible to lose weight and they give up within 24 hours.