Although obesity is one of our major public health problems, we have not yet developed a comprehensive and integrated strategy for addressing it. A recent article highlighted for me the inability of most physicians to effectively treat obese and even overweight patients (see: Too few docs tell patients they're overweight). Below is an excerpt from it:
Many people who are overweight and obese either don't realize it or are in denial -- and too few doctors are setting them straight, according to a new study in the Archives of Internal Medicine....If a doctor did comment on a patient's weight, it seemed to make an impression. Nearly 20% of obese people whose doctors hadn't brought up their weight described themselves as "not overweight," compared with just 3% of those whose doctors had addressed their weight. Obese and overweight patients who discussed the issue with doctors were also more than twice as likely to have tried to lose weight in the previous year....Doctors may be reluctant to broach the subject of weight for a number of reasons, [a researcher] says. For instance, busy physicians might not want to fall behind schedule by adding another topic to their list of things to discuss during an appointment. And many doctors have negative attitudes toward their heavier patients, whom they see as unlikely to stick to a diet and exercise program, he adds....The researchers weren't surprised by the high percentage of overweight people who thought their weight was normal, as several studies in recent years have found comparable -- or higher -- rates. A study published last year that used similar data from government surveys showed that 23% of overweight women and 48% of overweight men considered their weight to be just right. [The authors of the study]...chalk this up to what they call the "'norming up' of society." Roughly two-thirds of U.S. adults are now overweight or obese, and as Americans have grown heavier, the perception of what constitutes a normal weight has changed as well....In fact, most of the overweight study participants accurately estimated their BMI. But many didn't see their weight as unhealthy or recognize the need to shed some pounds.
For the most part, the idea of "seeing your doctor" for a weight problem is a lost cause. Most physicians are not appropriately trained in this area and many don't have the patience to address the issue. They are also accustomed to very short visits with patients which is not optimum for working with this group. I personally think that the answer lies in community-based or for-profit plans such as Weight Watchers. However and as noted before, physicians do have a key role to play. They need to raise the problem with their patients and then take steps to ensure that their the patients are enrolled in such plans.
I was very struck by the "norming-up" phenomenon described above -- many overweight people do not regard themselves as such. Physicians contribute to this problem by not raising the issue in the first place. In today's environment, it's therefore insufficient to merely define an overweight or obese state solely in terms of BMI or weight in pounds. We need an aggressive public campaign that illustrates more graphically what constitutes an overweight person as opposed to a just-right body type. I am sure that such ads would be controversial but we need to move forward in a more comprehensive and effective manner.