A Group Discussion About Obesity and Weight Loss

A response to Dr. Tran’s latest blog related one person’s lifelong struggle with obesity, but represented the voice of many.  The story struck a nerve with many of our docs, either because of their personal journeys or those of their patients.  It prompted further discussion within our group and those comments are excerpted below.

As health care professionals we feel very strongly about trying to help our patients but we don’t always know the best way to do so. On the one hand, we are bombarded by articles that emphasize the connection between obesity and many of the illnesses that we treat (diabetes, heart disease, fatty liver, endometrial cancer, breast cancer, and colon cancer, to name a few). On the other hand, we know that obese patients do not get medical care that is the same quality as others, often because they avoid the medical system (in part due to prior bad experiences).

There have been studies that show that a common motivator for patients changing an unhealthy behavior is that their doctor counseled them about it. In fact, in many electronic medical records, if a patient’s body mass index (BMI) is above a certain level, a note will pop up to the provider to discuss weight issues with the patient. This is a “meaningful use” parameter that is monitored by those tracking “quality care”. However, if we are too forceful in our recommendations or not empathetic enough, we may alienate our patients rather than help them.

As physicians, we did not have nutrition courses nor did we learn helpful ways to approach weight issues. Telling someone “You need to lose weight” without any other information is NOT helpful. Many health professionals do NOT “get it”. Despite what some may think, for many, weight loss is NOT as simple as just walking away from fast foods or just counting calories. My cousin who is a PhD in Dietetics has been telling me this for years.

Here are some comments excerpted from emails sent by our own health professionals who DO get it. We thank our readers for sharing personal stories that can lead to meaningful discussions.

“There are reasons for people consuming calories the way that they do. There are stress or emotional eaters, people who eat despite feeling full, people who eat without thinking about it, those with lack of satiety, those who think what they eat is actually healthy though it may not be for them, people who eat as treatment for mental or sexual abuse, etc., but the cause of obesity is multifactorial (genetic, metabolic, physiologic) and truly no one has fully figured it out. We have, though, made a lot of strides in determining risk factors, linked disease processes, and treatments.” -TC, M.D.

“I’ve worked with so many overweight clients, and the ones who are successful are the ones who are able to be curious about the part that their minds play into it. If weight loss was strictly about behavioral changes in the vein of calories in and calories out, I imagine that obesity wouldn’t be the epidemic that it is in this country.  Our minds are so complicated and influenced by a multitude of factors–personal history, genetics, environment, how we see ourselves, how we process information….

I also imagine that there is a large (not talked about) cultural piece that plays into this–Americans are a culture of instant gratification, of feeling like we are entitled to things as well as a county with a deep sense of innovation and the “pick yourself up by your bootstraps” mentality. These cultural norms can be in conflict with one another–as well as the norms perpetuated by the media (which undervalues women, people of color, weight, age….)” — JB, PsyD

“Our own Jody Miller (www.changeyourmindchangeyourbody.net) and the psychologists she teams up with all ‘get it’ in terms of knowing that this path is filled with ups and downs. I love the circle flow chart that Jody showed us and I think about it whenever I am having a bad time. So although people may regain weight, they may be able to re-group and resume healthy behaviors without losing all of their ground…

We know from the literature that overweight people start to avoid health care professionals as all they hear is “you need to lose weight.” Interestingly, the motivation “do it because it’s good for you” doesn’t work very well, or at least not with most people. (If it did, everyone would listen to all our advice. 😉 ) Jane Brody had an article about that in the New York Times Science section in the past month. She said you have to find something that you enjoy to stick with it. Group exercise or the comraderie of a Weight Watchers group may function in that way.” – JK, M.D.

“So…what is the right approach. Should doctors be discussing body weight with patients especially if it hasn’t been prompted by the patient? Can patients be given the option to NOT be weighed without feeling shameful? Could there be an intake questionnaire to ask patients before they are seen if they would like to or not discuss body weight?

From my experience, sustainable weight loss requires a comprehensive approach including psychological, behavioral, nutritional and exercise intervention. It requires compassion, non-judgement, relatability and trust. It is a long term process also as Thu tried to explain. I LOVE my Change Your Mind (CYM) Change Your Body workshop. I think it has helped many women shift their path from strictly weight loss to finding ways to take better care of themselves (and often weight loss results). Quite often I do work with psychologists with special interest in this field to collaborate with patients who feel that more psychological support would be helpful… and often psychologists refer their patients to me for one-on-one or CYM workshops to continue the journey after, or in addition to, therapy. I am a huge fan of the collaborative team approach.

Either way, every person needs to come to it when they are ready – not because someone else is worried or concerned about them or because their BMI is too high etc… Sometimes there is a little window if a patient has been diagnosed with diabetes, cancer or has a heart attack. But even then, motivation supposedly declines in less than 7 months. The motivation has to come from within, and the patient has to really want and be able to create change in their life. For so many, repeated cycles of failure and fear of failure stop women dead in their tracks from trying.

I commend you Thu, and all of the other Lady Docs who care so passionately about your patients. Who go beyond the four walls of your office to reach out to others to find more ways to support your patients, and for being open minded to alternate possibilities. This is why you are all so special and your patients love you so much!

I hope that this may be the first of many discussions as to how physicians can broach the subject of body weight and weight management without patients feeling humiliated and ashamed. Maybe Lady Docs could band together to come up with “best practices” and teach it to med students and/or for CME’s! JM, M.A., RCEP

Thanks to our readers for opening up this topic for discussion, for the benefit of other health professionals and all our other readers. Julia Korenman’s previous article, Obesity, Nature or Nurture is an excellent review of the many factors at work. I LOVE our cadre of health professionals who immediately poured out sensitive and heartfelt essays on their own struggles and those of their patients. Please feel free to add to the discussion.

REFERENCES:

Factors contributing to obesity.

Julia Korenman’s personal weight loss journey.

Benefits of modest weight loss.