If you are a patient who is overweight or obese, you may need to help your doctor feel comfortable when discussing this health issue and strategic ways to approach the problem. If you're a doctor struggling with patients who are obese, then you need to create a standard of communication and treatment, with some allowances for individual patient personalities. Here's a set of guidelines specifically for doctors, to help broach the subject of obesity and then to facilitate constructive conversation and treatment:
At every office visit a weight, waist measurement should be included in vital signs
At every office visit a discussion of how much physical activity or exercise happens daily
At every office visit a discussion of nutrition should occur - it can be broken down into salt, sugar, fat ingredients and daily levels of intake of each.
Then take your lead from the patient -
Does he (she) want help?
Is he willing to hear about a dietary approach that may be more moderate and healthy like the DASH Diet or the Mediterranean Diet?
Is he willing to accept a simple "exercise prescription" that you write down on an actual prescription form?
Is he willing to keep a journal if they are seeing you on a regular basis so they can share some issues during the visit?
Is he open to a recommendation to a nutritionist or dietary expert?
Is he open to joining a gym?
Does he have the finances to create a support team - nutritionist, personal trainer?
Does he need psychological support in the form of therapy - even short term - to help with emotional eating or other ingrained habits?
Does he have the support of family members or friends?
Do you have stories of other patients who have struggled similarly?
Doctors typically go into medicine because they want to help people. There is something about the "weight issue" and specifically what extra weight seems to signify - do you have willpower issues, are you weak, do you eat all day long - that's the kinds of assumptions that a small subset of the medical profession may harbor. Most doctors, however, know that gaining weight and struggling with weight is a complex health issue that can become more complicated when risk for dangerous diseases appear. For many patients these complications are just words - for doctors who know the consequences, they are serious issues that cannot be ignored. So it has to be a team effort - doctor and patient - that finds a comfortable way to talk about these weight issues without adding judgments or personal opinions.
Remember that your doctor's goal is to help you. The doctor has to remember that simply understanding the dangers of excess weight and its health implications is sometimes not sufficient to spur sustained habit change. So doctors need to create an arsenal of accessible tools and possible solutions, realizing that the goals may need to be small and incremental. Communication and feeling comfortable to talk and strategize is the initial key to treating obesity.
Next up: The patient's role in treating obesity
Published On: April 27, 2010