Kindly Póg Mo Thóin

Such is the concern of Dr. Sanjay Gupta,* in this article in Time.

If there’s one place where it’s a good idea to come clean, it’s the doctor’s office. Patients with an ache, a symptom or a bad habit like smoking do no one any good if they keep it to themselves. Yet there’s one time doctors are often less than forthcoming: when they have to tell patients they need to lose weight.

Researchers at the Mayo Clinic in Rochester, Minn., recently released the results of a survey of more than 2,500 obese patients who went to their doctor for a regular checkup over the course of a year. The investigators found that the charts of only 1 in 5 of those people listed them as obese. What isn’t on the charts is probably not communicated between doctor and patient either, and that means trouble. Those in the study who got the diagnosis were more than twice as likely to have developed a weight-management plan with their doctor than were the other obese patients.

“If you don’t have a plan, you’re not going to lose weight,” says the study’s author, preventive-medicine specialist Dr. Warren Thompson, whose research was published in August’s Mayo Clinic Proceedings.

Oh, let’s just count the problems with these paragraphs, shall we?

First off, notice that the concern is not that the patient’s height and weight are not noted in the chart, but that the doctors often did not make a notation that the patient was obese. “Obese,” as a notation on a chart, is tantamount to a diagnosis. And yet I fail to see the problem when the patient’s height and weight — the very measures used to calculate BMI and thus come up with a label like “obese” — are noted on the chart. I mean, presumably they didn’t call all those patients in to be weighed again, they just went off the charts. And how would they know if an obese patient slipped through without having The Scarlet O slapped upon him or her? I BETCHA THE INFORMATION IS ON THE CHART.

Second, there’s plenty that’s communicated between doctor and patient that’s not necessarily on the chart. In fact, doctors regularly will discuss the problem you came in for, but note another one on the chart because the insurance company will accept the faux problem, but not the one you came in for.

And, indeed, that’s what I suspect is behind the notational behavior of doctors that Gupta is tut-tutting here. Insurance companies are more than eager to drop people who might cost them money from their rolls, and a doctor slapping a label like “obese” on a patient — because, hey! it’s a medical diagnosis! — could very well result in that patient being dropped from their current plan and unable to obtain other coverage.

BTW, that’s not a new concern — about 30 years ago, I had a mysterious bout of weakness, swelling and unusual heart rhythm. It wasn’t quite rheumatic fever, but looked enough like maybe I’d had it that the pediatrician told my mother that he would keep an eye on me, but didn’t want to put anything like “rheumatic heart” on my chart, lest I have trouble getting insurance as an adult.

Finally, the whole “You can’t lose weight without a weight-management plan.” I realize that doctors think the sun and moon revolves around them, but perhaps they have not noticed the multi-billion-dollar diet industry? Seems I can’t swing a dead cat without hitting someone who’s ready to sell me one one diet plan or another (and gosh, is that Valerie Bertinelli on my TV just now?), so I’m gonna guess — without even mentioning the pressure I’ve had from my mother, grandmother or other relatives to follow a weight-management plan — that it just doesn’t require a doctor to smack one’s forehead and exclaim “I coulda had a weight management plan!”

The interesting part of the article to me is the part where real, live, practicing doctors say that they don’t want to stigmatize their patients with a diagnosis of obesity (because, sadly, fat hatred kills) and Sanjay Gupta gets his knickers in a twist about that,or about the fact that patients who haven’t been diagnosed with obesity need to let their poor, dumb doctors know that such a thing exists:

None of this absolves patients or parents from stepping forward and bringing up weight on their own. But whoever raises the topic, it’s important for patients and doctors alike to remember that modest amounts of weight loss can disproportionately benefit overall health, even if the loss doesn’t feel or look like much. That fact may be the best reason for everyone to show a little courage and say what needs to be said—-even if it hurts a bit.

Ooh, Sanjay — are you offering absolution? How very . . . priestlike of you.

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* I had sent the article off to Kate Harding because I was still not feeling all that well and figured she could do a great job with it. I had forgotten that she was on vacation, but she sent it along to Fillyjonk anyway. It wasn’t until I’d read Fillyjonk’s post that I realized that it was authored by Sanjay Gupta, master of the “let me give you a conclusion that doesn’t at all fit the piece I’m about to introduce but which reinforces a lot of cultural stereotypes that my paymasters want reinforced, and btw, have I mentioned I hate fat people?” head-fake. And that was *before* he cast aspersions on Michael Moore’s facts in “Sicko” but couldn’t actually back them up once Moore cornered him.

I’d plead illness, but mostly it was just the placement of the byline over the inexplicable photo of a woman’s back with her lacy black bra still on while a male hand holds a stethoscope to her back rather than just above the story.