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.
_____
* 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.
I am both obese and a real, live practicing doctor.
I don’t harp on weight loss for three reasons. First, people who are overweight know they’re overweight, and know they need to do something about it. Second, no matter how non-judgemental the doctor tries to sound, the patient isn’t going to take it that way. (I’ve been on both sides for these.)
Finally, there really isn’t much I can do to help. The only intervention (short of surgery) with any evidence for significant and sustainable weight loss is getting patients to keep a food diary with a calorie count. We are seeing good results from weight loss surgery, but not many of my patients can get it covered.
Diet pills (Adipex, specifically) are big around here, so most of the time when I bring up weight loss the patient asks about Adipex. I do my spiel about how Adipex doesn’t work in the long term, and the only way to lose weight and keep it off is to make changes in your lifestyle and adopt healthy habits. They listen politely and then ask me for a referral to a doctor who prescribes Adipex. It gets old.
My doctors over the years for the most part have been very proactive and positive about my (ample) weight–that look at is as part of my total health picture and not the sum total. But every now and then I run into some doozy doctor who can’t see past my size 16 pants. For instance, I started my last pregnancy at 190 lbs (I am 5′ 10″ so this was heavy but I was still fitting through doorways). My doctor immediately announced that I must have a “zero weight gain” pregnancy. Sigh. My first pregnancy, I gained (and later lost) 45 lbs, so this seemed to be a completely unattainable goal. I said this. To which he replied, “well my wife only gained 15 lbs during her last pregnancy.” Ok, good for her. Properly shamed, I went home and researched “zero weight gain” pregnancy–surely this must be a “thing”, so many of us fat girls getting pregnant–and could find nothing. For the rest of my pregnancy, I was shamed everytime I walked in the door of that office. Convinced any doctor would tell me the same thing, I didn’t bother to switch doctors. In my 8th month, I started to feel like something was wrong. I expressed my concerns to the doctor–who replied that it was difficult to tell “with all that weight” and it was probably just that I was overburdened by it.
I had had enough. I promptly switched doctors. And immediately found out that the baby had almost no amniotic fluid (the new doctor was remarkably able to to determine this with no mention of my weight). The baby was delivered immediately and is a healthy 5-year-old now who is bugging me to make him breakfast right now. I was told later that one more day without diagnosing this problem and I could have lost him.
Anyhow, my rambling long post is because while I think that weight can be and should be addressed in a medical context as part of the whole picture, too often it becomes the only factor a doctor will look at to the exclusion of all other medical conditions.
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?
Hang on a sec — a commercial diet and a weight-management program are not the same thing, especially to doctors. I’m pretty sure that no doctor is under the impression that, say, Slim-Fast is something their patients can do for the rest of their lives. In theory, a medical weight-management program should include appointments with a registered dietician at an absolute minimum, if not appointments with a whole range of other medical personnel, like an exercise physiologist.
I should add a link to Thorn’s post on how fat hatred kills.
In theory, a medical weight-management program should include appointments with a registered dietician at an absolute minimum, if not appointments with a whole range of other medical personnel, like an exercise physiologist.
Sure, but all too often, if you get any kind of medical advice about losing weight, it’s some kind of xerox copy of a diet thrown at you, or just shaming that you’re fat. Doctors tend not to be very helpful in that regard.
But Gupta’s article seems to argue that the only way that a fat person could even conceive of doing something to lose weight is to talk to their doctor about it. Which is bullshit, because we are surrounded by people offering advice and assistance for losing weight. It’s just more of the “fat people are too stupid to know they’re fat, and too stupid to know how to lose weight unless a doctor tells them” attitude.
Kat, are we the same person? Or did we have the same doctor? And for the record, 5′10″ is maybe a little squishy, but it certainly isn’t fat, it’s barely even overweight.
I had almost exactly the same problems with my first pregnancy. I started at 5′10″ and 160 lbs (not really heavy at all–now I’m at about 180, still not all that heavy for my height) and gained 50 lbs with my first one. And every time I saw my doctor he would lecture me about gaining too much weight. However, I also saw the other doctors in his practice while I was pregnant, and one of them caught my low amniotic fluid, I delivered the next week, and my 5 year old is also healthy and starts kindergarten on Tuesday (sob–my baby is growing up). I switched doctors with my second pregnancy, and I love my new guy. He was very matter of fact with the weight gain (again, 50 lbs) and when I brought it up, he basically said that as far as the fetus is concerned, as long as I don’t develop diabetes or anything, the fatter I get, the happier it is. It’s only if I car about losing the weight after that I should worry, and even then, 50 lbs isn’t that out of the ordinary and lots of women gain that much or more during pregnancy and lose most of it after. I absolutely love him.
There IS no effective medical weight-management plan. If there were, a good many fat people would be going to the doctor, getting and following an effective medical weight-management plan, and, lo, getting thin and staying that way indefinitely. Because, you know, they were smart and lucky enough to get an effective medical weight-management plan from their doctors. It’s funny how that doesn’t actually happen too often. (There are plenty of medical conditions you can sometimes improve more or less permanently with doctor-advised lifestyle changes — insulin resistance can be lowered or a low HDL raised, for instance. Fatness just isn’t one of those conditions.)
Gupta’s just a lazy hack.
Sure, but all too often, if you get any kind of medical advice about losing weight, it’s some kind of xerox copy of a diet thrown at you, or just shaming that you’re fat. Doctors tend not to be very helpful in that regard.
Oh, I agree with you. I was more thinking, given the standard of care at the Mayo Clinic, I suspect that Dr. Warren Thompson’s idea of how a patient should lose weight is a whole lot different than idiot Dr. Gupta’s, which seems to be, “Hey, if you tell the person they’re fat, magical weight loss will begin!”
I remember that my friend’s doctor felt that she was gaining too much weight with her first pregnancy, but the doctor had actual medical reasons to be concerned: her blood sugar was getting out of whack and she had a family history of Type II diabetes. Totally different than if the doctor had decided that the problem was that she was too fat rather than seeing it (correctly) as a symptom, not a cause.
it’s some kind of xerox copy of a diet thrown at you, or just shaming that you’re fat.
Hey, I seem to remember that appointment… twice. And I hated it so much, and was so ashamed to go to the doctor, that I very nearly didn’t go back to get my thyroid tested and finish treating my hypothyroidism.
Maybe doctors don’t tell their patients that they’re fat so that their patients might actually come back to the them for treatment of problems that are actually treatable. I’m a feminist, a fat activist, and usually quite outspoken, but something about the doctor’s office just puts me in a vulnerable place. Shame me about my weight, and, if I’m having a good day, I’ll find other doctor. If I’m not, I might just leave the problem untreated rather than go back to be shamed again. I know how much I weigh, thanks. I can read the numbers off the scale, too, you know.
As someone who has transcribed and edited more medical reports in her life than she cares to admit, I have seen doctors willy-nilly recommend weight loss under some of the most bizarrely inappropriate circumstances you could imagine. One example I’ll never forget: A 79-year-old fat woman who is bedridden, on both respiratory support and a feeding tube — you know, the thing they give you when you can’t keep anything down — clearly dying. And the doctor recommends that she lose weight! I thought my eyeballs were gonna shoot out of my skull and clear across the room and go splat against my picture window. Let’s see, the woman can’t move, can’t eat or drink — yeah, she must be bingeing through her nasogastric tube, that’s why she’s so ginormous. GAAAAH.
KS… wow! You and I are the same person! Mine starts kindergarten tomorrow too. Sometimes I feel like writing to that awful doctor and telling him that despite his lack of effort on behalf of my unborn child (who had the misfortune of being conceived by someone who did not fit his textbook guidelines) he is doing quite well, thanks.