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Can Doctors Win with Obesity Talk?

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Doctor bashing has escalated inside certain Internet chat rooms, where members are ranting about the New Hampshire physician who warned a patient that her obesity would wreck her health and social life.

Offended, the woman filed a complaint with the state medical board. Though the doctor apologized, visitors to the Web site still found his blunt approach appalling and complained about insensitive health-care practitioners.

"Doctors are used to being looked up to as if they were gods. I pity their mental/psychological state when weight is no longer present as an all-purpose bugaboo," seethed someone named "Fatthought."

We don't know whether the patient was upset with what the doctor said or the brutally direct way he laid out her future. Some physicians have such poor bedside manners that researchers have suggested they enroll in acting classes, so if they aren't truly feeling empathy - important to healing - they can fake it.

Regardless, the case illustrates why most doctors are reluctant to bring up the emotionally charged issue in the first place: They really can't win.

Doctors who don't say anything aren't doing their job. If they do comment on weight, it's often personalized and they risk insulting or demoralizing someone in need of help. The term "fat" is unflattering. "Morbidly obese" is a clinical term but no safer; it makes some overweight people feel like a sideshow exhibit.

Even a physician's own appearance can be problematic. A patient might think that doctors who are fit couldn't possibly understand what it feels like to be fat and that if they're overweight, they clearly don't know what they're talking about.

Then there are the patients who want solutions but refuse to take responsibility for their weight. Denial, common for an eating disorder, makes honest dialogue impossible.

But the conversations need to take place, especially for children. A Harvard School of Public Health study found that 70 percent of pediatricians don't confront the parents of obese youngsters, so the problem often is written on a chart but never addressed.

A doctor has the credentials to deliver a stinging but lifesaving message, one that friends and family often can't. And though there is no one-size-fits-all approach, they must have the freedom to make their point without worrying about getting sued for hurting someone's feelings.

Like all relationships, both sides have to work at communication. Patients can assure their doctor that they will do their part by keeping a food and exercise journal for four weeks, suggested Kat Carney, founder of the Web site, a support group for women with polycystic ovarian syndrome, a disorder that results in weight gain. A written record gives your doctor some hard data to work with and provides the starting point for a plan. It also can help determine if your perception of your efforts matches the reality, said Carney, who lost 90 pounds over 14 months using a journal.

"It comes down to `what are your personal health goals and what are you looking for in a personal physician?'" Carney wrote to her "cysters" in a thread that generally supported the New Hampshire doctor. "When I finally got past the intense sting (and it really hurt me) of the reality that I was morbidly obese, fat etc., and I decided I wanted to change my life, my relationship with my doctors changed."

Doctors should understand that many overweight people avoid medical care because they're ashamed of their body, they're too big for the waiting room chairs, the gowns leave their skin exposed, the blood-pressure cuff doesn't fit or the examination table tips when they lean forward.

If the physician is concerned about the patient's dignity, a suggestion about weight reduction will more likely be heard as a concern, rather than a criticism, said Susan Baker, author of "Managing Patient Expectations" (Jossey-Bass, $44).

"Large patients often report feeling embarrassed, judged and even humiliated in health-care settings," Baker said. "Ask on the intake form, Are you happy with your current weight?' The person who answers yes doesn't want to hear that weight is the sole reason for his/her medical condition." A doctor might respond, "Let's explore ways to keep you as healthy as possible at your present weight,'" Baker said.

If the answer is no, the practitioner can provide guidance that is perceived as consultative, Baker said.


(E-mail Julie Deardorff at jdeardorff(AT)


(c) 2005, Chicago Tribune. Distributed by Knight Ridder/Tribune News Service.

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