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    Jennifer Nelson, M.S., R.D. and Katherine Zeratsky, R.D.

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  • Nutrition-wise blog

  • April 2, 2010

    Obesity: Doctors slow to address the problem

    By Jennifer Nelson, M.S., R.D. and Katherine Zeratsky, R.D.

32 comments posted

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Surprising findings about doctors' attitudes toward obesity were just released by the Strategies to Overcome and Prevent (STOP) Alliance for Obesity. A survey of primary care doctors revealed that:

  • Almost 90 percent of doctors feel it's their responsibility to help patients lose weight.
  • Yet 72 percent said that no one in their practice has been trained to deal with obesity and weight-related issues.

A separate survey of patients, including many who were obese (defined as body mass index of 30 or more), found that:

  • Only 39 percent of obese adults were ever told by a doctor or other health care provider that they were obese.
  • Of these 90 percent were told to lose weight, but one in three said they weren't given any guidance on how to do it.

Why the disconnect? The report suggests that the failure to address weight problems — so-called "clinical inertia" — may be caused by doctors' views on obesity (stigmatizing attitudes, belief that patient won't try), lack of confidence in their ability to treat obesity, lack of effective treatments and poor reimbursement for providing them.

What if "clinical inertia" existed for patients with diabetes or heart disease? (Obesity has been linked to these conditions.) Unthinkable, right?

The STOP Alliance for Obesity suggests several ways for doctors to start addressing the obesity epidemic:

  • Monitor weight over time. Don't lecture but explain how weight gain and obesity relate to risk for other diseases.
  • Assess motivation for change. Prescribe small lifestyle changes, such as eliminating sugary beverages. Suggest that these changes be a family affair.
  • Define success differently. Set more realistic goals, such as a weight loss of 5 to 10 percent of body weight.
  • Take a team approach. Enlist the help of others with expertise in weight loss — registered dietitians, exercise specialists, nurses and community programs.

Do you think these steps will be enough? Let's hear your suggestions.

- Jennifer

32 comments posted

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  • March 6, 2013 8:29 a.m.

    The doctors are quick to let you know that you are obese but offer little in regards to losing it if you are also afflicted with heart disease, kidney problems and high blood pressure. There is a thin line on what to eat and what not to eat with your medication as well. Some foods are detrimental to your health when mixed with some of your medications. It is up to YOU the patient to keep tabs on these things and discuss them with the appropriate people or trained physicians or doctors who can give you the go ahead on things that you research yourself, like the diets promoting whole grains, fruits and vegetables, etc..,

    - Vanity

  • June 30, 2012 4:50 a.m.

    well maybe med schools should be offering specialties in obesity.... it is a very complex system...mental.. social... all of it

    - me

  • April 25, 2012 11:53 p.m.

    I would add health coaches to the list of team members under "take a team approach." Good advice is wonderful, but making real changes requires action and establishing long term habits, and coaches have the expertise needed to move a client into action and habit formation.

    - Bob

  • April 3, 2012 10:14 a.m.

    As an adult I reached 250 at my worst, but I've been overweight almost all my life, it got really noticeable somewhere between 1st-3rd grade, my mom had to buy my first pair of "fat pants" I had to wear "1/2 sizes" and even those were too long in order to fit me in my waist, that was the first time I noticed I couldn't have the "cool clothes" because of my weight, by 3rd grade I weighed 100 pounds. After elementary school teasing was worse than ever my own grandma grabbed one of my skin folds and said "you gotta loose the rolls!" My doctor never mentioned my weight in high school when I was first diagnosed with high blood pressure, he just kept changing the drugs, it took me over a year till I got on one that worked. After several visits about my migraines and much trial and no success he referred me to a specialist and finally when my normal specialist was on medical leave her partner told me quite rudely I needed to loose weight to control my pain and didn't tell me anything useful to loose it, I cried about it and complained about how I was talked to! I have another family member who is obese and I was at her appointment and her normal doctor was so rude to her too, and he was all "less calories or more activity/proper balance" and couldn't even explain to her how many calories to aim for for a woman her age and at her activity level! Or anything real useful. We basically have both started to work at loosing weight with lit

    - Annie

  • March 15, 2012 11:12 p.m.

    I have been heavy all my life, first my grandmother told me I was fat at a very young age. I thought grandmas were supposed to love you, instead of being mean. I'm a morbidly obese person and have yo-yo'd all my life. I started dieting in 3rd grade and was on a liquid diet my senior year. I had lost a significant amount of weight and had doctor appointment. I thought he be proud of my progress, instead that was not good enough, he continued to lecture me about needing to lose more weight, I was also being criticized at home. I am very frustrated with the current state of health care in the United State. I go to the doctor with a complaint and they tell me it is because I am fat. But the next person could come in and they would send them for tests to see what was going on. I am an emotional mess, and can't understand why a doctor who took an oath to help people, is not. So I wonder why, don't they just shoot me in the head and get it over with. What they don't understand is that I was emotionally abused all my life and it has continued. When I am on a diet if I don't lose weight every day, the scales gives me the right to beat my self up and doctors don't think we are upset with ourselves and can't get past these issues. Every time I go to the doctor and they don't do anything for me, my mind tells me that I am not worth helping, see the doctor won't help. So I must be worthless. Because the doctor reinforces what everybody else in my life has told me, the I am a LOSER.

    - Cathy

  • February 13, 2012 12:03 p.m.

    I agree with this post. People are overlooking the obese and not doing enough to try and help them. Sometimes those who are thin have a tendency to put themselves above those who are not as physically fit. Instead of turning their head, physically fit should help obese live healthier lifestyles. The article “The Food Police” is an excellent article that holds the same ideas and views on the topic. According to “The Food Police” we need to stop putting ourselves above the obese and remember that they are people too and realize that just because they are heavy, they are not in face inferior to the rest of society. The society we live in says it is socially unacceptable to be overweight, yet there is a lack of motivation to help them live a healthier lifestyle so they can live longer. So the fat stay fat and the thin stay thin. There needs to be a bigger movement towards helping the obese and less judgment on the part of the physically fit.

    - Ryan

  • December 15, 2011 4:30 p.m.

    I'm saddened but not surprised by this information. I hear it from people I work with all the time. Until I focused on the cause of my own emotional eating, I never kept off any excess weight. While developing a program called Loving Ourselves Weight Loss for my coaching clients, I did the work myself. The change has been liberating. As I approach physicians and nurses about the program they respond with automated responses about calories in and and calories out. We all know that; what we don't know is why we abuse food in the first place; why we choose food instead of feeling. My program looks at that and follows up with nutrition and fitness support. It works. Shame and guilt keep people stuck. I hope that eventually the medical profession will recognize that for many people, resolving the emotional triggers is a huge component of achieving a healthy weight.

    - Daryl

  • October 29, 2011 6:28 p.m.

    It's a start. I recently quit smoking and gained 30 lbs! my doctor was more excited that I quit smoking than the excessive weight gain in a little over a month. He kept telling me it will come off don't worry, but six month later it didn't. I asked for help with healthy diets, formulas for weight loss, and general tips. Nothing given was very informative. After researching myself, I encountered some success with lowering my caloric intake and increasing my exercise routine. i was able to lose 10 lbs. in 4 weeks. What I needed was a support system like I was given from Chantix. I joined Weight Watchers for the needed help. I still have 10 more lbs. to lose, heck I might go for another 20! my doctor should have given me more guidance to help me, but ultimately it is my body and my responsibility!

    - Tricia

  • October 28, 2011 5:22 p.m.

    I was a normal weight for 30 years until after my second child. The next 20 I have just yo-yo-ed, trying every mainstream diet, even the doctor supervised "medical weight loss plan". Each time I have gained more and am now about 300 pounds. I truly felt that after about 175 lbs, doctors in general, treated me differently. Honestly, I felt they were biased toward "normal weighted" people. For example, after breaking my 5th metatarsal in my foot (I weighed about 220 lbs.)the doctor said, "This is not healing well, and it often takes a long while..... if you were say, an athlete, we wouldn't hesitate to put a pin in the bone so the healing would be faster and more complete." I remember just getting to my car and crying....... I have asked my last three family doctors for help and on the "what are you here for today? question"-- I often wrote/said that I needed help with obesity and I could see how many other health issues were adversely affected by the weight (like lupus and fibromyalgia). The usual response? it's a matter of how many calories taken in compared to activity. No kidding! I want help, but don't even want to see a doctor now.

    - Laurie

  • October 12, 2011 6:13 p.m.

    I've been overweight all my life and have tried many methods of losing weight. I'm currently on a path that I know is going to work. I found a Weight Watchers leader and group that are great. I enjoy going there every week. I know that I will always need to go to WW weekly and weigh in even after I reach goal. That's a fact. It's also a fact that I have to keep on exercising. I know everyone can't afford a trainer but even a few sessions would help. I felt this was the route I needed to go to help prevent injury and as a result give up. I couldn't go on this journey by myself. Health insurance companies are just starting to give rewards for healthy lifestyles. Some will pay towards club memberships. Also, some employers are recognizing that the attendance of employees is connected to lifestyle. Some will include in benefit packages partial reimbursement of club memberships. Some employers also promote weight loss by hosting Weight Watchers at work. I don't think we can wait for others to fix the system. We need to jump on the band wagon and face it ourselves. The doctors can't fix us.

    - Doreen

  • August 31, 2011 8:28 a.m.

    I have used Bontril in the past and it worked to help deaden my appetite while I learned new eating habits. It was wonderful. Now, about 8 years later, I've packed on weight due to a knee injury. And my doc won't prescribe it. I'm about ready to find my old doctor several states away to try and help me out again. Doctors are ready to prescribe other meds, why not this one? It's approved by the FDA - HELP YOUR PATIENTS WITH THINGS THAT HELP THEM LOSE WEIGHT.

    - Jennifer

  • June 24, 2011 4:27 p.m.

    Jennifer, Obesity is a complex issue. We are dealing with the brain's highly integrative mechanism. Neuron activity runs rampant across regions of the brain, rapidly influencing thoughts,feelings and behavior. Therefore, it's difficult for the human mind to stay focused or attending to desired goals. The bombardment of stimuli in a person's life causes great distraction veering them away from their goals. The doctors know or sense how difficult the job is and how much discipline is needed to achieve the daunting task of weight loss and fat burning.Few can achieve it, those that do few can't maintain it; forgeting about food or sugar addiction, what causes it and how to overcome it. Also what about the bombardment of toxins on the liver and its affect on fat metabolism. By studying psychology, physiology and biochemistry, and sociology, you can truly see the enormity of the problem.

    - Stanley

  • June 16, 2011 8:11 a.m.

    Every time I have asked my doctor(s) the answer is: Weight watchers, I really think they get paid by weight watchers company! I ask about diet pills (because I have done my researchers and found one that seemed to be a great jump start, not permanent and I told doc that!) the response I get is well no one I know would reccomend xyz pill or anything like that and there is NO pill that will help unless you want to try orlistat and that will give you oily loose stools. UGH!!!!! I live in a very rural area and the doctors are all connected to either a low income clinic or an area hospital - it seems there is no escape. It is too bad about ephedra though that really did work :(

    - yo-yo-ing

  • March 23, 2011 3:42 p.m.

    As an addndum to my post below, my clients at first, tend to be taken aback when I am blunt with them. However they stayed long enough to let me know that they appreciated it. Now when they go shopping they see my face and hear my counsel ,which helps them to make better choices. :D

    - Cee

  • March 23, 2011 3:36 p.m.

    As a practising dietitian/RD for over 30 years I am not shy in suggesting that the dietitian is really the specialists who knows how to counsel and work with people to effect changes towards their goals. It does take practise to be very effective, but the training received during our study equips us. MDs, nurses, PhDs (researchers) know enough to evaluate needs, but cannot effectively translate need into plans. Nor do they have the time required to do an effective job of it. It is unfortunate that the patient is often not referred to the dietitian - for whatever reason.

    - Cee

  • March 3, 2011 7:24 p.m.

    Everyone is quick to say "eat right and exercise", but that is only half of the equation. What isn't addressed is how the body is burning the calories. I weighed 250 pounds so I cut down my calories to 1400 a day and walked. I got down to 210 pounds. I was at that weight for 4-5 months and couldn't lose any more weight. I eventually gave up and gained all the weight back. It wasn't until I started checking into gastric bypass surgery those doctors finally started checking into WHY I weighed so much. The hospital performed a metabolic study and found out that my resting metabolic rate was 60% of normal. My body only burns 1200 calories a day (at rest) to maintain my 250 pounds. Unless these kinds of tests are performed, people don't know how many calories they actually need. It's easy too eat too many calories if you don't know how many your body burns.

    - Dee Dee

  • October 13, 2010 2:31 p.m.

    I treat patients for weight loss and it is a very difficult process. People know that they need to lose weight and it is usually a sensitive subject. I try to explain it as gently as possible. Instead of accusing, state that losing 10 lbs may help to alleviate their back pain. I try to emphasize the positivity of reclaiming their health. People seem to respond better when motivated by excitement rather than fear. http://www.alt-compmed.edu

    - Liz

  • October 13, 2010 11:55 a.m.

    Being a practising clinician it very difficult to find time to explain the vagaries of a weght loss programme although we know evrything about wt loss. Could'nt a dietician do a good job of it?Also emergency cases demand more attention than say an impending emergency like obesity

    - Dr.Dipti.Sawant

  • September 11, 2010 5:37 p.m.

    Our healthcare system is at part to blame.

    - Rita

  • August 27, 2010 10:24 a.m.

    I find this article so true. My husband is now over 400 lbs and yet when he went in for a health screen a year ago the doctor didn't even MENTION his weight. In fact he said everything came back great. Are you kidding me? My husband wants to loose weight but is overwhelmed and gets discouraged. We don't know where to go to find the support he needs. I know it isn't just about food (yes that is a big part) but deeper stuff and yet I don't have any resources for someone that can help with nutritionally, psychologically, etc. When I did ask a doctor about it they said well he can get a nutritionist, but the nutritionist just said here's what you should be eating. Again not getting to the root or even talking with him about his daily lifestyle to figure out what could work, where the challenges are, etc. And I think it is easy for my husband to ignore the issues since it is overhwhelming when doctors with a health screen (this has happend 3 times now!) don't raise it as an issue and talk about the health risks down the road. Yes I think we need more help in this area of health care and doctors willing to address the issue and give guidance.

    - Kristin

  • June 20, 2010 10:39 a.m.

    I think that the problem of obesity is very complex and doesn't yield itself easily to intervention or treatment. I think the new research on how difficult it is for the brain to let go of a weight window has to play more seriously into every conversation and the psychological game of "how much did I lose this week" has to be aligned to create plans in which patients lose more significantly at the beginning and also have clear intervention plans when they hit plateaus. I don't think changing a way of being is ever just about info on nutritious foods, or talks with the doctor. It's much bigger than that-perhaps seriously obese individuals would benefit from a personal life/weight coach who integrates conversation on all facets of weight loss, motivation, well-being, life style changes, etc. A little less clinical and a lot more personal!

    - elizabeth

  • April 22, 2010 3:57 p.m.

    I working on my doctorate in obesity prevention within college age students and wanted to say that I was shocked by the high percentage (72%) of doctors who say they lack training in obesity related cases. I hope you dont mind, but I linked to this article and 2 other articles from Nutrition Data and Medical News Today on the topics of nutrition and obesity (see following link) http://publichealthbugle.com/?p=1594

    - Public Health Bugle

  • April 19, 2010 10:28 a.m.

    i have a personal history of obesity and have addressed it with exercise thru silver sneakers and getting a trainer. this 2 year journey has reduced my weight significantly and my meds in half with my dm2 controlled with an glycohemoglobin of 6. why don't insurance cover proactive programs to allow people to make a difference with life style choices that improve their disease process and the risk of developing many diseases. lets pay for proactive people lifestyle changes like trainers, gym memberships, nutrition instruction, smoking cessation, drug and alcolhol cessation etc. then our healthcare dollar would be available for the real healthcare unavoidable problems. have mds work with personal trainers and give them specific prescriptions. expand the health care field to include non traditional proactive activities.

    - priscilla

  • April 7, 2010 1:32 p.m.

    I would think Dietitians and exercise specialists are making the physician's job easy on weight management since the doctors usually don't have much time to spend with the patient anyways. What I don't understand is why is there so much hesitation to refer the patients to them. Is it ego or is it lack of confidance in RDs ?

    - BlueberryRD

  • April 7, 2010 12:10 p.m.

    Once when I asked for advice, my dr. muttered "well, since you aren't going to change the way you live..." and another time he told me I need to lose at LEAST 30 pounds in a rather angry tone. Well it may be a surprise to him, but I agree changes need to be made. I'm frustrated that my efforts don't seem to get me anywhere, and the dr. has nothing to offer in the way of support. Just do it he says. Not even encouragement. I'd love to meet with a nutritionist and take classes on shopping for and preparing things I've never tried before. I'd love to get specific fitness training and advice on how to keep at it. I'd love to have someone help me figure out how to fit these things into my life while still putting pleasing things on the table for my skinny, meat-and-potatoes husband. I need someone to cheer me on and help me when I feel like I've eaten carefully and exercied all I possibly can for many weeks and lost maybe 2 pounds. I don't want figuring out what to eat and fixing it while also finding the time for extra exercise to take over my life. I've got lots of other things to do. I need help for the long haul!

    - Susan

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