Sunday, July 30, 2017

Talking About Obesity

Talking to patients about weight isn't easy.

There's no question that obesity is a growing problem, with about a third of the population obese, and another third overweight.

But, just about no other condition lends itself more to ridicule and discrimination in our society.  And yet no one wants to be obese; unfortunately, those eating and lifestyle habits that many consider "normal" lead to excess weight.  Fat shaming is ever-present, and there's even research suggesting that people skip going to the doctor so that they can lose weight before their appointments.

So, how do I as a doctor discuss obesity with my patients?  It's challenging.  I want to help my patients without making them feel like they are being shamed; I want to be empathetic, but I do want to encourage changes that will lead to weight loss.

Regardless of my patient's body size, I ask the same questions of all new patients -- do you exercise?  If not, why not?  Tell me about your eating habits.  Do you eat fruits and vegetables?  Do you eat your meals at home?  Do you do the grocery shopping?  Do you know how to cook?

In someone who is obese, there are more likely to be answers to those questions that are less than ideal.  And, as we talk, we discuss ways of making changes that will improve health and ultimately lead to weight loss.

Of my follow-up patients, I keep track of trends -- if an overweight patient is losing weight, we discuss how he is doing it.  If a patient is gaining weight, I discuss with her what factors might be causing weight gain and how we can turn this around.

As a cardiologist, so many diseases that I treat -- coronary disease, atrial fibrillation, hypertension, hyperlipidemia -- are related to lifestyle and body size.  I have helped many of my patients to lose extra weight, and hope to continue to do so.