I advise those of you with weak constitutions to read the remainder of this post with caution. Pull up the fainting couch, keep the smelling salts handy, and put a fortifying drink on the side table. It’s about to get dangerously real up in here, y’all.
From the New York Times:
I will give you a moment to compose yourselves. There’s more.
Doctors more frequently made a diagnosis of obesity when a patient’s weight was higher than their own, and overweight doctors were less likely to believe a patient would follow diet advice. Only 37 percent of overweight doctors strongly believed that they were competent even to offer advice about eating and exercise, compared with 53 percent of normal-weight physicians. [emphasis added]
That I am wholly unsurprised by these results is perhaps obvious by now. Doctors are people, and their own experience is going to color how they interact with their patients. It wouldn’t surprise me at all if doctors who smoke (they exist! still!) are less apt to either counsel their patients who smoke to stop (at least with much gusto) or to put much stock in the effectiveness of their advice.
For my own part, I know that I am probably a better doctor for some patients than others. Ideally I’d be uniformly suited for all of them, delivering care that was consistent from one child to the next. I certainly strive to be. But I think it’s naive or disingenuous to maintain that I am actually capable of doing this. No matter how much I may educate myself about sports medicine and the common injuries that occur from one sport to the next, a patient who sees me for a running injury is going to have a better experience than one who sees me for a lacrosse injury. I run, I’ve had running injuries (including one right now, as it happens), and I know what they feel like and how the various remedies also feel. I can talk about what worked for me, and empathize with a young runner frustrated by the need to rest for two weeks. I don’t think I’ve held a lacrosse stick in my life. (That’s what they are, right? Sticks?) I’ve never been whacked in the ribs with one. The problems of a lacrosse player will always remain somewhat abstract, no matter how many I see.
The person a medical provider is plays a big role in how they practice medicine. I have no doubt that I am a much, much better pediatrician now than I was before I became a parent. (In fact, I’ve often commented that I feel like I should call five years’ worth of parents and apologize for how worthless I fear I may have been.) And it’s not surprising at all that physicians who have trouble with their own weight might bring that trouble into their practice, as well.
Obviously, there’s a downside to avoiding conversations about healthy lifestyle modification. Simply ignoring the health risks related to obesity does those patients a disservice. But there’s a flip-side to that, as well. Reading on in that Times report:
Sara N. Bleich, the lead author and an assistant professor at the Johns Hopkins Bloomberg School of Public Health, said that finding ways to remind doctors to pay attention to their patients’ weight and diet was essential.
“If you can effectively address the weight issue,” she said, “you can address a whole host of adverse health conditions as well.”
I’ve written before about how hard it is to lose weight effectively and lastingly. It is apparently very, very difficult, far more so than I think most people who have never struggled with their weight understand. Including doctors. I doubt that overweight doctors are more inclined to forget the importance of addressing obesity with their overweight patients than are thin doctors. It’s likely many elide the subject for fear of seeming hypocritical or ridiculous. But more to the point, I suspect they may be more skeptical about how they can “effectively address the weight issue” than their svelter peers, having seen how hard it has been for them to lose weight themselves, and this skepticism may inform their relative reluctance to address the issue.
I wonder if the authors of this study thought to ask that question.