Curbside Consultation

Are Obese Physicians Effective at Providing Healthy Lifestyle Counseling?



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Am Fam Physician. 2007 Mar 1;75(5):738-741.

Case Scenario

The three closest restaurants to my practice site are fast-food restaurants. A colleague and I were frustrated because we counsel our patients on their blood pressure and cholesterol, and they leave the clinic and drive into the adjacent drive-throughs. Then I realized we went to McDonald's twice that day. What if this is more than modeling a bad habit? How successful can a physician be when counseling patients about ways to lose weight if the physician does not have a healthy lifestyle? If the physician is obese, how can he or she approach the subject of obesity with patients?

Commentary

More than 40 percent of American adults are classified as obese by the Centers for Disease Control and Prevention,1 and obesity is associated with many comorbidities (e.g., hypertension, type 2 diabetes, asthma, depression, orthopedic problems, sleep apnea).2 Physicians are not immune to obesity. The Physicians' Health Study demonstrated that 44 percent of male physicians are overweight, and 6 percent are obese.3 Although there are no published data on obesity in female physicians, the Nurses' Health Study demonstrated that 28 percent of female nurses in the United States are overweight, and 11 percent are obese.4

The main treatment for obesity is lifestyle and behavior modification. Most identification of obese patients and counseling on management strategies are completed by physicians in the office setting. Few studies have evaluated the role of physicians who are obese in dispensing advice on weight management and dietary modifications.

Patients come to physicians expecting professional advice and a role model to emulate. Studies show that it is more difficult for physicians to give credible medical advice when they do not follow this advice themselves.5 Confidence scores from patients receiving health counseling from physicians who are obese are consistently lower than those from patients seeing physicians who are not obese.6

Family physicians provide preventive services and may be held to a higher standard of healthy behavior than physicians in more technical specialties. Not surprisingly, physicians with poor personal lifestyle habits are less likely to counsel patients about a healthy lifestyle.7 Physicians who are obese are less likely to diagnose obesity in patients and are less comfortable with providing obesity counseling.1 A study demonstrated that overweight physicians do not necessarily classify themselves as such.8 Furthermore, physicians who are not overweight are more likely than physicians who are overweight to proactively address obesity with patients before related comorbidities develop, and to do so more aggressively.7 These findings may be caused by the physician's personal denial of his or her own obesity, lack of personal experience with effective weight loss and related resources, or fear of lacking credibility.

Physicians who are obese can still send a strong personal message to patients about obesity. Obese physicians should regularly visit their own physician and should adopt a healthier lifestyle, including diet and exercise. Appropriate self-disclosure to patients about the physician's personal struggle with weight may help patients realize that they are not alone in their challenges with weight loss. Physicians can be role models by sharing personal weight goals and achievements and giving patients real-life examples of personal weight loss. Finally, obese physicians can send strong messages about weight management by creating an office environment that promotes healthy lifestyles.9 Physicians can display healthful and motivational images in clinical areas and nutrition and exercise information in examination rooms and the waiting area. Physicians also can lead weight-loss programs in their offices.

Encouraging office and nursing staff to participate in healthier lifestyles sends patients the message that the entire health care team is committed to being role models for a healthier weight and lifestyle. Physicians can include healthy food options in vending machines or in the staff lunchroom, lunchtime walking programs, and incentives for fitness participation.

Physicians who are self-aware and who challenge themselves to making healthy lifestyle changes are strong role models for patients, even if obese. This should be an important motivation for physicians to join the ranks in the battle against obesity.

Address correspondence to Jo Marie Reilly, M.D., at reillypas@aol.com. Reprints are not available from the author.

Author disclosure: Nothing to disclose.

REFERENCES

1. Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002. JAMA. 2004;291:2847–50.

2. Barlow SE, Dietz WH. Obesity evaluation and treatment: expert committee recommendations. Pediatrics. 1998;102:E29.

3. Ajani UA, Lotufo PA, Gaziano JM, Lee IM, Spelsberg A, Buring JE, et al. Body mass index and mortality in US male physicians. Ann Epidemiol. 2004;14:731–9.

4. Manson JE, Willett WC, Stampfer MJ, Colditz GA, Hunter DJ, Hankinson SE, et al. Body weight and mortality among women. N Engl J Med. 1995;333:677–85.

5. Hash RB, Munna RK, Vogel RL, Bason JJ. Does physician weight affect perception of health advice?. Prev Med. 2003;36:41–4.

6. Abramson S, Stein J, Schaufele M, Frates E, Rogan S. Personal exercise habits and counseling practices of physicians: a national survey. Clin J Sport Med. 2000;10:40–8.

7. Wells KB, Lewis CE, Leake B, Ware JE Jr. Do physicians preach what they practice? A study of physicians' health habits and counseling practices. JAMA. 1984;252:2846–8.

8. Perrin EM, Flower KB, Ammerman AS. Pediatricians' own weight: self-perception, misclassification, and ease of counseling. Obes Res. 2005;13:326–32.

9. McCrindle BW. Do as I say, not as I do. The new epidemic of childhood obesity. Can Fam Physician. 2006;52:284–5.

Case scenarios are written to express typical situations that family physicians may encounter; authors remain anonymous.

Please send scenarios to Caroline Wellbery, MD, at afpjournal@aafp.org. Materials are edited to retain confidentiality.



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