November 2000 • Volume 6 Number 11
Create an 'obesity-friendly' office
BY SHERI PORTER
It may take a small investment in time and money, but consider it your job to ensure that obese patients feel welcome in your office. So says family physician Raul Zimmerman, M.D., co-director of the Halifax Medical Center Weight Management Program in Daytona Beach, Fla.
Zimmerman promotes an "obesity-friendly" office, and it starts with attacking America's collective heftiness for what it is -- a serious national health problem -- instead of sweeping it under the rug. "There are a lot of us out there who aren't acknowledging the problem and advising patients," says Zimmerman, citing a study in which 58 percent of obese patients said their physicians didn't bring up their weight during the course of the office visit.
The next hurdle is attitude -- which should be open and nonjudgmental. "This is a chronic illness," Zimmerman says. "No one laughs at other chronic illnesses such as diabetes or coronary artery disease. Obesity can be just as deadly." Train your staff to be sensitive by being a good role model, he says. Don't tolerate behind-the-back whispers and jokes about obesity, even in private.
Your office equipment and instruments may need an update as well. Some examples:
- Invest in a scale that registers more than the standard 300 pounds. How can you measure success or assess the rate of weight loss if your patient weighs more than your scale can measure, asks Zimmerman.
- Where the weigh-in takes place is also important. "This is a private matter to most of us, and it is particularly private to obese people who sense the social stigma, " Zimmerman says. Don't place scales in public places such as hallways.
- You may also need to order larger blood pressure cuffs and, if you're drawing blood, extra-large tourniquets and sometimes even bigger needles.
- Think about those exam gowns. "The gowns can be embarrassing for normal-size people, but when you're big, everything is falling out," says Zimmerman. Find a supplier who stocks plus sizes.
- Check out your exam table. Are steps attached? If the table isn't anchored down, cautions Zimmerman, the entire table may tip when the patient steps up. His advice? Anchor the table securely to the floor or provide a safe step up.
- Look at your office furniture. "Two of the most embarrassing things to obese people are breaking chairs and not fitting between the arms of a chair," says Zimmerman. Make your large patients comfortable by providing a few sturdy armless chairs in the waiting room and also in selected exam rooms.
Lastly, Zimmerman urges physicians to turn defeat into victory: "When a patient comes in, one of the first things I focus on is what went right since the last visit. I give a lot of positive strokes for those good behaviors. Once I've done that, then we talk about slip-ups."
FP Report is published by the AAFP News Department.
Copyright © 2000 by American Academy of Family Physicians.
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