By Chris Cunningham
NEW YORK, Jul 26 (Reuters Health) - Even though more Americans are obese
than ever before, physicians are not tackling the weight problem of most of
their obese patients, according to a new study.
Dr. Randall S. Stafford, of Massachusetts General Hospital and Harvard
Medical School, and his research associates found that doctors report obesity in
only 38% of their obese patients. Once the number of obese patients is taken
into account, the research team estimates that doctors provide advice on weight
loss, exercise, and diet to only about 25% of obese patients.
The team found that when a patient's weight is associated with an
obesity-related illness such as coronary artery disease, diabetes, or sleep
apnea, these patients are treated more aggressively. But even in these patients,
doctors counseled patients about weight loss at only about half (52%) of office
visits.
Stafford and his team used data from 13,536 visits to physicians' offices
during 1995-1996 to learn about physician practice patterns for discussing
obesity with patients.
The authors said there appear to be a number of reasons why physicians find
it difficult to discuss obesity with their patients, including the belief that
counseling patients to lose weight is futile. Follow-up studies show that after
7 years, 95% of dieters are back to their pre-diet weight. Other reasons include
a lack in the skills needed to talk about weight loss, not seeing obesity as an
important medical issue, and a lack of reimbursement from health insurers.
Although obesity was once defined as 20% or more above desirable body
weight, 30% or more of body mass index (BMI) is now the preferred obesity
measurement. People who have a BMI of 27 or more are 70% more likely to have
type 2 diabetes mellitus, hypertension, osteoarthritis, cardiovascular disease,
stroke, respiratory tract disease and some cancers, according to the study
published in the July issue of the Archives of Family Medicine.
Previous research has shown that eating less and exercising more are the
most effective ways to loose weight and keep it off. Medications that aid in
blocking fat digestion are also effective for weight control and may help
selected patients. Surgery is also an option, but it is not without
complications, and should only be used on the most morbidly obese, the
researchers write.
Dr. Diane Eliot, a professor of medicine at the Oregon Health Sciences
University in Portland, Oregon, says although most physicians take courses on
nutrition and obesity in medical school, the use of that knowledge decreases
because they become frustrated at not seeing results in their patients. "It's
not reinforcing," she told Reuters Health. And addressing weight problems takes
time, she said.
"It's very hard to get people to change their behaviors," she said. "It's
not the kind of change physicians can address in a (short) office visit. I know
a lot of resources and give work books to my patients," she said. "There are all
kinds of things you can give them, but they're out of my office in 10 minutes."
She says most physicians are aware of programs such as Weight Watchers and
Jenny Craig, but that it's more complicated than simply referring the patient to
a program. Other issues, such as depression and genetics, may also contribute to
a patient's inability to lose weight. "We know that there must be something
about some metabolisms, because some people eat and gain tremendous amounts of
weight while others eating similar amounts don't," she explained.
People get discouraged even before they start, she noted. Eliot recommends
that overweight individuals go about weight loss in small steps. "Just losing 10
to 15 pounds can have a positive (health) effect on people," she says.
