Surprise! Your doctor may not be the best person to get you to lose weight – and it seems that it’s largely because they are averse to talking about it at all. A recent article from NPR breaks down some of the troubling reasons behind why this relationship isn’t making real significant strides in this public health fight.
78 million Americans are obese. There are 164,000 primary care doctors that are able to treat them. That’s a daunting division as it is, but when you think about the average amount of time a physician sees a patient – maybe 20 minutes, it seems impossible to achieve the task of vastly reducing the prevalence of obesity. The kind of personalized information that is needed for each patient would take longer than 20 minutes to gather, and creating a personalized subsequent behavior change and nutrition plan takes even longer. Interestingly, the NPR pieces cites the American Association of Family Physicians in reporting that not even 50% of primary care providers calculate a patient’s BMI (there are a lot of problems with BMI as a measure, and they’ve been widely discussed – how they don’t take into account muscle mass, for example – but for some obese patients, they can be a reasonable crude measure of where the individual is in terms of major health risks and how to initiate a weight loss program). But physicians who know the history of a patient and have tracked their health for years are in the best position in terms of knowing how risky an individual’s weight is.
Of course that’s not all that needs to be considered – I actually don’t think it’s even the most pressing or pertinent issue as to why physicians aren’t able to tackle the obesity epidemic. As the NPR article says, the psychologist in charge of the University of South Carolina’s weight management center calls the topic of weight loss and obesity a “mine field.” There can be resistance in going to the doctor for any number of reasons – shame or embarrassment, frustration, avoidance or denial, and even the very real fear of what a physician might tell them. And, importantly, deep concern and worry about not having the means – financially, mentally, community or family-wise, to tackle what seems like insurmountable changes in lifestyle. On the other side, doctors claim that some patients react defensively if they suggest that weight loss needs to be in their future.
This is a complicated dance, and I can’t help but draw parallels in these kinds of responses to the relationship between eating disorder patients and their physicians, psychologists, and nutritionists. Weight is so inextricably tied to identity, personally and culturally, for so many people, that the mere suggestion of a necessary change – either gaining or losing weight – can feel like an assault on the person’s actual self. How do we best navigate this? These conversations, first of all, can’t be brief. They just can’t. They require a meaningful relationship between those negotiating solutions, and for the individual who is in a precarious health position – whether it be due to restricting and bingeing and purging, or due to inactivity and unbalanced diets and genetic factors – it requires the sense that the person ostensibly helping them knows them personally, what their fears and concerns are, is patient, and most of all, is able to be consistently present and supportive through the successes and inevitable failures of the journey. And those relationships can be mighty hard to come by.