Heavy Conversation: Discussing Weight With Your Doc

Featured Article, Healthy Living
on January 1, 2014
Medical Scales

Going to the doctor is rarely enjoyable, unless you happen to have a crush on your MD. But for people who are overweight, it can be downright traumatic.

It’s an open secret that some doctors discriminate against heavy patients. Others are afraid or embarrassed to bring up the obesity issue. But experts say there are ways to navigate this touchy issue—and protect your health in the process.

It’s not all in your head

Think your doctor is judging you because of your weight? You may be right. A recent study of 300 medical students found that two out of five had a subconscious bias against obese people. Another study showed that doctors weren’t as warm or empathetic to their overweight patients as they were to those who maintain a healthy weight.

The consequences, in some cases, can be serious. “Doctors killed my grandmother because she was obese,” says Dr. David Katz, director of the Yale University Prevention Research Center and author of Disease-Proof. Her breast cancer “was never detected early because she assiduously avoided doctors. She assiduously avoided doctors because she was fat, and all they ever talked about when she went to them was, well, you’re fat, you should lose weight. So it was an exercise in humiliation. They didn’t offer her anything constructive.”

Marsha Hudnall, president and co-owner of Green Mountain at Fox Run, a weight-loss retreat for women in Ludlow, Vt., divulges similar tales. “I have personally heard stories of people being told to lose weight for sinus infections—a person goes to the doctor for a specific problem, but the doctor becomes focused on what he or she sees as a bigger problem.”

On the flip side, research shows that many doctors are hesitant to bring up weight, or weight loss, at all. Only one in three obese patients is diagnosed with obesity, and only one in five gets any weight-loss counseling, according to Dr. Sara Bleich, associate professor of health policy at Johns Hopkins Bloomberg School of Public Health. Physicians who are themselves heavy are even less likely than other doctors to bring up weight as a health issue.

Can your doctor help you lose weight?

Doctors may not have all the answers (make that, usually don’t have all the answers) when it comes to weight loss, but studies show they can help you drop pounds, if only by virtue of being the ones in the white coats.

“Research generally shows that obese patients are more likely to make changes to their diet if their doctors advise them to,” says Bleich. The advice isn’t likely to be very detailed. It could be as simple as suggesting you consume more whole grains and fewer sugary beverages. “But to the defense of doctors, they don’t receive very good training about this in medical school.”

For more substantial help, you may need to consult a dietitian or registered nurse who has the proper training and can offer ongoing support by phone, email or through in-person visits. “It takes a lot to really understand what it is in the person’s life that’s causing them to be heavy and then work with them over time to actually help them lose weight,” says Bleich.

Rx for Your Relationship

Don’t let guilt, shame or discomfort about your weight keep you from getting the health care you need. Follow these tips.

Ask point-blank for assistance. Don’t be shy—ask your doctor for concrete weight-loss tips, says Dr. Sara Bleich, or better still, inquire whether the office offers counseling from a dietitian or registered nurse.

Ditch the guilt. Eighty percent of adults in this country are overweight or obese, says Dr. David Katz, and the environment we live in plays a role in excess body weight. “Don’t blame yourself for the problem—but do accept some responsibility for the solution,” he says.

Speak your mind. If you feel that your doctor looks down on you because of your weight, confront the issue directly, Katz suggests: “Say, ‘Doc, I know I’m overweight, I know you know I’m overweight. If it were easy to fix, I would have fixed it already, so we can talk about it, but don’t judge me.’ A doc who can’t deal with that doesn’t deserve to be your doctor.”

Give the doctor a chance. “If you’re able to see that a doctor is receptive to your questions and your input, you know you have the foundation for a good working partnership,” says psychiatrist Dr. Wendy Oliver-Pyatt, founder and executive director of Oliver-Pyatt Centers for eating disorders.

Dump your doctor if need be. If your doctor isn’t respectful and open to your concerns, you have every right to choose a new one. “You are an equal partner, with rights and with reason to choose who to, and who not to, partner with,” says Oliver-Pyatt.