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Shedding light on shedding pounds


Sharpening your obesity counseling skills can help battle a national epidemic.

Cheryl G. of Denton, TX, once weighed 258 pounds. She recalls doctors who immediately said on her first visit, "You need to lose weight." She'd reply, "No kidding," but deep down she wanted to cry.

"It sounded like criticism," says Cheryl, a federal employee who's shed 90 pounds over the past two years. "I knew I was overweight, and I had worked at slimming down. I was frustrated. Yet doctors would launch into their advice before they found out anything about me."

What's more, their advice was generally too vague and hurried to do her any good, although one doctor did hand her a pamphlet. They didn't take the time to discover that she ate whenever she was stressed out, or to recommend confidence-building baby steps like substituting a small hamburger for a Big Mac.

It may be overly harsh, but Cheryl's take on physicians' exam room manner can help you better respond to the nation's obesity epidemic. According to the CDC, 30 percent of adults are obese, and another 35 percent are overweight. However, only 40 percent of obese patients were advised by their physicians to lose weight, the CDC says.

But then, maybe nobody has ever taught doctors how to deal with the problem. A 2003 study in Clinical Pediatrics revealed that only 25 percent of physicians felt either competent or slightly competent in this area. "Physicians have typically had very little exposure to obesity treatment," said internist Jarol Boan when she introduced the school's first course in obesity management at Duke University last year. "Part of the reason students don't get training is that obesity isn't considered a disease."

Some, in fact, consider obesity a result of overindulgence. But whether lifestyle, genetics, or a virus, as some theorize, has caused the nation to balloon up, nobody's denying the medical implications. Too much weight increases a person's risk of developing illnesses such as hypertension, diabetes, high cholesterol, osteoarthritis, and cancer. Last July, then federal Health and Human Services Secretary Tommy Thompson responded to what he called a "critical public health problem" by declaring that Medicare would no longer classify obesity as a nondisease. This change, he said, would open the door to Medicare eventually covering proven obesity treatments that otherwise would go unreimbursed.

Private insurers are beginning to follow suit. Last fall, Blue Cross and Blue Shield of North Carolina announced that it would cover physician visits and diagnostic tests to treat obesity as a primary condition. (See below for tips on how to get reimbursed for counseling overweight patients.)

Clearly, the healthcare establishment is mobilizing to confront this epidemic. And no one has a more crucial role to play than physicians. Patients whose doctors advise them to lose weight are three times more likely to shed pounds than those who don't have that discussion, according to the CDC.

We've interviewed experts for advice on how to talk to the Cheryls in your practice. In the war against obesity, what you say and how you listen are more powerful than any medicine you could prescribe.

Broaching the subject: terms, tone, and technique Use terminology that won't deepen the pain that overweight and obese patients typically feel about their condition and cause them to possibly tune you out. A 2003 study in Obesity Research reported that patients favored blander terms like "weight problem" and "unhealthy body weight" over "obese" and "excess fat." Those findings should come as no surprise in a body-conscious culture that employs the word "fat" as an insult.

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