Many doctors don't discuss diet with obese patients

With the nation's high rates of obesity and the low odds of weight loss, perhaps weary doctors are just giving up. National statistics show that only about half of obese Americans were advised by their doctors to cut down on fatty foods. The rate, from a 2006 survey, has not changed from a survey taken in 2002.

The data, from the recently released 2009 National Healthcare Disparities Report, found that doctors discussed food choices with 52% of their obese white patients compared to 45% of obese blacks and 42% of obese Latinos.

Poor adults and less-educated people were less likely to be told to cut down on high-fat and high-cholesterol foods. The report notes that any obese person would likely benefit from counseling about diet and exercise. It would be interesting to see a survey of doctors on why they would choose not to discuss diet with an obese patient. Do they feel it's useless?

-- Shari Roan

Photo credit: Robert Sullivan / AFP / Getty Images

Comments

[tlzoumer]

My guess is the risk of being sued for being insensitive or something else ridiculous along those lines. As a healthy person, I'm growing weary of this issue. There are no excuses any more. You can go to any public library and use a computer to get all the health and nutrition information out there OR turn over the food you are purchasing and read the label. I can tell you fresh carrots will never hurt you. Take responsibility for your body and your choices. If a doctor would tell an alcoholic to lay off the booze then I think it's fair for them to tell someone who's risking their health because of obesity to lay off the KFC Double Stacks.

[Yoni Freedhoff]

As a physician who does discuss diet with obese patients I can tell you it's not because I learned how in medical school or residency, it's because I took it upon myself to learn about nutrition after I graduated.

I'd wager that the primary reason docs don't talk to their obese patients about diet is that they don't have a clue what to tell them to do other than, "eat less and exercise more" which is about as useful as the stock market advice to "buy low and sell high"

[David]

Too bad it is not the fatty foods causing the obesity epidemic...look at the USDA data and you will see that fat consumption is going down while carb consumption is going up. From a macro look at this data it appears that it is the high carb consumption driving the obesity epidemic. Also recent studies have shown that saturated fat is not the cause of heart disease.

[Janice]

I can think of a couple of other reasons. One, if a doctor hammers a patient about her weight & diet choices - that's a very sore toe for heavy people - that patient might just stop going to the doctor at all, and whatever other conditions that patient might have, or be developing, would go undetected & untreated.

Two, many patients live in situations in which it's darn hard, if not impossible, to change their diets - they don't do the food choice or prep, & the person(s) who do are unbelieving, or unreceptive, or fat themselves.

Three, eating healthy - lean protein, fresh fruit & vegetables, whole grains, all that - is more expensive - whereas rice, bread, potatoes, beans, fat, fatty meats, cheese, etc. are cheaper, keep well & are available in storable bulk.

When I came down with Type 2 diabetes, it was relatively simple for me to change my lifestyle because I can control what my meals are composed of. People in families can ask, but it may not always be granted.

That said, I do think it's an excellent idea for doctors to go into the matter of diet more fully with the patient. I got vague advice, Nazi diets and mostly useless comments. When I was given stats & test results, they weren't really explained as to what they meant. Perhaps my doctors assumed I knew more than they did, I dunno -- but if my doctors had mentioned that losing weight would improve my back condition, my sore knees, my allergies, etc., and continued to recommend a nutritionist, maybe I wouldn't have become diabetic at all.

[newsbuzz]

54% of American Women would rather be hit by a truck than fat, check out this story to see why... http://www.curiousbee.com/original/fat_worse_than_hit_by_truck.htm

[Phillip]

Well, if doctors did discuss healthy eating habits with their patients it would result in fewer visits which would hurt the "good" doctors pocket book.

[annie]

my doctor talked to me, and rather bluntly. he suggested i lose 25lbs, which i already knew i needed too. i didn't mind, it means he's looking out for my health.

in response to another reply, i'm don't think that it's the doctor's responsibility to plan a diet for their obese patients. notifying them of the problem should be enough... if they didn't already know.

people need to take more responsibility for themselves. read up on nutrition, pay attention to choices in the market, bypass the fast food, USE COMMON SENSE and stop making excuses. your weight is your responsibility. there's no harm in asking for help but don't put the responsibility off on someone else.

and yes, i think some doctors are afraid of their patients' reactions. this new movement that suggests you're a size-ist if you think people need to lose weight is mind boggling. it's not new that too much weight causes health problems. get a grip people. you may love your size but it's not healthy. period.

[Resistance Bands]

I really like using my resistance bands because I don’t have gym equipment taking up space in my house. I also take them with me when I travel

[Alissa]

This article is so true. I've tried to discuss my weight (not obese but hippy) with my doctor at Kaiser and he won't recommend any type of weight loss or diet plan. He sent me to a nutritionist who thought I was 5 years old with pictures and books. I needed advice and Kaiser acted like I was stealing. Their ads talk about preventative care but I've never experienced it. Too bad.

[Neal Kaufman, MD]

I agree with Shari Roan’s article that not enough doctors talk with their patients about obesity and what to do about it. I don’t think it is because they “think it is useless”. Rather the ability to counsel patients effectively is based on the old paradigm of only providing expensive, in-person or on-the-phone, one-on-one counseling commonplace in many practices today. Changing reimbursement approaches and emerging internet and cell phone technologies will allow clinicians to cost-effectively provide patients with the day-to-day support they need to prevent a variety of diseases and self-manage their conditions, all integrated into traditional clinical practice. By building on the benefits of trusted clinical relationships, clinicians will be able to help their patients improve overall health and obtain sustainable results.

Technology now allows clinicians to expand their medical practice by providing cost effective and engaging behavior change support to many patients, one person at a time – without diminishing the role or value of the physician or educator. Effective online and cell phone approaches have just-in-time delivery of personalized and up-to-date data and information a patient needs to easily and accurately keep track of their performance and use that knowledge to plan and implement new approaches to reaching their goals.

One example of a technology assisted and clinically-linked weight management intervention is the transformation of the NIH’s Diabetes Prevention Program to the internet (see Using the Internet to Translate an Evidence-Base Lifestyle Intervention into Practice K.M. McTigue, et.al, Telemedicine and s-Health Vol 15, No 9. Pages 851-858). For more information go to www.dpshealth.com/vlm. Programs such as this one are allowing clinicians to play an active in a patient’s behavior change activities at a fraction of the cost of traditional personnel intensive interventions.

[annie]

david, where are these studies because i still believe saturated fats aren't doing your body any favors. it's all about balance. carbs are not bad, as so many people would like to believe they are. it's when you combine carbs with the saturated fats, sugars and salt or after refining them that they become a liability. if more people would eat whole grains, brown rice and other good carbs they might shed a few pounds.

i've heard people say saturated fats are not bad for you and they're usually the overweight people.

you don't need studies anymore to eat a well balanced meal. all studies seem to do these days is try to take someone off the hook for the problem of obesity.

[annie]

alissa! don't you get mail from Kaiser?! they send me so many newsletters and event invitations on healthy eating. doctors don't have time to stand there and figure out your diet. Kaiser's website on the other hand has a lot of great suggestions and programs. they also sponsor farmer's markets once a week at the location i go to in west los angeles.

i love Kaiser for that. they give you tools but it's up to you to use them.

[Jere Krischel]

The problem here is that they're giving bad advice - fats are fine, they need to recommend limiting carbohydrates.

[Helen Sudul]

In a nation where food is being shown and encouraged to be consumed
THe mere suggestion of eating healthy or searching for something healthy
in a SEA OF JUNK FOOD is aneedle in a haystack. Why are these ghastly
new products ( like Double-Down by KFC) getting so much press? Why are
eating contestants treated like some sports event? It seems all we know is
fast food,convenience and satisfying our taste buds. We are mere puppets
controlled by the food comglomerates of the globe... Isn't it time to shut off
the food hawkers and start cooking healthy food for the family. A onedollar
burger with freesoft drink will eventually cost millions from the illness they
can create? Does anybody care anymore....except KFC stockholders.?

[India Andrews]

You never know how sensitive someone is about their health. With all of the crazy people out there who get mad or find offense at the drop of a hat, maybe some doctors don't bring up the subject unless the patient does so first.

[Abbi]

I think it must be hard as a physician. My friends that struggle with weight often take great offense at being called on the carpet for their food choices. But I do think it is a dr's place to say something. In particular if there is no thyroid issues.

[Kevin]

I would guess that they are tired of their efforts being met with anger, defensiveness, whining, and excuses. You can tell which people are going to react that way if you bring up their obesity and lack of exercise. I suppose it is their duty to bring it up anyway.

They should built pyramids to us. We are the kings and queens of denial. We eat tons of high calorie foods, but we deny that we are doing so. We walk around the block once a month and call that exercise. We can see that we are getting fat, but we refuse to get on the scale and end its plausible deniability. When it becomes impossible to deny that we are getting fat, we deny responsibility, or we go into a frenzy of diet and exercise that doesn't last more than a few weeks before we go back to our old habits. Next come joint problems and diabetic foot sores; but for some this is not a wake-up call but another excuse not to exercise, and they continue speeding downhill. Heart disease, high blood pressure, type II diabetes, even amputation and blindness...the problems mount, as do the costs to society. I'm not leveling blind accusations, I know folks like this. One died recently. She was a lovely person, but she ate herself to death at a relatively young age. Devastated her family. She spent months in the hospital at taxpayer expense.

[teri]

Why not help the obese with the underlying causes of their obesity that drive excess eating? Poor parenting, adhd overeating, & anxiety are the big three, in my view.

[Panny]

Maybe that's because many doctors know that fat or cholesterol is not the problem... high glycemic foods are.

[T.C.]

I am a physician and I am constantly telling my patients about weight loss. I show them their BMI and what it should be. I make suggestions about diet and exercise just to hear every excuse under the sun. I find that most patients want a personalized diet and exercise plan handed to them. I have had patients not return to my office because they don't like to hear this information, however I continue because I think it is very important for their health. I don't know what the answer is but I'll keep trying.

[Laura]

Doctors plain don't discuss prevention with their patients. Why should they? There's no profit in it. Before I was found to be at high risk of breast cancer, I was honest about my alcohol intake when I completed the medical history forms: a couple of glasses of wine with dinner, almost every day. I was shocked to learn that this is considered "heavy drinking" that dramatically increased my risk of cancer. This information is easily available on the 'net, but I found it myself. Not one doctor so much as mentioned it to me.

[timoticktock]

Consider this as well: when physicians are graded poorly on the Press Ganey survey by these ignorant patients, the physician's jobs are in jeopardy. Those surveys are linked to promotion and pay: right or wrong.

We would not want to correct a patient who is frequently (in our experience) going to LIE about their diet/is in DENIAL about their diet and weight/or takes OFFENSE at the advice and then rates us as "poor physicians" on the mandatory survey because of our concern about their completely voluntary health condition. Frankly, we say (among ourselves) stay fat for all we care.

[B.A.]

Plenty of doctors are overweight themselves, and it seems like that would make it more difficult for them to communicate the importance of losing weight and that it is actually a realistic goal. This sounds like a joke, but the prevalence of overweight doctors and nurses is a concern and is a topic of serious discussion. I've seen articles to this point published in medical magazines and on health websites. Many health professionals have problems with eating too much and not exercising. Given the hypocrisy, maybe the people on here saying it's all a matter of profits are right...

[pttugas]

The key is telling your body there won’t be any more famines. There are two primary ways of doing this:

1. Eat real food. When you’re eating quality food and it’s assimilated efficiently, the body begins to receive what it needs to function at its best. This is one very important step in turning off the famine response. The presence of nutrient-dense food in the diet signals to the body that there is plenty of food available and there’s no need to pile on fat stores. Digestion is also an important part of this equation because you want to make sure the real food you eat is assimilated properly. Including raw and cultured foods in your diet on a regular basis can improve your digestive health and ensure you’re getting the most out of your food.

2. Reduce stress. Another folly of modern society is the intense level of stress most of us are exposed to, often since very early childhood. Stress induces the famine response as much as dieting. After all, the body doesn’t distinguish between types of stresses; the same biochemical reactions occur whether you’re stressed by your work, a difficult marriage, lack of real food, poor sleep habits or any number of stressors. So it’s very important to address this and take the appropriate steps to reducing and managing the stress in your life. Read more about the stress connection to weight loss here and here and here.

Without addressing these two components, a healthy body composition is virtually impossible to achieve. Plus, healthy food choices reduce stress, and reducing stress makes it easier to choose healthier food. So making one small change at a time really can add up, and the right choices will come more naturally over time. Granted, this involves patience and won’t produce results like "Lose 10 pounds in one week!" But it will set you on the path to lasting health.

[Ari Gronich]

This is A Great article showing the sheer lack of care and complete ignorance of the medical establishment. Why on earth would a Doctor NOT share information about health and nutrition? This is the question the article asks. How can we have any kind of comprehensive health care reform or preventative medicine when the providers who have the respect of the nation are competely and disgracefully negligent in their duties...

It doesnt start however with the providers, but with the educational system for the providers. I was told by a doctor friend of mine that in medical school he recieved approximately 4 weeks total of nutritional training. ALL the while by year 2 the medical students were VERY VERY familiar with all of the pharmaceutical reps and the latest in prescription medication. There is so much that we train our Doctors and Medical professionals on that has NOTHING to do with actual health and everything to do with treating disease. It is about time that our Medical Schools start Teaching about HEALTH care before they teach SICK care and it is really about time that doctors and medical personell who got into the profession to really make a difference and help people take the initiative upon themselves to get educated on providing preventative lifestyle changes that can really be effective across the board on creating a healthier society...