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Physicians in a Fat Nation: Where Do We Stand?

We are a fat nation. As physicians dedicated to health promotion, we will be called on to take sides in this most partisan of battles. Michael Bloomberg, mayor of New York City, recently attempted legislation that has been derided as heading toward the ”nanny state.” I’m not sure we have many choices.  We’ve all had the diabetic in our offices with the 3 liter soda (sugared, of course) and 2 pound bag of chips (in the bag, of course — half consumed while waiting), snacking.   We can blame the victim, the consumer. But in reality we have little chance. I’ve watched the super sizing of America. I suppose we can’t blame the corporations whose only goal is to raise more money for their shareholders. We can’t blame the nameless minimum wage servers who serve up larger and more caloric portions. It’s part of the American dream: Give them what they want. We, on the sharp end of the knife, dare not say, “you hurt because you’re fat.”  It is just not politic nor good practice. We cajole, we inform, we educate. It is a Sisyphian challenge. We fight against all the odds, against the advertisements, the media, the American ideal of bigger is better. In hard times, it’s worse. There was a Doonesbury cartoon in which Zonker, working in a fast-food establishment, is forced to tell the customers the caloric value of their foods. He tells his customer that the ‘big boy breakfast is 5,800 calories — but then,” he says, “you won’t have to eat until Thursday.” Yup. I concur with Dr. David Katz of Yale, who said:...
Fat Physicians Need Not Apply

Fat Physicians Need Not Apply

Texas-based Citizens Medical Center recently made the decision to refuse employment to obese healthcare providers. An article posted on Medscape addresses the firestorm of responses by readers on the decision and discusses whether hospitals should be allowed to deny employment to doctors and healthcare providers who are significantly overweight. What was the rationale behind the belief to hire only thin doctors? Some observed that obese physicians are poor role models for patients, who should be taught healthy behaviors (ie, good nutrition and exercise).  Other proponents maintained that people “do as you do” and not as you say, and that obese physicians are “implicitly condoning” obesity. Others vehemently oppose the stance and find it discriminatory – arguing that a physician’s competency and knowledge trumps their physical appearance — especially when genetic and health-related factors can play a role in obesity. Physician’s Weekly wants to know… Would you support an initiative to refuse work to obese doctors at your...
Obesity & BMI Levels Remain Steady

Obesity & BMI Levels Remain Steady

A study from researchers at the CDC has found that the prevalence of obesity did not appear to change significantly in 2009-2010 when compared with data from 2003-2008. The rates of obesity in adult men and women were 35.5% and 35.8%, respectively, in 2009-2010, and the age-adjusted BMI was 28.7 kg/m2 for both genders in the same time period. The analysis revealed, however, that there were statistically significant increases in obesity among African-American and Mexican-American women between 1999 and 2010.   Abstract: JAMA, February 1,...
Overweight Teens Often Missed by Preventive Care

Overweight Teens Often Missed by Preventive Care

Despite the well-documented rise in pediatric obesity, University of California, San Francisco researchers report in Pediatrics that overweight teenagers do not appear to be receiving the preventive care they need. Following a survey from 2003 to 2007 of 9,220 adolescents aged 12 to 17 who were asked if they received screening for nutrition, physical activity, and emotional distress, the researchers found that obese teens received more screening than normal-weight peers, but overweight teens did not. Obese participants in the survey were 40% more likely than normal-weight peers to report undergoing screening of their physical activity and were 60% more likely to be screened for nutrition. Those who were overweight but not obese did not receive more screening than normal-weight teens for physical activity or nutrition in any of the survey years. Screening rates for physical activity were 75.5% for obese participants, 68.8% for overweight participants, and 68.6% for normal-weight participants; corresponding rates for nutrition were 77.6%, 69.7%, and 66.2%, respectively. Over the 4 years of the study, screening appeared to decline overall. In fact, odds for screening dropped by half for both physical activity and nutrition and by 30% for emotional distress, even after adjusting for factors related to screening. Physician’s Weekly wants to know… Do you believe short office visit times, low reimbursement, and/or a lack of local resources for referring patients for pediatric weight management play a role in the level of screenings? How could screening rates for overweight children can be...

Battling Obesity: Improving Interactions with Patients

Healthcare providers have frequent interaction with patients struggling with their weight. It’s estimated that 60% of doctors’ office visits are filled with people who are overweight or obese. While new diagnostic and treatment options to battle obesity continue to be investigated, recognition is rarely given to the social consequences of obesity. Negative stereotypes and patient-provider interactions can lead to poor emotional and physical health among those who are obese. These factors can also lead to disparities in quality of care among high-risk individuals. Weight Discrimination In a recent survey, over 2,000 Americans were polled to determine the role of weight discrimination in society. The prevalence rates of weight discrimination were comparable to that of racial discrimination; among women, weight discrimination was actually higher than racial discrimination. Another survey compared a cohort from two different time periods, finding that rates of weight discrimination have increased by 66% in the past decade. An analysis of 2,400 overweight and obese adults recently found that the most common frequently reported source of weight stigma was from doctors (69%), followed closely by nurses (46%), dietitians (37%), and mental health professionals (21%). These findings emphasize that healthcare professionals are not immune to negative attitudes toward obese people. Weight discrimination can occur in both subtle, nonverbal ways and in overt ways. Negative stereotypes include obese patients being perceived as lazy, less competent, dishonest, noncompliant, and lacking in motivation and self-discipline. To determine if bias is present, providers should consider the following: Do I make assumptions based only on weight regarding a person’s character, intelligence, professional success, health status, or lifestyle behaviors? Am I comfortable working with...
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