July 7, 2021 – Kevin Gendreau, MD, a weight loss doctor at Southcoast Health in Fall River, MA, lets patients know he was once obese. He says this knowledge inspires and motivates them to lose weight.
After losing 125 pounds in 18 months, “I can understand their binge eating, struggles, and plateaus on a very personal level,” he says.
Peminda Cabandugama, MD, endocrinologist and obesity medicine specialist at Truman Medical Center at the University of Missouri-Kansas City, has weighed between 180 and 240 pounds over the past decade. He now weighs 225 pounds and has a healthy lifestyle.
“Patients have come to me saying, ‘I used to see another doctor who specializes in weight loss who was not heavy. But how can he understand what I’m going through? ‘ He said.
Cabandugama shares his weight loss struggles with patients “to dispel the myth that weight management is as easy as overeating and not exercising.” It involves an assortment of emotions and hormones, some inside and outside of our control. I hope that sharing this will allow me to connect more with my patients so that they know that even their healthcare professional is going through the same challenges as them. “
“Patients are more likely to change their behavior when doctors support them and have had similar experiences and talk about their stories,” says Wendy Bennett, MD, obesity researcher and associate professor of medicine at Johns Hopkins University of Baltimore.
Do patients respect overweight doctors?
While Gendreau and Cabandugama lost weight, some doctors who would like to lose the extra pounds were unable to do so. What impact does this have on patients?
Doctors sometimes have biased attitudes towards overweight patients, but few studies have examined whether patients are biased towards overweight doctors. Results vary and may depend on whether or not the patient is overweight.
A random online survey of 358 participants suggested that, regardless of their own weight, people had prejudices about doctor’s weight gain. They viewed overweight or obese doctors as less trustworthy and credible, which could lead participants to reject their medical advice and change doctors.
“Patients expect physicians who provide health care to do everything possible to take care of their own health and well-being,” says Pamela Peeke, MD, assistant professor of clinical medicine at the University of Maryland in Baltimore.
“I’m a doctor who thinks you have to follow the rhetoric – that the best teachers are the ones who live it,” she says.
Still, “I don’t think, based on this one experimental study alone, that we can conclude that overweight physicians interfere with patients’ efforts to change their behavior,” notes Bennett, who was not part of the study. .
“I think patients often want to connect with their doctors on more personal levels, but without the story behind the advice, patients can find it difficult to trust a provider who seems to contradict the messages,” she says.
A study Bennett helped lead suggests that patients aren’t biased against overweight doctors if they need to lose weight themselves. A national survey of 600 overweight patients showed that 87% trusted the dietary advice of overweight primary care physicians, compared with 77% who trusted the dietary advice of physicians who were at a healthy weight.
“It shows that patients trusted doctors more like them, which can lead to better relationships. We know from race studies that patients often trust doctors of the same race as themselves, ”Bennett explains.
Gendreau says that when he was severely obese some patients wondered whether to trust his weight loss advice.
“It was very embarrassing when they turned to me and said, ‘What about you?’ I would respond that it is my job to inform them of the risks to their health, ”he said.
Almost half (48%) of physicians said they were trying to lose weight, according to the Medscape Physician Lifestyle and Happiness Report 2021. As a result, many physicians may find themselves in the position of seemingly advising to “do this.” that I say, not what I do ”.
Nearly 3 in 5 Americans are trying to lose weight, according to Gelesis survey results released in December 2020.
Should Doctors Pay More Attention to Wellness?
Physicians have an ethical duty to safeguard their health and well-being so that they can provide safe and effective medical care. If they don’t have a healthy lifestyle, they need to make adjustments, advises the American Medical Association’s code of ethics.
Peeke agrees with WADA. “We are committed to doing it – we have to do everything we can to save time, even if it’s just 15 minutes of hiding and eating that healthy lunch that we brought with us,” she says.
Gendreau suggests that the busy doctors do what he did.
“I started by bringing healthy snacks – little Ziploc bags filled with mixed nuts and berries – and developed from there. That way, if I was hungry or stressed between patients, I would have easy access to something nutritious, ”he says.
He and Peeke also suggest making protein shakes or berry smoothies that are low in sugar.
“These can keep you full for hours as you sip them between patients,” says Gendreau.
It can be difficult to convince busy doctors to make lifestyle changes. Sixty-five percent of people who responded to the Physicians’ Lifestyle and Happiness report say they sometimes, rarely, or never focus on their health and well-being. Only 45% said they were eating a healthy diet and 65% said they exercised.
“Self-care is not a priority for most physicians because we are taught to take care of others and put them first,” says Gendreau. “Like many doctors, I had so many other priorities: family, friends, career. In addition, my last year of medicine was so difficult that my priority was to finish. I put my health aside and thought I could fix this later.
According to David Eisenberg, MD, assistant associate professor of nutrition at Harvard TH Chan School of Public Health, only about 1 in 5 medical schools require students to take a nutrition course.
“I didn’t get an ounce of nutrition training, which is why I became a Pew Foundation Fellow in Nutrition and Metabolism. I had to come out of my traditional training, ”explains Peeke.
“Doctors aren’t trained enough to do the behavioral counseling and motivational interviews that are needed,” Bennett explains. “We do a good job of diagnosing obesity based on body mass index and understanding the relationship to future health issues. But most doctors struggle with both a lack of time and the skills to make significant behavior changes. “
“The medical school curriculum is so focused on the pathology and pathophysiology of obesity, rather than how to prevent it with the right diet and exercise program,” says Gendreau. “My patient physicians often tell me that their own nutrition education is lacking, which can affect their weight loss journey and what they teach their patients.”
Gendreau, crediting his own weight loss journey as well as his obesity medicine scholarship, says his confidence in weight loss discussions with patients has skyrocketed.
Redefining obesity as a chronic disease
Rather than criticizing overweight people, including doctors, for their personal health choices, a better approach is to view weight or obesity as a chronic disease, Bennett says.
“If we understand that obesity is a chronic health problem that people grapple with, we can empathize with them,” she says, recommending that more providers share their weight loss journeys with the patients they see. provide lifestyle advice, which can help address and repair potential biases.
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