does your weight affect how you address obesity in your patients?

2
February 2006 Obesity Management 1 R ecently, the media called attention to the fact that overweight pediatricians may not feel comfort- able in addressing overweight and obesity in their patients. 1 In fact, this is an issue for all healthcare providers. Is your own weight affecting how you address the weight issues of patients? As a healthcare provider, you could be in a no-win situ- ation. If you are overweight or obese, your patients may question why you do not help yourself, and whether you would be able to help them modify their own weight. Alternatively, if you are of normal weight, you may appear incapable of relating to their issues. How do you address this dilemma? It is quite likely that the body mass index (BMI) distri- bution among healthcare providers is similar to that in the general population. This means that less than 35% of you have a healthy BMI (<25.0 kg/m 2 ), about 35% of you are overweight (BMI 25.0–29.9 kg/m 2 ), and about 30% of you are obese (BMI > 30.0 kg/m 2 ). Weight is an issue for almost all of your patients, with most making an effort to either lose weight or avoid gain- ing it. For children and adolescents, the goal is to avoid excessive rates of weight gain. Because it is important to address weight in so many of your patients, I hope each of you will ask yourself whether your own BMI is making you uncomfortable in addressing weight issues in your patients? If you are obese and not doing anything about your weight, how comfortable are you about advising your obese patients to lose weight? If you qualify for an obesity medication but are not taking it, how com- fortable do you feel recom- mending one for your patients? If you are over- weight, do you avoid addressing your patients’ weight issues, because you think they are asking them- selves why you are not doing something about your weight? The solution is not to avoid addressing weight issues with your patients, but rather to be comfortable doing so, regardless of your BMI. You should not be considered a bad role model simply because of your BMI. We know that genetics plays a powerful role in determining body weight and not everyone has the genetic potential to be below 25.0 kg/m 2 . But you can be considered a bad role model if you do not try to do the same things you recom- mend to patients with the same BMI (and waist circum- ference) as yours. It is not feasible to ask all healthcare professionals to achieve a BMI below 25.0 kg/m 2 , just as it is not feasible to ask the same of all your patients. Further, we know that within the current environment, it is difficult for most people to keep a BMI below 25.0 kg/m 2 . Whatever your BMI class, it is important for you to be a role model for your patients. For example, if your BMI is below 25.0 kg/m 2 , you should be a role model for avoid- ing weight gain. If you are in the overweight classifica- tion, you should avoid gaining more weight and perhaps try for some modest weight loss. If you are in the obese category, you should be a role model for what you tell Does Your Weight Affect How You Address Obesity in Your Patients? Editorial Whatever your BMI class, it is important for you to be a role model for your patients. James O. Hill, Ph.D.

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Page 1: Does Your Weight Affect How You Address Obesity in Your Patients?

February 2006 Obesity Management 1

Recently, the media called attention to the fact thatoverweight pediatricians may not feel comfort-able in addressing overweight and obesity in their

patients.1 In fact, this is an issue for all healthcareproviders. Is your own weight affecting how you addressthe weight issues of patients?

As a healthcare provider, you could be in a no-win situ-ation. If you are overweight or obese, your patients mayquestion why you do not help yourself, and whether youwould be able to help them modify their own weight.

Alternatively, if you are of normal weight, you mayappear incapable of relating to their issues. How do youaddress this dilemma?

It is quite likely that the body mass index (BMI) distri-bution among healthcare providers is similar to that in thegeneral population. This means that less than 35% of youhave a healthy BMI (<25.0 kg/m2), about 35% of you areoverweight (BMI 25.0–29.9 kg/m2), and about 30% ofyou are obese (BMI > 30.0 kg/m2).

Weight is an issue for almost all of your patients, withmost making an effort to either lose weight or avoid gain-ing it. For children and adolescents, the goal is to avoidexcessive rates of weight gain. Because it is important toaddress weight in so many of your patients, I hope each ofyou will ask yourself whether your own BMI is makingyou uncomfortable in addressing weight issues in yourpatients?

If you are obese and notdoing anything about yourweight, how comfortableare you about advising youro b e s e p a t i e n t s t o l o s eweight? If you qualify foran obesity medication butare not taking it, how com-fortable do you feel recom-m e n d i n g o n e f o r y o u rpatients? If you are over-w e i g h t , d o y o u a v o i daddressing your patients’weight issues, because youthink they are asking them-se lves why you a re no tdoing something about your weight?

The solution is not to avoid addressing weight issueswith your patients, but rather to be comfortable doing so,regardless of your BMI. You should not be considered abad role model simply because of your BMI. We knowthat genetics plays a powerful role in determining bodyweight and not everyone has the genetic potential to bebelow 25.0 kg/m2. But you can be considered a bad rolemodel if you do not try to do the same things you recom-mend to patients with the same BMI (and waist circum-ference) as yours.

It is not feasible to ask all healthcare professionals toachieve a BMI below 25.0 kg/m2, just as it is not feasibleto ask the same of all your patients. Further, we knowthat within the current environment, it is difficult for mostpeople to keep a BMI below 25.0 kg/m2.

Whatever your BMI class, it is important for you to be arole model for your patients. For example, if your BMI isbelow 25.0 kg/m2, you should be a role model for avoid-ing weight gain. If you are in the overweight classifica-tion, you should avoid gaining more weight and perhapstry for some modest weight loss. If you are in the obesecategory, you should be a role model for what you tell

Does Your Weight Affect How YouAddress Obesity in Your Patients?

Editorial

Whatever your BMI class, it isimportant for you to be arole model for your patients.

James O. Hill, Ph.D.

Page 2: Does Your Weight Affect How You Address Obesity in Your Patients?

your obese patients about the importance of weight loss.Are you willing to try for modest weight loss? Are youwilling to try weight-loss programs? Are you willing totake obesity medications? It would seem insincere togive advice to your patients that you are not willing totake yourself.

Moreover, following the advice you would give yourpatients could have a powerful impact on how you relateto them. If you are doing the right things to keep yourBMI below 25.0 kg/m2, you can discuss with your over-weight patients how hard you have worked to keep fromgaining weight. Most non-overweight people are work-ing to keep from gaining weight. When patients knowyou have to work hard to maintain your own weight, itgives you more credibility with them. If you have lostweight and kept it off, even though you are still over-weight or obese, it lends credibility to your weight-lossadvice. In fact, by addressing your own weight, you mayget a much better sense of how hard it is for your patientsto lose weight and keep it off.

You also need to look at your office staff and the envi-ronment around your office. Is your staff modeling thebehaviors that you are recommending to your patients?

Is the food environment in your building conducive tohealthy eating? Is your staff seen wearing pedometers?Your patients have to address the environments in whichthey eat and undertake physical activity, especially wherethey work, and so should you. You can create an envi-ronment in your office that encourages healthy eatingand physical activity in both your staff and your patients.

The bottom line is that not all healthcare providers canbe at their optimum body weight. You cannot be criti-cized as a role model simply because of your weight.However, you can be criticized if you do not behave as arole model. At the end of the day, our success will not liein getting all of our patients to a BMI below 25.0 kg/m2

but in getting all of them to adopt a lifestyle that maxi-mizes their health. ■

—James O. Hill, Ph.D.Editor-in-Chief

Reference1. Perrin EM, Flower KB, Ammerman AS. Pediatricians' own weight:Self-perception, misclassification, and ease of counseling. Obes Res.2005;13:326-332.

2 Obesity Management February 2006