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Why Is The Discussion Awkward?

I read a study that reported that 48% of obese people going into their physicians’ offices for yearly checkups stated that their physicians never mentioned the person’s weight problem during the physical. That absolutely astounded me: How can a primary care physician not mention a thing about the singular health issue that is bound to cause multiple problems (some life-threatening) over time? The study did not provide insight as to why the doctors failed to discuss the weight problem with their patients but I have some suspicions:

The doctors were rushed and did not have the time to discuss the weight control problem.
The doctors are more comfortable in the zone of “diagnose and treat” as opposed to “prevent”.
The insurance companies that the doctors participate with will not “pay” for weight control discussions.
The doctors simply did not have a solution to offer their overweight/obese patents
The doctors were fearful of hurting the feelings of the patients

The last point: hurting feelings. Let’s discuss this a bit from a doctor’s perspective. If I have a new patient that comes into my office for an issue such as a sore throat, cough, skin rash or something else that has nothing to do with his/her poor weight control, it is not easy to bring up the topic of the person’s weight. If the person had come in with high blood pressure, diabetes or orthopedic pain, it would be much easier to immediately seize the opportunity to bring up weight control as part of the treatment plan. However, even in the case of the new patient whose issue has nothing to do with the weight, I will still find a way to bring up the subject. I see not doing so as poor medical treatment.

Let’s get away from the doctor world for a bit and discuss the awkwardness of discussing weight issues with overweight/obese family members and friends. We are always fearful of hurting the feelings of the ones we love. Unlike a mole on the back where a person cannot see this, our overweight/obese family and friends know quite well that they have a weight problem. If we see that the weight seems to always be this way, is it our place to bring the subject up? Will we damage our relationship with that special person(s)?

It is easy for me as a doctor to bring up weight control issues to people that are overweight/obese but clearly not as easy for friends and family to discuss with their their overweight/obese loved ones. However, there are ways of approaching this in a non-judgmental, non-critical helpful and positive manner. The encouragement and offer of support can perhaps motivate a loved one at risk to start heading to a healthier and happier place.

If you saw a loved one about ready to get hit by a car would you not scream out and try to save him/her? I am not saying this is as dramatic as an “almost” accident, but staying silent is not the right course of action. The discussion does not need to be awkward at all.

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