Fat Doctors, Fat Patients?
When it comes to skyrocketing obesity rates, everyone seems to have a theory: go low-carb, high-carb, high-protein, raw, cut portions, do aerobics, weight train -- and still, the pounds keep piling on the population at large. Self-discipline clearly has been established as a failed modality -- with 99% of dieters unable to keep weight off permanently. But now the American Heart Association has a new idea that will take some of the onus off of chubby individuals. It says that we need to institute weight-management initiatives on a societal level by making it easier for people to choose healthy options.
In a statement published in the journal Circulation, the group suggests that the government should institute broad-reaching environmental and policy changes that would make it natural and easy for people to lose weight. Spokesperson Shiriki Kumanyika, professor of epidemiology at the University of Pennsylvania School of Medicine, proposes, for instance, making high-fiber, low-fat foods more available, increasing access to sidewalks for walking, expanding public areas for physical activity, rethinking food choices offered to students in schools, and controlling portion sizes in restaurants.
"It stands to reason that if we are to combat this [obesity] epidemic, we need to create a modern world where the path of least resistance leads to physical activity and healthy eating," explain David Katz of the Yale University School of Medicine. "You need to create a culture where you are the odd man or woman out to take the elevator."
Plenty of evidence indicates that in fact, individuals do tend to put on weight when others around them have poor health habits, and so we might hypothesize that a community weight-loss initiative would have the reverse effect -- encouraging peers to lose weight together.
In fact, a 2007 study published in The New England Journal of Medicine found that if you have obese friends, your chances of becoming obese rise by 57 percent. That conclusion came out of 30 years of research that following 12,000 people. Other findings were that having an obese sibling increased your likelihood of getting fat by 40%, while having an obese spouse increased your risk by 37 percent. In other words, obesity seems to spread in a viral manner.
Which brings me to the conundrum of doctors -- who aren't exactly models of slim perfection. If we're going to institute community-wide weight-loss initiatives, shouldn't our health mentors walk their talk? If only!
A national study of male physicians in 2004 found that 44 percent were overweight and six percent were obese. And a survey taken at the American Medical Association convention in June of 2006 revealed that 66% of the attending doctors were either overweight or obese. Though doctors might advise diet and exercise routines, how much power does that advice have when spoken from a face sporting a double-chin? In fact, a 2002 study out of the Mercer School of Medicine and the Atlanta Medical Center concluded that "Patients seeking care from non-obese physicians indicated greater confidence in general health counseling and treatment of illness than patients seeing obese physicians."
In a Medscape debate about the physician's responsibility to model healthy weight, Dr. Roy Poses says that doctors have too much to worry about, what with declining compensation and busy schedules, and so they shouldn't have to deal with the hassle of staying slim. "Where will they find the hour a day to exercise?" he asks. Oh, give me a break. That's just as true for the rest of us. And besides, the excuse is bogus anyway. Dr. Poses obviously hasn't read my last blog, Overeating Trumps Inactivity as Cause of Obesity, in which I comment on the study out of the Universities of Aberdeen and Maastricht, which showed that the problem is not so much exercise (we expend the same number of calories today as we did 20 years ago); the problem is calories (we're eating an average of 523 more calories per day). In other words, the problem for doctors isn't lack of time any more than it is for the rest of us; it's lack of self-control.
As Dr. Robert Centor says in the above-mentioned Medscape debate: "How can we [doctors] recommend lifestyle changes to our patients if we do not believe in those changes strongly enough to apply them to ourselves?" Good point, Dr. Centor!