The Gravity of Weight

The daunting science of weight control.

Calling a Spade a Spade: Does Your Physician's Own Weight Matter?

Steering between the Scylla and Charybdis of weight discussions

In a recently published article in the journal Obesity Reviews, Zhu and colleagues examined the relationship between a health professional's own weight and its effects on his or her own "health-promoting" recommendations. The authors note that research has already established that health professionals' own smoking and exercise habits do, in fact, influence how they practice and what they recommend to patients. But what about a doctor's or nurse's own weight? Does it have any relevance?

New York pediatrician and writer Perri Klass, M.D. sensitively tackled that issue in an article, When Weight is the Issue, Doctors Struggle Too, some years ago in The New York Times. Dr. Klass admitted she has herself had chronic difficulties controlling her own weight, and asked, "How on earth...am I supposed to give sound nutritional advice when all they have to do is look at me to see that I don't follow it very well myself?" She added, "...how am I supposed to help stem the so-called epidemic of childhood obesity when not a week goes by that I don't break my own resolutions?" After talking about nutrition and exercise with an adolescent patient who had been gaining weight, she describes looking the mother in the eye and adding quite spontaneously, "If this were easy, I would be thin and fit." But not all physicians are apparently as psychologically-minded and compassionate as Dr. Klass.

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According to Zhu et al, overweight and obesity are not uncommon in doctors and nurses. For example, the authors refer to a study by Miller and colleagues that noted that in a sample of over 750 nurses in the U.S., 54% were overweight or obese by body mass index measurements. And in a sample of 1.2 million staff in the National Health Service in the United Kingdom, 700,000 were classified as either overweight or obese.

In their own systematic, in depth review of nine studies, Zhu and colleagues found that those nurses and physicians who were themselves of normal weight were more likely than their overweight colleagues to provide overweight or obese patients with guidelines and advice to achieve weight control and "use strategies to prevent obesity in their patients. " But weight status of the physicians and nurses apparently did not seem to influence either their general assessment of their patients' weights or their referral practices. Perhaps not surprisingly, "specialty was one of the strongest independent predictors for weight management practices," such that those involved in primary care like pediatrics or family practice were more likely to discuss weight than surgeons. The authors recommend further research since there are so few studies that address this issue directly and the relationship between health practitioners' own weight and their behavior toward patients is "complex." Their research, though, suggests that physicians' and nurses' weights seem to be "less strongly and consistently" associated with how they practice than smoking and exercise behaviors.

Whether overweight or obese or not, though, how should health professionals address these issues in weight-challenged patients? An earlier study by Wadden and Didie, aptly titled, What's In a Name? found that obese men and women rate the word "fatness" significantly the most undesirable description for their weight, but also did not like the words "obesity," "excess fat," or "large size." The researchers found that obese patients preferred more neutral words like "weight problem," "BMI," (body mass index), "excess weight," and "unhealthy body weight."

Wadden and Didie cautioned physicians that use of those more undesirable terms could be "hurtful or offensive" and even "derogatory" to patients. Like Odysseus, then, those professionals who work with these patients have to steer clearly between the Scylla of using terms that may seem derogatory and the Charybdis of avoiding any discussion of weight control whatsoever. But sometimes a spade is just a spade.

Sylvia R. Karasu, M.D., is Clinical Professor of Psychiatry at Weill Cornell Medical College and senior author of The Gravity of Weight.

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