The obesity epidemic is like the elephant in the room -- we all know it's there, looming over us, but few are willing to talk about it. Discussing personal weight is admittedly a sensitive topic, but we have reached the point where even our healthcare providers, the ones we look to for guidance towards better health, avoid talking to us about this potentially life-threatening state. Ask yourself: is your doctor or nurse practitioner (NP) comfortable having that conversation with you, or do they beat around the bush in order to spare your feelings? How would you really feel if your doctor or NP told you that you are obese, or even called you fat? Would you return for your next follow-up visit? Which one of these terms would be the stronger motivator for personal change?
Most of my clients come to me for guidance with weight loss. Many of them say that their primary care providers haven't mentioned their weight as an issue, nor have they suggested weight loss to improve health and quality of life. People are talking though, and just last summer the British prime minister of health suggested that doctors should tell overweight people directly that they are fat because it has a stronger emotional impact and pushes people to take personal responsibility for their condition. She argues that by calling heavy people obese, we aren't directly addressing the issue at hand. Others believe that by calling overweight people obese instead (which describes a medical condition of excess weight gain to the extent of adverse affect on health), we are describing a state that happens to someone (reducing the blame) rather than pointing the finger right at the person themselves the way calling someone fat does.
Call it what you want, but let's just start talking about it because healthcare providers have the power to inspire people to change. Remember when smoking was our biggest health concern? Researchers found that doctors who had a talk (even a brief one) with smokers saw more of their patients kick the habit. We should use the same approach to address the obesity epidemic, and providers simply need to start talking to those who should lose weight. Unfortunately they may not have the time to do so, but even just planting the seed in the patient's mind and then referring them out to a qualified professional would help. Really though, knowledge alone is not the solution; if it were that easy I wouldn't be writing this blog since there is an abundance of information is available to us. Lasting change takes time and effort as well as some knowledge and guidance; this is where Registered Dietitians can help close the gap since they truly are the nutrition professionals.
So what do I say when I counsel my overweight clients? Well, they appreciate honesty, and although I may not call them fat, I absolutely will tell them what their appropriate weight or waist circumference should be in order to remain free of chronic diseases like diabetes, cardiovascular disease, and numerous cancers. My goal is to provide them with the appropriate tools for successful weight loss and to assist them in building the necessary skills they need to live a healthier life. We all need a plan in order to reach our goals, and most of us will need help in effectively carrying out that plan. If we can't get our healthcare providers to talk straight with us, then whom can we turn to?
Many doctors aren't that enthusiastic about this conversation, with a recent study revealing that less than half of those who are overweight, and less than two-thirds of those who are obese are actually being called that by their doctors.
Last time I checked, nearly 70 percent of U.S. adults qualified as overweight or obese, so really, the time is now. Providers need to be talking seriously to people about their weight. Maybe the reason why providers are hesitant to bring the weight issue up with their patients is because they don't feel prepared for the conversation itself, or maybe they themselves are overweight or even obese. So who should talk to them? Again, knowledge is not the answer or we wouldn't have fat doctors, nurses and even dietitians! Really, it doesn't matter if you are fat, obese, plump or chubby, if you find that your healthcare provider is not talking to you about your weight, you should be proactive about making a change. No one else will do it for you! Ask your doctor for a referral to a Registered Dietitian to help you reach your goals; don't try to do it on your own. Changing behavior is hard, but not impossible and doctors just can't do this with you in a brief office visit. Lasting change takes time and effort, so take charge and ask for what you need, you can do it with some help!
Manuel Villacorta is a registered dietitian in private practice in San Francisco, California. He is a national media spokesperson for the American Dietetic Association and the founder of Eating Free.