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Primary Care Physicians Roles in Obesity Treatment Teresa Foster Saint Louis University, Madrid

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High blood pressure. Heart disease. Stroke. Type 2 diabetes. Cancer. Gallbladder disease. Sleep apnea. Reduced life expectancy. High cholesterol. What do these diseases and disorders have in common? They are all associated with obesity, one of the leading yet most preventable causes of death in the United States. Sixty one percent of American adults are overweight or obese. The epidemic is not limited to adults; fourteen percent of children and adolescents are overweight, which is triple the number measured in 1970. The statistics keep getting larger, but the measures taken to combat obesity are not becoming any grander. Primary care physicians maintain relationships with their patients and, if properly educated, can help their obese patients return to healthy body weights. A body mass index is used to categorize people as overweight and obese. Overweight indicates a body mass index (BMI) between 25 kg/m 2 and 30 kg/m 2 and obesity is defined as a BMI over 30 kg/m 2 . An obese patient can greatly reduce their risk of disease due to excess pounds by losing only 5% to 10% of their total body weight. Of the many life-threatening diseases, obesity is perhaps one of the most preventable. Weight management can be as easy as joining a gym and choosing nutrient-dense foods. If more aggressive treatment, such as bariatric surgery, is required, Medicare recognizes obesity as a billable disease and can help those who may not be able to afford it. Unfortunately, many become complacent with over-sized waistlines and prefer the taste of convenience foods over additional years of life. Over 300,000 deaths a year can be attributed to obesity and obesity-related complications, many of which could have been postponed with proper education and treatment. Most people turn to their doctor whenever a health problem arises. However, this may not be effective in the case of obesity. Primary care physicians may not be adequately educated or willing to aid patients in weight loss. The National Academy of Sciences recommends that

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medical students receive a minimum of 25 hours of nutrition instruction, but many medical schools fail to meet this recommendation. Researchers at the University of North Carolina at Chapel Hill studied over 100 medical schools and discovered that only a quarter offered the suggested 25 hours of nutrition education. How can primary care physicians be expected to aid in the obesity epidemic if they are not educated properly to do so? A study directed by the Strategies to Overcome and Prevent (STOP) Obesity Alliance, an organization associated with George Washington University, found that 89% of primary care physicians believed that they were responsible to help their patients with weight loss. Of these physicians, 72% responded that they did not feel equipped to advise patients about proper nutrition, dieting, and exercise. In another study, patients were interviewed about the role their physicians played in weight analysis. Only 39% of obese patients interviewed had been informed of their obesity and the damage excess weight can cause. Nine out of ten of informed obese patients stated that their doctors had instructed them to lose weight, but one third of them were not given specific instructions how. The ever-expanding waistlines of our nation can take a toll on not only our health, but also our pocketbooks. In 2000, obesity cost the United States $117 billion. Half of bankruptcies declared in 2005 were due to medical expenses. This is not surprising, as five of the top ten most expensive medical conditionsheart conditions, cancer, hypertension, diabetes, and arthritis can all be linked to obesity. The cost of treating these conditions and others continues to rise as more and more patients are diagnosed with them. This epidemic cannot be ended if obese patients are not informed of their condition. Even if doctors are properly educated about nutrition, many are hesitant to confront patients about their weight. Multiple cultural stereotypes, such as laziness and unattractiveness, surround

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the condition and doctors are hesitant to make their patients uncomfortable with an honest diagnosis. The fact that the most common cause of weight gain is poor behavioral choices also hinders the discussion; doctors fear patients becoming upset or defensive and refusing further advice. A 2000 study published in an obesity journal found that the heavier a patient was, the more reluctant doctors were to broach the topic of weight loss. Mayo Clinic researchers found that only one in five obese patients had their condition documented by doctors, showing just how hesitant doctors are to address the issue. Women and children were more likely to have it documented, perhaps because these populations are more conscious of the issue. The complacency that we have towards such a dangerous epidemic is astounding. If doctors are insecure about or incapable of helping, and patients are too ashamed or unmotivated to confront the issue, who will? If another disease, such as cancer, was this prevalent, much stronger measures would be taken. There would be fundraisers for research, public service announcements to inform, and pamphlets discussing where to turn for help. Obesity is a difficult issue to conquer because it is difficult to pin down a direct cause. Behavioral, cultural, psychological, and genetic factors all can help to determine the number on the scale. To avoid confronting the various causes, we have instead adapted for the problem. Bigger desks, sturdier furniture, and wider airline seats have been devised while snack companies continue to bombard us with flashy advertisements for new, delicious, processed food. This cannot go on forever; eventually we will be forced to face the crisis and develop a solution. Education is the key to combating the obesity epidemic; however, this cannot be done if it remains a shameful topic to discuss. The stigma surrounding excess weight needs to be shed to make progress possible. It is ridiculous and irrational to continue to not be able to discuss the most lethal disease afflicting our nation. America is clearly fascinated with weight loss, as

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evidenced by the hundreds of fad diets that fade in and out of fashion; we just need to be taught the correct, healthy way to get into shape. Primary care physicians must be educated properly about nutrition. This begins with making 25 hours of nutrition instruction not just a recommendation, but a requirement, for medical school students. Psychological instruction concerning the multitude of emotions behind obesity should also be required. This will make them more sensitive to the shame and embarrassment obese patients might feel, and will help them to identify if an emotional disorder exists behind the excess weight and if a patient could benefit from psychological counseling. Doctors should be made aware of other health care professionals available to help patients shed pounds, such as registered dieticians and athletic trainers. They can step in to help with more specialized knowledge when a doctor does not feel comfortable devising a weight management plan for a patient. The proportions of Americas obesity epidemic are astonishing, but it is not too late to reverse the damage. The solution lies in education. If nutrition courses were mandated in medical school, physicians would be better equipped to answer diet questions, identify problems stemming from excess weight, and aid patients in weight management. They could help patients of all ages become healthier, from teaching new parents how to properly feed a young child, to educating athletic youth about the importance of a healthy diet for sports performance, to aiding aging patients in shedding a few excess pounds in exchange for several more years of life. If we become properly informed, we can eliminate the obesity epidemic in America.

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Works Cited Barida, A., Holtan, S., Slezak, J., et al (2007, August). Diagnosis of obesity by primary care physicians and impact on obesity management. Retrieved from http://www.mayoclinicproceedings.com/content/82/8/927.full Chen, Pauline W. (2010, September 16). Teaching doctors about nutrition and diet. Retrieved from http://www.nytimes.com/2010/09/16/health/16chen.html?scp=1&sq=medical%20school %20nutrtion&st=cse Foster, G., Wadden, T., Makris, A., et al (2003, October 10). Primary care physicians attitudes about obesity and its treatment. Retrieved from http://www.sochob.cl/pdf/obesidad_comorbilidades/Primary%20Care%20Physicians%20 Attitudes%20about%20Obesity%20and%20Its%20Treatment.pdf Herper, M. (2005, April 14). The most expensive diseases. Retrieved from http://www.forbes.com/2005/04/14/cx_mh_0414healthcosts.html. Leading health indicators: overweight and obesity. Retrieved from http://healthypeople.gov/Document/html/uih/uih_bw/uih_4.htm#overandobese Overweight and obesity: at a glance. Retrieved from http://www.surgeongeneral.gov/topics/obesity/calltoaction/factsheet02.pdf STOP Obesity Alliance (2010, March 22). Primary care physicians agree on responsibility in addressing obesity, but lack right weight management resources. Retrieved from http://www.news-medical.net/news/20100322/Primary-care-physicians-agree-onresponsibility-in-addressing-obesity-but-lack-right-weight-management-resources.aspx