Talking to Me?

Can We Talk About Obesity?

Maybe one of the reasons obesity has been such a tough nut to crack is that we simply cannot talk about obesity in any constructive way most of the time. A recent study in Primary Health Care Research and Development by Anita Laidlaw and colleagues finds what many other studies have found:

In primary care consultations with patients who have overweight and obesity, patient weight is seldom being mentioned. This is despite the fact that many of the patients are presenting with chronic and ongoing conditions (eg, musculoskelatal pain, cardiovascular issues) known to be exacerbated by excess weight. Lack of weight discussions between patients with obesity and primary care practitioners can be perceived by patients to suggest that their obesity is not an important health concern.

In a 2013 Medical Care publication, Jennifer Kraschnewski and colleagues documented that rates of weight counseling have actually declined as the problem of obesity has become more serious. This decline was noted to be most pronounced in consultations with people who have obesity and related conditions.

How can this be?

Consider the recent experience of one patient with a family history of obesity, diabetes, and cardiovascular disease. He has a BMI that has in the past approached obesity, but is presently at about 27. He has high cholesterol and prehypertention. His physician has prescribed medication for cholesterol and is encouraging him to start taking medication for hypertension.

But when the subject of orlistat — a medication for reduction and maintenance of weight — comes up, the doctor is blunt. “You don’t need to keep taking that. You just need to eat less fat.”

There’s no discussion of diet and nutrition. The conversation ends with the physician saying “I don’t want to discuss this again.”

It’s tough to deal with health issues that you can’t talk about.

Click here for the study by Laidlaw et al and here for the study by Kraschnewski, For excellent perspectives on how to foster constructive conversations about obesity, click here for materials from the Obesity Action Coalition, here for Why Weight? from the STOP Obesity Alliance, and here for Treat Obesity Seriously from the Obesity Society.

Talking to Me? Photograph © Niek Braam / flickr

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July 11, 2015