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Opportunity of influence: Starting a conversation about weight
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Approximately two-thirds of US adults — 127 million people — are overweight or obese with a BMI of at least 25. Not only is this a personal issue, but it is a national and economic issue as well. Almost 10% of US medical costs are tied to obesity, which is about $147 billion per year in direct medical costs, or $270 billion if you include lost productivity due to death, disability or total disability.
People who are obese may not realize that their medical costs are also “obese.” The average obese person will spend $1,470 more per year in medical expenditures than the normal-weight person — $4,870 vs. $3,400. Aside from the personal and financial toll, being overweight or obese increases the risk for cardiovascular disease, diabetes, hypertension and a host of other weight-related conditions such as sleep apnea, osteoarthritis and gallbladder disease.
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These burdens on the individual and society created by being overweight or obese are not breaking news; awareness of the problem seems to exist. That being the case, why have the rates of overweight and obesity in the United States grown exponentially in the past 2 decades? The simple answer is that people are consuming more calories than their body needs to maintain or lose weight. But, there is no simple solution. Maintaining a healthy weight is influenced by level of physical activity, genetic predisposition, environment, culture, societal influences, medications, certain medical conditions and other possible factors such as sleep deprivation, temperature-controlled environment and the possible existence of a “fat virus.”
Changing behavior
For most people who are overweight or obese, achieving and maintaining a healthy weight will require making a behavior change, especially regarding lifestyle. The first step in the process is acknowledgement — acknowledging that a weight problem exists and that it poses risks to one’s health. This seems to be a logical and straightforward approach, but it is complicated because there appears to be a generational shift in what is considered “normal” body weight.
Compared with 20 years ago, overweight and obese individuals today are more likely to consider themselves “normal weight.” This is easy to explain if two-thirds of the people around you look like you. From a societal perspective, the new “normal” weight is at least overweight. Unfortunately the new “normal” weight still poses undesirable health consequences.
Physician acknowledgement
As health care providers, we wonder what can we do to help people who are overweight or obese. It might be as easy as starting a conversation about weight with your patients and providing them with the facts.
A recent study in the Archives of Internal Medicine, based on analysis of the 2005 to 2008 National Health and Nutrition Examination Survey data, examined the influence of physician acknowledgement of weight status on patients’ perception of their weight, desire to weigh less and actions to lose weight. Two-thirds of the people who were overweight (BMI >25) and one-third who were obese (BMI >30) reported never being told that they were overweight or obese. The researchers concluded that when patients were told by their physician that they were overweight, they were more likely to have realistic perceptions about their own weight, interest in losing weight and actual attempts to lose weight.
The results of this study provide a practice pearl for all health care providers: Treat BMI as a routine vital sign and discuss the results with your patients. Successfully losing weight requires intensive interventions, but patient awareness and desire to lose weight are a necessary first step. Don’t assume that people who are overweight or obese consider themselves overweight or obese, and don’t underestimate the influence you have in discussing weight status with your patients. You have the potential to make a difference — start a conversation about healthy weight.
Mary M. Austin, MA, RD, CDE, FAADE, is president of the Austin Group, LLC, in Shelby Township, Mich. She is also an Endocrine Today Editorial Board member.
Disclosure: Dr. Austin reports no relevant financial disclosures.
For more information:
- Baron R. Arch Intern Med. 2011;171:321-322.
- Finkelstein EA. Health Aff (Millwood). 2009;28:w822-831.
- Post RE. Arch Intern Med. 2011;171:316-321.
- US Department of Health and Human Services. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Accessed March 30, 2011.