Physicians must educate patients about obesity

There is no simple solution; all recommendations must be tailored to the individual.

Judith Stern

One of the current national health objectives is to reduce obesity among adults to 15% by 2010. As 2010 approaches, it seems unlikely that the goal will be achieved.

“We are in a crisis situation in the United States and in many other countries in the industrial world,” Judith S. Stern, ScD, told Endocrine Today. “I don’t think that the medical community can see an end to the situation. There is no way to keep obesity in check besides lifestyle modification, diet and increased exercise,” she said. All three of these methods are challenging to implement; the term ‘epidemic’ is a good description.

Stern, distinguished professor in the departments of nutrition and internal medicine at the University of California, Davis, and cofounder and vice president of the American Obesity Association, recently spoke with Endocrine Today about obesity and how the medical community can continue to address the problem.

Physicians should help patients understand that there is no easy fix to overweight and obesity.

“There are at least 31 comorbid diseases — type 2 diabetes, hypertension, osteoarthritis of weight-bearing joints, to name a few — associated with obesity and the prevalence of those diseases is getting worse as obesity increases,” Stern said. “The problem is that drugs that are available for obesity are mostly first-generation drugs.

“It is similar to where hypertension medications were in the late 1950s and early 1960s. Now we have drugs that are better at controlling blood pressure compared to earlier drugs. We just aren’t there for obesity medication yet,” she said.

Consider the individual

For now, physicians have to focus on helping patients change their lifestyle and behavior. Helping patients to recognize a weight problem is often the first step.

“When working with kids, physicians often have to address the problem through the parents. Let’s say you tell a parent that their child is obese. They normally have one of two responses: ‘What do you mean, my child isn’t perfect?’ or ‘Are you blaming me for this?’” Stern said. “Physicians are concerned that they could lose patients this way. It is important to figure out a way to work with parents in a sensitive way.”

Change in children has to begin with parents; avoiding use of the word ‘obese’ may help. The CDC defines obesity in different terms for children and adolescents. Children in the 85th to less than 95th BMI-for-age percentile are defined as ‘at risk for overweight’ and those >95th percentile are ‘overweight.’ The word ‘obese’ is not used to define a weight category in children.

When dealing with teens, physicians should speak to them as individuals. “Ask your patient ‘Are you concerned about your weight?’ and just listen to what they have to say,” Stern said. “If they want help, figure out how help can be tailored to their needs.” More frequent office visits to be weighed can sometimes help but patients should be weighed in private.

Recommend summer camps where the emphasis is on activity. About 20 years ago, Stern did a study of boys at a summer camp where there was extreme physical activity (five to six hours a day) showed teenage boys could lose significant amounts of weight.

However, following up in this situation is difficult, particularly for physicians to do so personally. “Sometimes the best way to help teens is to get them into a social support network,” she said.

Getting adults to recognize a weight problem can sometimes be the most difficult. If a patient does not want to receive help, there is little that a physician can do.

In general, it is a good idea to be familiar with community resources for diet and fitness. There are many programs available to help people get their weight under control.

Here are some questions to consider before recommending programs to your patients. . .

What does the weight-loss program consist of?

• Does the program offer one-on-one counseling or group classes?
• Do participants have to follow a specific meal plan or keep food records?
• Do participants have to purchase special food, drugs or supplements?
• Does the program help participants be more physically active, follow a specific physical activity plan or provide exercise instruction?
• Does the program teach participants to make positive and healthy behavior changes?
• Is the program sensitive to a participant's lifestyle and cultural needs?

What are the staff qualifications?

• Who supervises the program?
• What type of weight management training, experience, education and certifications does the staff have?

Does the product or program carry any risks?

• Could the program hurt someone?
• Could the recommended drugs or supplements harm a participant's health?
• Do participants talk with a doctor?
• Does a doctor run the program?
• Will the program's doctors work with a participant's doctor if they have a medical condition such as high blood pressure or are taking prescribed drugs?

How much does the program cost?

• What is the total cost of the program?
• Are there other costs, such as weekly attendance fees, food and supplement purchases, etc.?
• Are there fees for a follow-up program after you lose weight?
• Are there fees for medical tests?

What results do participants typically have?

• How much weight does an average participant lose and how long does he or she keep the weight off?
• Does the program offer publications or materials that describe what results participants typically have?

Source: National Institute of Diabetes & Digestive, Kidney Disease, Weight-control Information Network

Knowing your community

Take Off Pounds Sensibly (TOPS) is a nonprofit, noncommercial-based weight loss support group with over 10,000 locations. The program has a fee of approximately $25 a year and has weekly meetings to provide members with positive reinforcement and motivation to adhere to food and exercise plans.

Some chapters even allow participants to pay the 50-cent fee on a weekly basis, allowing flexible access to help when it is most needed. The program is available to adults and adolescents.

In addition to support programs, dietary recommendations should be tailored to each patient, using the knowledge that a physician has about that patient’s lifestyle and demands.

Stern said until recently she generally recommended low-fat diets with lots of fruits and vegetables, high fiber and protein. “I’m backing off from that opinion. In order for it to be effective, it needs to be a diet that that specific person can stay on,” she said. No one diet will work for everyone.

“If it is a diet that they can follow and it is nutritionally balanced, with the vitamins and minerals and protein they need, I don’t have a preference. Hopefully, whatever diet they choose will also help address the next problem: weight maintenance.” – by Leah Smith