Are doctors part of the obesity solution -- or part of the problem?
Obesity is widely discussed, and increasingly doctors are weighing in. Here in Canada's largest province, the Ontario Medical Association recently called for food labeling and a tax on junk food to "help prevent thousands of premature deaths associated with obesity."
It's the sort of provocative prescription that yields attention -- and it did. Google "OMA" and "obesity," and there are over a quarter of a million hits. But evidence for food labeling is, at best, mixed, and experiments with so-called "fat taxes" have been less than successful (Denmark dropped its tax after just a year).
But should the OMA be more focused on Ontario doctors?
Doctors, after all, are the ones we tend to turn to for health advice and counseling. If Canada has a weight issue, should our physicians be doing more?
The answer seems to be yes. The problem is that docs aren't doing much.
That's not to say that doctors couldn't be part of the solution. In fact there is good evidence that if docs talk to patients about their weight issues, there are good results. Last June, for example, the Canadian Medical Association Journal published a paper showing that patients were more likely to lose weight if advised by their doctor. That result echoes the results of other studies.
But if doctors can have influence, surprisingly few seem to see themselves in that light.
The same CMAJ paper cited a survey finding that 45 per cent of American docs said that they didn't feel qualified to treat obesity. More incredibly, 72 per cent of U.S. primary care physicians surveyed said that no one in their practice was trained to deal with weight-related issues.
The more things change, the more they stay the same: in a classic paper published over a decade ago, obese Americans were contacted and asked if their health care professionals had advised them to lose weight. A majority reported no. I don't think the results would be any different on this side of the 49th parallel.
If we doctors are doing a poor job of discussing obesity with patients, it turns out that patients themselves don't really seek opinion from their physicians.
In a 2009 Ipsos Survey, 23 questions were asked about weight management practices. While almost three-quarters of the overweight and obese Canadian adults surveyed had tried to lose weight (58 per cent in the previous 12 months), only 21 per cent reported seeking help from their physician in the previous year.
Let's then quickly summarize: doctors could have a major role in helping people lose weight but, all too often, neither physicians nor patients are bringing up obesity in the doctor's office.
If anything, I'm not surprised. Maybe it relates back to our training, which is heavy on disease treatment and light on prevention. Back in medical school, I remember class after class discussing the pathology of diabetes and the results of this illness; frankly, I can't remember ever sitting through a lecture in which we talked about preventing diabetes through better eating habits and addressing obesity.
And in the years since med school, having logged hundreds of hours listening to lectures and reading journals and discussing challenging cases with colleagues, relatively little time has been spent on weight management.
It's easy to blame others, so I'll focus on myself. As it turns out, I live and practice in Ontario (and I'm a member of the OMA). Am I doing enough to address obesity? For years, I didn't even have a scale in my office.
What did I do to change things? First, I invested in a scale and a measuring tape. Second, I started asking more questions of patients. Some of those conversations were awkward. But, to my own surprise, people have been pretty keen for advice.
I'm a specialist, not a primary care doctor; many of the drugs I use can increase a patient's weight. Now prescriptions are often given with tips on avoiding weight gain. I emphasize the importance of drug compliance, but also exercise and a proper diet.
When discussing obesity, we tend to look for big, sweeping solutions. The causes of obesity are complex; alas, so are the needed solutions. Today, the Montreal Economic Institute releases my paper on what governments should and shouldn't do, what the private sector should do, and what physicians should do.
For the record, in my own practice, I incorporated my ideas about what physicians should do. It didn't involve legislation; it did involve a scale -- and common sense.