Physicians, Address the Obesity Issue with Patients

Last week, a middle aged woman came to the office for routine follow up of her thyroid nodules. As is my usual practice, I reviewed her vital signs and saw that she had lost weight from her previous visit. I praised her for the weight loss and asked her the specifics of her successful approach. Her initial response surprised me when she looked at me, and said, "Doctor, of all of the physicians that I see, you are the only one that talks with me about my weight."

As an endocrinologist and one of the authors of the resolution that passed at the AMA House of Delegates Annual Meeting in 2013 declaring obesity a disease, talking to patients about the devastating effects of its multiple complications is easy for me. Obesity affects one-third of this country's population, and has multiple co-morbidities, including heart disease, diabetes, and cancer, all of which are in the top 10 most fatal conditions in the US.

So why does this significant public health problem, with a known pathological basis, and evidence-based treatments, not get the appropriate attention from the physicians of this country?

My speculation is that many physicians still think their patients with obesity do not really want to talk about their weight. If only they would eat less, they would lose weight, or if the drugs for obesity and nutritional therapy would be covered by insurance, they would lose weight, or if the surgery did not have complications, more people would accept this option and lose weight.

In my experience, I don't think my patient's complaint is particularly unique. Patients want to talk to their doctors about all of their medical problems, including obesity. In addition, as country, we can't afford to wait around for all of the treatment and insurance related problems with obesity to be fixed. My challenge to my colleagues in all areas of medicine is ask your patients about their weight, then provide education regarding lifestyle changes, medications, and surgery according to the guidelines. We have a public health crisis in obesity, but as a physicians, we can attack it one patient at a time.