Overweight people already know they are overweight. So should doctors keep nagging them to lose pounds?
No surprises here. (PictureNet/Corbis)That’s the issue tackled recently by one of my favorite medical blogs, called “Musings of a Distractible Mind.” The author, who goes by “Dr. Rob,” is Dr. Robert Lamberts, an Augusta, Ga., physician who is board certified in internal medicine and pediatrics. On his blog, Dr. Rob muses about a variety of topics like llamas, twinkies and favorite patients. But I was particularly moved by a recent post, which was written after Dr. Rob’s encounter with an overweight patient who was clearly accustomed to being lectured about obesity. As Dr. Rob was about to discuss whether the man needed surgery for sciatica and back pain, the patient interrupted him, hanging his head in shame and blaming his weight for the problem. Dr. Rob writes:
This whole episode really bothered me. He was so used to being lectured about his obesity that he wanted to get to the guilt trip before I brought it to him. He was living in shame. Everything was due to his obesity, and his obesity was due to his lack of self-control and poor character. After all, losing weight is as simple as exercise and dietary restraint, right?
Perhaps I am too easy on people, but I don’t like to lecture people on things they already know. I don’t like to say the obvious: “You need to lose weight.” Obese people are rarely under the impression that it is perfectly fine that they are overweight. They rarely are surprised to hear a person saying that their weight is at the root of many of their problems. Obese people are the new pariahs in our culture; it used to be smokers, but now it is the overweight.
Dr. Rob says obese patients don’t need lectures.
Instead of patronizing obese patients with a lecture, I try sympathizing with them. Just because something is simple doesn’t make it easy. How do you quit smoking? You just stop smoking. We should just pull out of Iraq. There should be peace in the middle east. People should stop hurting each other and start being nice. All of these are good ideas, but the devil is in the details. Losing weight is a struggle, and it really helps to have people giving you a hand rather than knocking you down.
Dr. Rob writes that he still tries to help patients to lose weight, but he is concerned that a “culture of accusation and shame” is making matters worse for them.
The idea that their personal worth lies on their BMI is extremely damaging. There are a lot of screwed-up skinny people out there; just look at super-models. It is a lot easier to lose weight when you actually like yourself and want to do something about your health. Our culture of accusation and shame simply makes obese people hate themselves. If you hate yourself, why should you want to take care of your body?
Is obesity a problem? Sure it is. But we need to get off of our self-righteous pulpits. Obese people should not be made into a group of outcasts. The “them” mentality and the finger-wagging are no more than insecure people trying to feel better by putting down others.
What do you think? Is a “culture of shame and accusation” contributing to the nation’s obesity problem? Post your thoughts below.
Healthy living doesn't happen at the doctor's office. The road to better health is paved with the small decisions we make every day. It's about the choices we make when we buy groceries, drive our cars and hang out with our kids. Join columnist Tara Parker-Pope as she sifts through medical research and expert opinions for practical advice to help readers take control of their health and live well every day. You can reach Ms. Parker-Pope at 
The easiest and most pleasurable way to eat well is to cook. Recipes for Health offers recipes with an eye towards empowering you to cook healthy meals every day. 
From 1 to 25 of 791 Comments
I ’should’ lose 20 lb. “You are a smart woman; it isn’t rocket science.” After hearing this sort of crack from my doctor over something like eight years, I changed doctors. I thinnk the comments helped make me utterly weight obsessed.
— ajjPhysicians should not take paternalistic positions and lecture patients about their weight; rather, they should serve as allies in the quest for good health and advise patients about the potential or actual deleterious effects of obesity upon their health status. Frankly, it seems that very few physicians can offer more information regarding weight management than can be gleaned from books or the web. Also, many MD’s seem to be struggling with weight problems themselves.Who will lecture them?
— WNagging not required. Insults not desired. Straight talk is: “You’re too fat. You need to lose XXX pounds. Let’s develop a plan.”
— Steve OngleyThere is a paradox that we claim obese people harm society economically, yet our policies support a culture of excess. If our society truly wants to help overweight people lose weight, there are many ways that different institutions can provide support. State governments can increase the time requirement for children’s physical education classes (currently only 2 thirty minute periods per week are required in NY state for grades K - 6) Health insurance companies can give discounts to people who join and use a gym. Employers can provide or subsidize health club memberships and provide time during the work day for exercise. The government can change its farming support policy so that fruits and vegetables are subsidized instead of cheese and meat and corn syrup. The standard serving of soda at a fast food chain was 8 oz. before Nixon put in place price supports for corn. The FCC can ban television advertising of sugary or high-fat foods, as some European countries do. All this and more can be found in a documentary Peter Jennings produced shortly before his death: “How to get fat without really trying”
— BarbaraI don’t know if it’s contributing to the problem, but it certainly is acceptable to blame fat people in a way that is not OK for other conditions. On top of that, doctors can be dismissive of the health concerns of obese people, a problem I have personally experienced. Doctors are also, like the general population, not immune from making assumptions about how and why a person is overweight. My last GP started in on The Lecture. I stopped him, gave him the rundown on my medical history (including the opinion of my endocrinologist) and asked what magic bullet he had. He shut up.
— AlexisMaybe the doctor could say instead, “is there anything I can do to help you address your weight?” rather than simply saying “you need to lose weight?” or “would you like to discuss any of your health issues, such as x, y, z, or your weight?” As a veteran of the weight-loss war, through multiple major battles and skirmishes of up-and-down, of trying it all (diaries, exercise, eating right - and still battling the emotional eating problem) - I might not benefit from this approach because my problem isn’t knowledge, techniques, tricks. But I’ll bet a whole lot of people out there might be in need of knowledge. At the very least, the doctor could demonstrate concern without making the patient feel terrible.
— wastingtimeAll my life I have been waiting to be thin. In retrospect, when my support network, including physician,trainer,friends,family - when everyone concentrates on empowerment - then I am successful. When everyone is judgemental, I am reduced to a scared chubby 5 year old who has no control - and I am not successful. Ask me what would be useful to my plan, do not tell me what worked for you/your sister/your friend. Ask me and love me…
— Getting healthier all the timeYes, yes and yes! And take a walk too, relax, sit under a tree and read a book. Eat whole foods, and find the time to pamper yourself and heal from within. The best diet, “Fit for Life Diet”. Eat only fruit for breakfast, as much as your want. Lunch and dinner: eat carbs and veggies or meat and veggies. Never mix carbs and meat together. Snacks: nuts and dried fruit. Never eat prepacked processes food. If you don’t find time to take care of yourself then you will need time to be sick.
— cluppinIt seems to me the primary focus should be to have your blood pressure cholesterol and blood sugar under control (naturally or otherwise). One also should not lead a couch-potato lifestyle. This applies to everybody, including plenty of skinny people. SKINNY does not automatically equal healthy.
— LisaA “culture of shame and accusation” is NOT contributing to the nation’s obesity problem- it is poor diet and poor choices.
Just like we are not born knowing how to read, we are not born knowing what to eat. People need to be taught how to eat right & then take personal responsibility for their health. Illiteracy can also impact a person’s health- this does not mean that doctors should teach people how to read.
— Che SemerarhPeople move more easily when they weigh less.
My excellent doctor always encourages walking and other forms of gentle exercise for the problem of excess weight.
He also warns people against diet drugs and quick fixes…and he knows that most people will not stick with the high-powered gyms.
Today is a great day to take a weight-reducing health-enhancing walk.
— FranI don’t think that a doctor should “nag” her patient about losing weight, but patient education about all of the illnesses associated with obesity should be part of a patient/doctor consultation. My father was very obese and got a blood clot in his leg that led to a stroke. The association between obesity and blood clots is well known but probably seldom discussed in a doctor’s office–as are a whole host of other weight-related disease.
Doctors, too, however, should be trained in nutrition, and I’d venture to say that most aren’t. It isn’t enough for them to tell a patient to go lose weight. They should be able to tell the patient how, perhaps by writing a prescriptive diet or exercise program or at least referring them to one.
Then, too, insurance doesn’t usually cover visits to a nutritionist which can be very expensive. The medical system really needs to be re-worked to so that keeping a person healthy is the focus rather than just managing disease.
— MargaritaYes, doctors should lecture their patients about their weight probelms–though “nagging” isn’t necessarily the best approach for every person. Doctors should work holistically to counsel patients who have *any* serious health problem, including obesity. There is a way out of obesity (i’ve been there) and, moreover, too many people don’t fully realize the associated risks–especially now that so many young people become obese and overweight in their early life. i’m 27–too young to have already been obese and recovered.
— lydiaOh, yes. God forbid that we should be overweight, over 60, or under a million dollars in net worth. These are civil crimes carrying severe penalties.
— GerontiusDoctors can nag so long as the doctor is healthy and fit; practice what you preach.
— JoeI agree with Dr. Rob. Firstly there’s no reason to shame large people, and secondly, that recrimination will only lead to worse mental, and then physical, health. For most of us, hating ourselves will not make us thin. It’s hard enough to get up at 6am to jog in the morning before work; if you don’t believe that you matter, that you have anything to contribute to society, why bother?
Anti-obesity programs need to tackle several contributing factors: lack of information, lack of access to healthy food, lack of access to safe outdoor exercise space, and the stress of modern life. Most of all, the obese should know that they’re not alone; we’re all struggling to be healthy and happy.
— KirstinI don’t know that the “culture of shame and accusation” contributes in a straightforward way to people becoming obese, but I think it does contribute to people staying obese, and I strongly suspect that it contributes to the severity of the ancillary health issues related to obesity.
I’ve lost 50 lbs in the last year and have 30 to go, and weight’s always been an issue for me, so I can speak from some experience. Like the patient that Dr. Rob describes here, I tend to assume that every health issue, every symptom, is a result of being obese. Doctors seem (in my limited experience) to do the same. Therefore there seems little point in consulting a doctor about any of it; I’ll just be told to lose weight, right? What if I’m fatigued and achy? It seems likely that the doctor will decide that obesity is a more likely explanation than, say, Lyme disease, and so won’t bother with the test. If other obese folks think the same way, then it’s likely that we’ll wait to go to the doctor until we’re sicker.
I appreciate Dr. Rob’s analogy with “just” stopping smoking. Yes, in the abstract it’s just that simple. In the world of flawed humans, it isn’t. The best thing I did for myself was NOT try to lose weight sooner, while I was dealing with a divorce, a move, adjusting to single parenting, etc. I needed to lose weight but it was just too much to take on just then. Probably the most helpful things that health care workers and friends/family can do are to acknowledge that losing weight is hard, and to acknowledge that losing weight will NOT magically fix any other problems. Slimming down won’t make Mr. Right magically appear, won’t get you a promotion, won’t make your kids angels. Your weight is just one, relatively insignificant, aspect of your life.
— Still Heavy But Less SoAs a painfully thin young person I had all the symptoms of an overactive thyroid, and it was impossible for me to gain any weight. No doctor ever tested my thyroid. Years later I began to put on pounds and more than one Dr. said I was simply getting older and must control my diet. I was once lectured about dieting by a male Dr. with a very large belly. When I was about 50 pounds overweight, and had other low thyroid symptoms, a Dr. tested my thyroid, prescribed medication and said it would help me lose weight. Didn’t happen. When I became diabetic the medications, especially insulin, caused weight gain. My current Dr. dismissed my concerns about medication causing weight gain and told me diet and exercise was what I needed. Not all weight gain is caused by stuffing one’s face with junk food/beer/sweets. I have been humiliated, lectured, blamed, and blown off. Yes, I am fat and yes, I did eat 2 cookies yesterday. However, I do not appreciate being treated as though weight gain is a character flaw or that I am morally lax. Overweight people need help and attention to the causes, rather than lectures.
— carolMy husband has needed to lose some weight for a number of years and I know he’s been given the “lose weight” lecture by a doctor at least once. But of course that just states the obvious and makes him feel guilty.
But his current doctor chose not to guilt trip him and instead sent him to a nutritionist who has worked with him to eat better and lose a little weight. He’s still got a long way to go, but at least he’s moving in the right direction and he thinks about it and works on it every day instead of just feeling guilty about it.
I think its great that the doctor took action to work with my husband to achieve goals he already had, but it only worked because he left the guilt trip at the door.
— SarahDr. Rob has a problem, as do his obese patients, because doctors don’t have an answer for people who can lose weight but can’t keep it off, even when they try. If medical research can find an answer for erectile dysfunction, why can’t they find something that will at least help obese people with weight loss and weight maintenance? I realize that a pill is not a substtitute for healthy living, but some people need more support than others.
— CeliaI think a “culture of overeating and undermoving” is contributing to the obesity epidemic. At my worst I was close to 250 lbs but started eating right and exercising and am now down to 195 lbs. I am still working on it. You have to keep working on it!
— DSo what does one do when a loved one is obese, knows it, and seems unable to do anything about it? The referenced blog says “I do my best to work on weight loss with my patients.” Well, how?? That was the closest thing I saw to a statement about what to do in a column full of what not to do.
— wjfBig Deal!
The Health Behavior News Service just ran a feature on this topic: “Larger Patients: ISO Less Lecturing, Better Health” at .http://www.cfah.org/hbns/PreparedPatient/current.cfm
Fear of another weigh-loss lecture does keep some people away from needed health care.
— Lisa EspositoI suspect that a culture of shame does, at least indirectly, contribute to the nation’s obesity problem.
— John VernonI agree that almost all people know when they should lose weight. It is not easy: when overweight people try to lose and fail, their self-esteem suffers and this can lead to anxiety and depression. Depressed people almost by definition are not going to take good care of themselves. Therefore, a vicious cycle emerges whereby people try, fail, feel worse and then literally get worse - from a weight and overall health standpoint.
Here’s what I do not understand. For all the research conducted in healthcare, is there not a recommended protocol for speaking with overweight individuals about this problem? I envision doctors understanding the patient’s prespective on their obestiy based on some simple questions and then speaking to their patients about their weight in a way that is most likely to change behaviour. For example, someone who is embarassed would be approached differently than someone who is indifferent.
Is this information available?
People need to be lectured on their weight. The fatsos need to grow up and see the lecturing as the price of being foolish with their eating habits and lifestyle. Why candy coat it? It is what it is. Everyone is so, so sensitive these days. Put the donut down!
— Phil Dog