Doctors avoid weight- loss talk
Most overweight people not advised to diet, survey suggests
Canada may be in the grips of an obesity epidemic but doctors are advising “surprisingly few” overweight or obese Canadians to lose weight, a national survey finds.
Less than a third of overweight people who responded to the survey had ever been advised to lose weight by a physician, without specifically asking — “a further indication of the widely held societal view that obesity is an issue of personal responsibility rather than a medical problem,” researchers write in the journal Chronic Diseases and Injuries in Canada.
In addition, fewer than one in five of total survey participants reported having their waistlines measured by a doctor in the previous year, even though Canadian guidelines recommend doctors screen every adult for weight- related problems by measuring waist circumference — considered the new “vital sign” that predicts a person’s risk of disease and death beyond body mass index alone.
People with abdominal fat are at the highest risk of Type 2 diabetes and heart disease and stroke. Belly fat is also the leading cause of a cluster of abnormalities known as metabolic syndrome.
The survey also found that 40 per cent of overweight or obese Canadians described themselves as “about right.”
Lead author Sara Kirk calls it part of the “normalization” of excess weight: As the population grows heavier, overweight becomes the new norm.
Fifty- nine per cent of adult Canadians are either overweight or obese. Unless trends change, by 2026, the proportion will reach 70 per cent, a federalprovincial summit on healthy weights heard last week.
Severe obesity is tracking at an even faster rate than obesity. Class III obesity, meaning a body mass index of 40 or more, has tripled over the past three decades — a phenomenon that is posing significant challenges for the health care system, from patients too large to fit inside CT scanners or MRI machines, to what intensive care physicians have described as the “nightmare” of trying to insert breathing tubes into patients whose airways are heavy with fat.
Overall, people with a BMI greater than 30 are four times as likely to have diabetes, three times as likely to have hypertension and 1 ½ times as likely to have heart disease, the researchers write.
Despite such “stark statistics,” obesity is poorly managed in Canada, said Kirk, Canada Research Chair in Health Services Research at Dalhousie University in Halifax.
“We don’t manage this problem well, we don’t provide people with what they need in order to manage their weight successfully and we have very negative attitudes toward people who have a weight issue,” she said.
For their study, the team from Dalhousie, Mcmaster University in Hamilton, Ont. and the University of Alberta in Edmonton analyzed data from a survey conducted by Ipsos Reid on behalf of the Canadian Obesity Network in 2009.
A total of 2,004 respondents were included. Eighty- five per cent of them had seen a physician in the last 12 months. The mean age was 47. Overall, 53 per cent reported being overweight ( 33 per cent) or obese ( 20 per cent).
Almost three- quarters of the overweight and obese adults surveyed had tried to lose weight — 58 per cent in the previous year.
But only 21 per cent reported seeking help from their doctor.
When they did ask for help, most were advised to exercise or diet, join a weight loss program or “slimming club” or take meal replacements or supplements.
Only four per cent of people with obesity were told about surgical options — even though surgery is considered the most effective treatment in the long term for severe obesity.
“Obesity is a risk factor for a host of chronic diseases,” Kirk said. The more weight a person gains the harder it is to lose that weight.
But “family physicians, or any of the health professionals, really don’t want to talk about weight. They don’t know how to start that conversation. Often they start it with a flippant remark that can do more damage than good,” Kirk said.
“There is a whole layer of weight bias and stigma which is incredibly ingrained in our society that means that people aren’t getting the support they need.”
Doctors and other health professionals need help learning how to discuss weight with patients in a sensitive and nonjudgmental way, Kirk said. While many don’t have time to counsel patients about weight loss in a one- off appointment, “they’re really the gatekeepers to all the other services you need — access to dietitians, access to people who can help them with physical activity or psychological counselling,” Kirk said.
“If they’re not going to the physician for the diagnosis, they’re not going to have access to evidence- based health care.”
Dr. David Lau, the lead author of the 2006 Canadian guidelines for the management and prevention of obesity, says tools have been developed to help doctors measure waistlines “in less than 30 seconds and without causing any embarrassment to patients.”
Even a five per cent reduction in body weight can lead to dramatic improvements in health, particularly the risk for diabetes, said Lau, chair of the diabetes and endocrine research group at the University of Calgary.
“We’re not talking about transforming the overweight and obese to become a lean person. We’re not talking about dramatic 50- pound weight loss. We’re talking about modest weight loss of a five to 10 per cent,” he said.