Doctors share weighty topic with patients
Many physicians don’t advise the obese on health concerns
Overweight and obese patients might not be the only ones who dread stepping on the scale each time they visit the doctor’s office.
Research shows that many physicians don’t know how to constructively discuss a patient’s weight, or they avoid the subject entirely.
Penn State doctors recently published a study showing that weight counseling by primary care doctors has decreased even as the nation’s obesity rate has grown.
They compared patient data from the mid-1990s with data from 2007- 08. Patients seen a decade later had a 46 percent lower chance of receiving weight counseling. Counseling took place in 6 percent of visits. During the same time period, the number of overweight or obese adults jumped from 52 percent to 63 percent.
While the authors could not offer a definitive explanation for the decrease, they noted barriers for doctors include pessimism that patients can change, time limitations during appointments and inadequate training to address the topic.
Dr. Sonia Sehgal, an instructor at the University of California-Irvine’s School of Medicine, said today’s future doctors are taught how to discuss sensitive topics with patients, be it sexuality, dementia or weight.
“Over the last couple of years we’ve introduced some education in what’s called motivational interviewing,” Sehgal said. “It’s a style of discussion with a patient that discusses their readiness for change. What was happening before, medicine was very paternalistic. A doctor would say, ‘You have a problem with your weight. I want you to start losing weight.’ The patient would say, ‘Yes, yes, yes,’ in the office and when they went home it wasn’t realistic for their lifestyle.”
Sehgal said the technique centers on the patient and doctor deciding together what the patient wants to accomplish and how to go about it.
“It’s more of a discussion and a compromise and a negotiation for a shared goal of good health,” she said.
Data from the National Health and Nutrition Examination Survey found that only 45 percent of overweight patients reported that they had been told by their doctors that they were overweight. For obese patients, 66 percent said their doctors had mentioned it.
Other surveys have found that doctors might mention weight but don’t feel equipped to help their patients lose excess pounds.
Dr. Ray Nanda, medical director for Kaiser Permanente’s weight-management program in Orange County, Calif., said most overweight patients he sees in his primary care practice in San Juan Capistrano come in for routine health problems, not to ask about losing weight.
“Just like I would look at their temperature or their blood pressure, I also look at their weight and their body mass index,” Nanda said.
W hile looking at the patient’s electronic medical record on the screen, he will ask, “How are you doing with your weight?”
“You just leave it out there in the open instead of telling someone, ‘We need to talk. You’ve got a weight problem.’ That initially sets off your defense mechanism.”
Nanda said depending on what patients tell him, he can refer them to educational programs for help with nutrition and exercise.
“What I teach my doctors is you need to treat a person, not a weight problem,” Nanda said. “Are you sensitive about the subject? Are you objective? Are you judgmental? Are you looking at this as a moral failure? Are you looking at things as a medical problem?”
Nanda said sometimes doctors don’t want to discuss diet and exercise with their patients because they struggle in those areas, too.
“I coach my doctors to even use themselves as an example, whether it’s good or bad,” he said. “Say, ‘I, too, have trouble getting my exercise every day,’ or, ‘My family has these big gatherings with a lot of food.’” Jody Schmidt, assistant director of Elmwood Cemetery, is seen on camera as a crew working for the Investigation Discovery Channel prepares to film an interview with her about Alma Theede at the cemetery’s offices. and divorced others, why she lived such a lifestyle when her mother was so willing to help, and how a prostitute and convicted murderer could have been allowed to adopt children.
These are questions Weekely hopes to answer through interviews, narrative and dramatic reenactments.
“This is that kind of duality of Alma,” Schaefer said. “She apparently liked kids, and it appears the two she adopted liked her, or at least thought of her as a mother, and we’ve got records showing that she would take other people’s kids in. The social workers would find out where the kids were and would take them away, but she apparently had some sort of a nurturing side to her.”
Toward the end of her life, records show that she was running a boarding house in Midtown on Carr, between Cleveland and Bellevue. “That’s the only kind of job I’ve seen that she had,” Schaefer said.
Theede died in 1970 in a Millington nursing home at age 75, and is buried as Alma Theede in a plot alongside Charles Cox. On the tombstone, beneath her name and the date of death, reads, simply: Mother.
In addition to establishing shots of the cemetery and the interviews, there are exposition shots of the Downtown area that Theede frequented, as well as houses where she lived over the years. Weekley and her crew will be on the road in the U. S. and Canada for two months, eventually heading to Ohio to chase leads on another Memphis story, that of Georgia Tann, the notorious baby black marketer from the 1920s through the 1940s, whose deplorable living conditions caused the death of many children in her care.