Approximately 22 percent of U.S. adults are considered obese, according to the American Academy of Family Physicians (AAFP), and obesity has become a major public health problem. In battling this issue and its resulting co-morbidities, patients must turn to their physicians to receive the medical treatment they need even though many are uncomfortable in the doctor’s office setting.

While these patients need medications and other treatments for their health problems, the AAFP reports that some obese people may delay going to their physician because they know their weight is their primary health problem. That makes it important for physicians to be sensitive in how they communicate with their obese patients.

“I treat these patients just like I do any other patient,” said Dr. Douglas Heimburger, a physician nutritionist at UAB Hospital. “Conversation should always be respectful and appropriate whether you’re dealing with an obese patient or a cancer patient.”

Should the physician overlook the weight issue and just treat the medical problems if the patient seems uncomfortable with a discussion about weight? Heimburger says no. “A patient who is overweight knows he’s overweight. It’s the doctor’s responsibility to be straightforward and tell the truth about his condition,” he said.

The AAFP suggests that when explaining to the patient the association between weight and medical co-morbidity, the physician should positively phrase any recommendation for weight loss. For example, the doctor might say, “Losing 10 percent of your current weight would improve your blood pressure” instead of, “If you don’t lose weight, you will eventually develop congestive heart failure.” The physician also can encourage the patient to avoid further weight gain and eat healthfully and exercise as a means to improve health, independent of weight loss.

Dr. Jamy Ard, one of the directors of UAB’s EatRight Weight Management Program, says his primary approach with obese patients is to tell them that they can improve their health by changing their lifestyle. “We are helping them reach their weight goal, and we always inform them about the health risks they face because of their weight,” said Ard. “Many of these patients don’t understand how many problems are related to obesity and inactivity.”

When weight-related health problems do occur — including diabetes, hypertension, sleep apnea and osteoarthritis, among others — weight loss should be discussed as a treatment for these conditions. Heimburger points out that while physicians would like to be able to attack the obese patient’s health issues directly at the weight problem instead of giving medications, the healthcare system does not make it feasible to do that. That’s why physicians can refer overweight patients to a physician nutritionist for the weight issue.

“We deal with the weight problem and the lifestyle habits that lead to the obesity,” said Heimburger. “If we address the problem appropriately, the patient will benefit from weight reduction as well as an increase in their activity. We have a triple punch — diet change, increased physical activity, weight loss.”

Ard says his staff does a number of tests to show obese patients the problems caused by their weight and the benefits of weight reduction. “That helps put the big picture into perspective for the patient,” he added. “It’s not just about looking better or fitting into your clothes. It’s about their health.”

How the physician communicates with his or her obese patients is important in making them more comfortable with their visit to the doctor’s office, but the office environment should also be made comfortable and accessible for these patients. Heimburger says that most physician offices are equipped for overweight patients. “It’s important that we accommodate these patients to avoid any type of humiliation,” he said.

The AAFP offers some suggestions for increasing an obese patient’s comfort in the physician’s office:

• Have one or two sturdy, armless chairs in the waiting room. Sofas should be firm and high enough for the patients to rise out of easily. This type of furniture will benefit elderly patients as well.
• Use wide examination tables that are bolted to the wall or floor, if possible, to ensure that the table does not tip over when the patient sits on one end.
• Large examination gowns can make patients feel more comfortable.
• To aid in accurate blood pressure readings, use large arm or thigh cuffs. A standard-size blood pressure cuff should not be used on patients with an upper-arm circumference of more than 34 cm.
• Standard office weighing scales may preclude obtaining an accurate weight for patients who exceed 300 pounds. Office scales that can weigh patients of more than 500 pounds are available. Make sure to place scales in a private area.

Quality of care for overweight patients becomes extremely important as the number of overweight people continues to increase in the United States. Family physicians will continue to be the front line in the healthcare system for improving care for this population of patients.



January 2008