Meeting the challenge of “fat as the new normal”

Oct 5, 2012

Author: Mary Jane Lennon

In her recent article in the Globe and Mail, Carly Weeks writes about how our perception of who is “overweight” or “obese” has become skewed by the prevalence of people matching these descriptions in the general population. Ms.Weeks goes on to detail studies that show people consistently under-estimatethe extent to which they themselves, or their children, exceed a medically healthy Body Mass Index. In other words, we tend to judge ourselves and others in comparison to the people around us, so if 6 of the 10 people sitting around our table at Thanksgiving dinner are overweight, then the fact that we – or our children – are a bit plump is no cause for alarm. We – and they – fit right in.

What is even more unsettling is the ways in which these perceptions play into the interactions between Canadian patients and their physicians. I think it’s safe to say that most patients are not going to bring up the subject of their own weight, and clearly, it is difficult for GPs, not only to convince their patients of the need to lose weight personally or to put their children on diets, but also for them to raise the sensitive issue of body weight in the first place. For many physicians – whether they are feeling overwhelmed by their caseload or are just motivated to keep patient visits flowing efficiently throughout the day – addressing the symptoms is the first, and most likely,
course of treatment.  

There’s no doubt that the failure to address the health challenges created by obesity has widespread consequences, not only for Canadian patients and physicians as individuals, but also for the Canadian healthcare system as a whole: high rates of obesity are leading, and will continue to lead, toward exponentially high rates of investment in the treatment of a myriad of diseases, including diabetes, cardiovascular disease, and even cancer.

A perusal of related research reveals a number of different suggestions for the best way for physicians to broach the subject of obesity (including never using the actual word ) so that patients will be open to discussing the subject and taking steps to, in fact, lose weight. Our research among Canadian patients suggests that it is also important for physicians to understand how a patient’s sense of personal control over his/her health impacts the conversation they should be having with their patients.

For those who have a real sense of personal efficacy, the feeling of being in control, in the sense of being confident that changing one’s diet will have a definite payoff in terms of overall wellness, is an amazing motivator to make substantive lifestyle changes. For these patients, our understanding of their social values indicates that physicians should talk in terms of the decision to diet ultimately being their own as opposed to something that is urged upon them by the physician. For others with
less of a sense of control, it will be more motivating to know that losing weight is something that the doctor recommends: for these people, the physician’s approach should be more directional than collaborative.

Of course, as is the case with any issue that requires delicate communication skills, listening can be more important than talking. But it’s what one listens for – the underlying motivations driving behavior – that can make the difference when it comes to successfully moving patients toward healthier lifestyles.