Comparing obesity to cancer is comparing apples to oranges, here.
A person with certain kinds of cancer is currently objectively sick. The likelihood of survival without treatment is stastically very low to nonexistant. And even then, as you say, the physician can and should offer treatment, not force treatment or insist upon treatment or refuse to stop seeing the patient if they refuse a certain kind of treatment.
A person who is overweight may or may not be currently objectively sick. The person may be at increased risk, based on population data or family history, and those issues should be addressed. But population data does not equal personal risk, and I don't treat populations in the exam room.
If there is borderline or elevated cholesterol, addressing diet with this in mind is certainly the right thing to do. If there is evidence of insulin insensitivity or PCOS, than recommending exercise and helping the patient find a feasible exercise regimen is the right thing to do. If there is arthritic knee pain which may be improved by loosing weight, addressing the weight directly may be helpful, with the caveat that the pain itself may preclude many typically suggested activities.
Further, it's been shown that, for some conditions helped by weight loss, comparatively small amounts of weight can make a large improvement in health outcomes. Such a patient may lose some weight, derive health benefits, but still be objectively overweight and continue to be the recipient of negative weight-based comments.
If physicians would talk about health related behaviors with all patients, regardless of weight, council patients based on their current exercise and eating routines rather than an assumption of what those routines are, and address patient's particular complaints directly, I think it would go a long way towards improving the tenous relationships often held between the health care community and the people it is trying to reach.
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branchandroot
(no subject)
Date: 2010-10-11 05:26 pm (UTC)A person with certain kinds of cancer is currently objectively sick. The likelihood of survival without treatment is stastically very low to nonexistant. And even then, as you say, the physician can and should offer treatment, not force treatment or insist upon treatment or refuse to stop seeing the patient if they refuse a certain kind of treatment.
A person who is overweight may or may not be currently objectively sick. The person may be at increased risk, based on population data or family history, and those issues should be addressed. But population data does not equal personal risk, and I don't treat populations in the exam room.
If there is borderline or elevated cholesterol, addressing diet with this in mind is certainly the right thing to do. If there is evidence of insulin insensitivity or PCOS, than recommending exercise and helping the patient find a feasible exercise regimen is the right thing to do. If there is arthritic knee pain which may be improved by loosing weight, addressing the weight directly may be helpful, with the caveat that the pain itself may preclude many typically suggested activities.
Further, it's been shown that, for some conditions helped by weight loss, comparatively small amounts of weight can make a large improvement in health outcomes. Such a patient may lose some weight, derive health benefits, but still be objectively overweight and continue to be the recipient of negative weight-based comments.
If physicians would talk about health related behaviors with all patients, regardless of weight, council patients based on their current exercise and eating routines rather than an assumption of what those routines are, and address patient's particular complaints directly, I think it would go a long way towards improving the tenous relationships often held between the health care community and the people it is trying to reach.