Fat Primary Care Providers?

I do remember those ads that told us that 3 out of 4 doctors recommend a certain brand of cigarette. Advertisers use images of the gray haired, white coat wearing physician because it conveyed a sense of trust. Tobacco companies understood that showing those images on billboards and in magazines might help distract smokers from those pesky studies showing the link between cancer and smoking.  Physicians and other trusted health care providers do influence the patient's behavior. Many studies have shown that the physician's recommendationt to stop smoking positively impacts smoking cessation rates. We also know that physicians who smoke are not very likely to make  those recommendations. And even if they did, would the patient listen to a provider who reeks of tobacco?

I think the same principals hold true for fitness. A recent  Australian study showed that overweight physicians are not as likely to counsel their patients on diet and exercise  as are physicians with a normal BMI. This same Australian study showed that physicians with a normal BMI are more likely to document obesity in the patients chart than overweight physicians (93% vs 7%).  If the health care provider doesn't even bring up the issue or offer guidance, then it can not be expected they will positively influence change.  Even if the out of shape provider offers advice, would the patient listen?

I have referred many of my patients to the nutritionists associated with the medical group. I had several patients come back to tell me that they would not return to the programs because the nutritionist weighed about 300 pounds, according  their description. They told me that they couldn't believe anything she said because of her obesity.  I can't imagine how many other patients never tell the providers why they don't attend those nutrition classes.

Like it or not, we are held to a higher standard. Like it or not, we influence our patient's behavior by our own. I am working on my own fitness and with my very hectic life I understand the struggles that my patients are having with adopting a healthier lifestyle. I know that for the most part, I make healthy choices but sometimes, I screw up too. After a crazy busy day in a clinic where I saw 42 patients and felt stressed the whole day by their complexity ( no simple colds or UTIs in the group), I was exhausted and cranky when I picked a drive through place to grab supper ( the hotel does not have a kitchen). I thought about a salad for about 20 seconds and then ordered that huge burger, fries that I don't even like and a Sprite. I wolfed down the burger, a couple of fries and had a few sips of the pop and went downstairs to the vending machines and grabbed some of those little chocolate donuts.  I felt guilty but I ate them ( not all but probably half of the pack). 

How do counsel my patients who do this nearly every day? I tell them that focusing on the bad doesn't help. I will make healthier choices the rest of the week- increase my exercise and make a plan for next time. I will be stressed again. I will be too tired to cook.  I will be too exhausted to exercise.  I don't pretend to be perfect. I don't pretend to have all the answers.  I know that if I am not able to work on my own issues I can't help anyone else work on their issues.

I read this interesting pledge that 2015 class of  medical students at Hopkins University developed with their faculty advisors:

• I will engage in regular physical activity.
• I will consume a balanced and nutritious diet.
• I will refrain from the use of harmful substances.
• I will diminish personal stressors and look after my mental well-being.
• I will encourage my patient to adopt these healthy lifestyle behaviors. 
• I will work alongside my patient as a partner in this journey.
• I will identify and guard myself from potential prejudices against my patient based on unhealthy behaviors, recognizing the often complex origins of these habits.
• I will respect and seek to understand the beliefs and traditions of my patient that affect his or her health.
• I will do my part to promote healthy lifestyle behaviors within my community.

I am so on board with this!