Obesity: Are Physicians Prepared
to Treat Patients?
Three articles and one commentary published in the January 25, 2010, issue of Archives of Internal Medicine hypothesize that the wave of the future for treating obesity may use combined and intensive treatments and restructured care, much in the same manner that other diseases are treated.
Data have suggested that a large gap exists between recommendations for obesity treatment and current practice among physicians. Possible reasons for this gap include:
- Reimbursement issues
- Limited physician time during office visits
- Lack of physician training in counseling
- Limited resources
- Belief that patients are not motivated
- Lack of proven and effective treatment methods
Weight loss drugs vs surgery
At the British Pharmacological Society’s winter meeting, Dr Nick Finer, clinical director at Addenbrooke’s Hospital, called for more frequent prescribing of anti-obesity drugs, stating that these drugs are both comparatively cheap and effective if taken according to directions. Dr Finer thinks that the potential benefits of pharmacological treatment for obesity is missed because of the reluctance of primary care physicians to address obesity. Although the weight loss garnered from surgery is greater, the use of drugs to prevent the need for surgery is missed.
Physician comfort and competence
Tim Caulfield, the Canada research chair in health law at the University of Alberta and a research director and professor in public health sciences, published an article in Canadian Family Physician claiming that many physicians do not have the skills and/or knowledge necessary to appropriately treat obesity. In fact, he notes that earlier studies have found that 83% of physicians are less likely to perform physical exams on reluctant obese patients and 17% less likely to perform pelvic exams on obese women. Another study showed that 25% of physicians think that they are not at all or only slightly competent to recommend treatment options for obese patients.
Another study, published in Obesity Research, stated that doctors are less likely to offer weight-loss treatment to overweight men than overweight women, but that they are more likely to offer weight-loss treatment to obese men than to obese women.
It seems that a weight loss of only 5%-10% can reduce symptoms of comorbidities related to obesity. The recommendation is for comprehensive treatment of obesity, integrated into a multipronged approach that takes the patients’ and their families’ input into consideration. As the medical community becomes more aware of the dangers of obesity and the resultant strain on the health care system, it is crucial that all physicians take counseling courses during their medical school education to improve their level of comfort when speaking to obese patients. Publications devoted to the treatment of obese patients, such as Obesity Management, are useful to all health care practitioners, who are now faced with a 64% rate of overweight and obesity in America.
A successful weight-loss program includes:
- Evaluation of the health effects of an individual’s current weight
- Evaluation of a patient’s readiness to change
- Setting of appropriate weight-loss goals with much input from the patient
- Provision of information related to diet and exercise
- Ongoing physician support and motivation
- Focus on weight maintenance following weight loss (an important component of any weight-loss plan)
Hill JO, Wyatt HH. Outpatient management of obesity: a primary care perspective. Obes Res [serial online]. 2002;10(suppl 2):124S-130S. Available at: http://www.medscape.com/medline/abstract/12490661?prt=true. Accessed February 1, 2010.
OBGYN.net. Physicians treat obesity differently based on gender. Available at: http://www.obgyn.net/newsrx/womens_health-Weight_Loss-20010705-16.asp. Accessed February 1, 2010.
Plourde G. Treating obesity: Lost cause or new opportunity? Can Fam Phys [serial online]. 2000;46:1806-1813. Available at: http://www.cfpc.ca/cfp/2000/VOL46-2000-PDFs/SEP00%20PDFs/vol46_SEP00_cme_1.pdf. Accessed February 1, 2010.
ScienceDaily. Doctors ‘could do more’ to help obese avoid surgery, expert says. Available at:
http://www.sciencedaily.com/releases/2008/12/081216201410.htm. Accessed February 1, 2010.
ScienceDaily. Most physicians aren’t prepared to deal with obesity epidemic, researcher argues. Available at: http://www.sciencedaily.com/releases/2007/11/071120130156.htm. Accessed February 1, 2010.
ScienceDaily. New tools and systems may help patients, primary care clinicians manage obesity. Available at: http://www.sciencedaily.com/releases/2010/01/100125172948.htm. Accessed February 1, 2010.
Review Date 3/10