Do doctors who are carrying a few extra pounds shy away from advising overweight patients to lose weight? Are they less likely to counsel patients about making lifestyle changes – eating broccoli, being physically active – if they don’t follow the same advice in their own lives?
An interesting new survey presented last month at a meeting of the American Heart Association suggests that physician health plays a role in how they talk to their patients about a healthful lifestyle – and that when doctors don’t practice what they preach, it might be to the detriment of their patients’ health.
The survey was carried out among 1,000 primary care doctors. Among the findings: 27 percent said they exercised at least five days a week and 39 percent reported eating the recommended five servings of fruits and vegetables per day. Only 4 percent said they were smokers.
The survey comes on the heels of a study earlier this year, published in the Obesity journal, that found doctors who were overweight or obese were less likely to talk to their patients about weight loss than doctors with a normal body mass index. A similar study that appeared in 2010 in Preventive Cardiology reached the same conclusion: Doctors who exercised regularly and were at a healthy weight were the most comfortable discussing lifestyle behaviors with patients.
American Medical News spoke recently about this issue with Dr. Jo Marie Reilly, a family physician and associate professor at the Keck School of Medicine at the University of Southern California. Her take: “Practicing what we preach is important. Physicians are just more aware and better able to counsel patients if they take care of themselves.”
There’s certainly something to be said for being a good role model, and that includes health care organizations as well as individuals. It doesn’t send the right kind of message when the hospital cafeteria menu is loaded with high-fat, high-calorie food, or when patients can glimpse the staff at the medical clinic clustered in the loading dock for a smoke break.
The doctors in the Obesity journal study seemed to sense that “do as I say, not as I do” can create problems in caring for patients. Physicians of normal body mass index who participated in the survey had higher confidence in their ability to offer lifestyle counseling. They also were more likely to think that patients wouldn’t trust weight-loss advice coming from an overweight doctor.
One conclusion that might be drawn is that patients with less-than-ideal lifestyle behaviors tend to get a free pass from doctors whose own behavior doesn’t match the ideal and who are thus reluctant to bring up the subject in the exam room. In other words, they don’t want to appear hypocritical, even if remaining silent isn’t in the patient’s best interests.
But there’s another way to look at this. Perhaps doctors who struggle in their own lives with weight, nutrition and activity are more sensitized to how patients might feel about lifestyle advice, and more apt to be accepting when patients fall short.
Although the studies didn’t examine how patients perceived normal-weight vs. overweight doctors, it raises the question: Do patients truly resent it when an overweight doctor tells them to lose weight? Some of them surely do, but others might feel an overweight doctor is better able to identify with and understand the difficulty of making lifestyle changes.
One also has to wonder where to draw the line. Should a physician who has depression (and, sadly, the incidence of depression is higher among doctors than the population at large) counsel patients about their mental health? If the doctor drinks, is it hypocritical to talk to patients about problem alcohol use? Is it OK for a doctor to refuse a flu shot? To be seen in public eating a burger and fries? By these measures, everyone in the medical profession has probably been a hypocrite at one time or another. It doesn’t necessarily make them bad doctors; it makes them human beings susceptible to the same struggles that confront every other mortal.
What seems to matter is how the conversation is framed, suggests Dr. Reilly. Even when doctors aren’t perfect, they can still help patients by talking about their own struggles with weight or other issues. And they can take the time to have the discussion about lifestyle habits if that’s what patients need, she told American Medical News. “It’s really important that we take that time to counsel patients about how their health habits influence their lives at every visit, and that we look at that as important as any medication,” she said.