Pediatricians and obesity

No implied warranty, no political message...just interesting:

A recent survey 738 North Carolina pediatricians found that self-described thin docs are reluctant to counsel their patients about obesity compared to their heavier colleagues.

Physicians who viewed themselves as "thin" had more than five times the odds of finding obesity counseling "more difficult" compared with those of "average" weight. Pediatricians who perceived themselves as "overweight" were twice as likely to report problems, according to the study.

"I wonder if the patient's going to perceive me as someone who can help with this problem," said Perrin, who is not overweight. "I imagine them saying to themselves, 'OK, she's clearly very trim. What does she know about my struggles?'" [AP]

I found these results interesting because they're exactly the opposite of what I would have predicted.

Comments

[dec]

No-one likes to upset fat people. They've got enough on their plate as it is.

[Mnemosyne]

Actually, I'm not surprised at all. Weight is a very emotional issue for most people and doctors are very bad about discussing emotional issues (like, say, birth control or STDs) with their patients.

And I'm even less surprised it's the "thin" doctors who are the most reluctant. Overweight people (and I used to be one) can be extremely defensive when confronted. I have a friend who worked for Weight Watchers way back when (when they still had full-time group leaders) who hated being assigned to the 50+ Pounds To Lose groups because they were very rude to her if she dared admit she'd "only" lost about 30 pounds.

[Chris]

My father is a thin pediatrician. I wonder if there was something he wasn't telling me all of those years...

[jrochest]

Yep: I'm currently doing WW, and I spend a good deal of time on weblogs discussing dieting, weightloss and its correlative, fat acceptance. There's often a good deal of agression towards skinny people who tell fat people how much to weigh. Understandably, I'd say. If you've grown up as the butt of every humiliation you wind up with a good deal of unexpressed anger.

On the one hand, nagging overweight patients about their weight doesn't actually help them lose weight -- it just makes them avoid you. The example the article gives (strep throat vz obesity) is a good one: if the kid's got strep throat, treat the strep throat, never mind if they're chubby. On the other hand, overweight doctors might just remember how miserable it was being a fat kid.

[djw]

A credible source of empathy is extremely helpful when dealing with children.

[gordo]

Looks like stigmatizing fat has hampered our ability to deal with the problem.

When I look at TV or movies, I'm astonished at the number of fat jokes. Sometimes we're supposed to laugh when a fat person eats a lot, sometimes when they break furniture, and sometimes when they make funny noises (farting, stomach rumbling). Sometimes what's supposed to be funny is when they put on "sexy" clothing or fall in love with someone--the very idea that a fat person thinks he or she could be attractive is supposed to have us doubled over in laughter.

Despite my name, I've always been very thin. Knowing how fat people are treated, I would be very hesitant to initiate a discussion on a person's weight, even if I were a doctor. I mean, they know how much they weigh, and they're certainly reminded of the health risks often enough.

[Lindsay Beyerstein]

No argument with any of the points presented so far. I just always bought into the stereotype of the thin doc haranguing his or her heavier patients. (I never really thought about whether overweight docs were just as likely to join in the chorus.) Anyway, this study made me reconsider that stereotype. (I don't know if these results are representative of NC peds, or pediatricians in general, let alone the medical profession as a whole.)

I was really impressed that the doctors in the study seem to be so aware of the perception of hypocrisy by young people. It seems as if well-meaning adult authority figures often ignore that element of their relationship with their minor charges.

[Arwen]

This could also be a recent phenomenon: I have friends & family with rather horrid stories, but they're not from the last decade or so.

[TomK]

Personally, I had a skinny doctor tell me I was a tad to fat and my cholesteral was a tad high.

So I was like "Listen here you skinny bitch" Bite of bacon cheeseburger "if you think I need some twig who has obviously" shot of baconfat "never enjoyed the experience of" bucket of fried chicken "eating to give me advice..."

No. Actually, I was like "I know I am fat, but I didn't know cholesteral was a problem. I better talk to a nutritionist about that, huh?" and she was like "yeah, given your families history, I'd say sooner rather then later." Then I was like "Thats why I see a doctor, cause I didn't know that." I didn't get pissed.

[Joel]

Fat people aren't always defensive about losing weight -- I've known a few who feel that they've done something horrible to themselves. They often need psychological as well as diet and exercise consulting.

But when they are, it can be hell. I once commented on the cellulite on the sides of a chunky female model and I was assailed by Fats Rights people. Thin doctors and nurses think twice because they may find themselves accused of being dupes of the fashion industry and provokers of anorexia.

I feel that there needs to be a Just Right movement. You don't want too much fat and you don't want to be bone thin. Love your body at the right weight for your build. (While perusing an issue of Cosmopolitan recently I saw that the Hanes Company was doing just that. The models were neither too fat nor too thin. Their frames were different and it was refreshing, believe me.)

[R. Mildred]

It makes perfect snese to me an anorexic, people who actually percieve themselves as overweight are going have some mild issues about being fat and eating, and are going to be much more likely to worry about other people being overweight especially because by the time someone is self identifying as overweight they have porbably already started doing the little constant checks about other people's bodies for reassurance, and when you are specifically looking at people's bodies in a diagnostic way, then I could easily imagine that little habit of being hyper critical of their own body (which most fat people who think of themselves as "overweight" (which is inherently negative) rather than "fat" (which can be positive depending on how a person uses and thinks of the word) are, regardless of whether they've decided to do something about their weight or not yet) might tend to be turned outwards on their patients.

Of course I'm probably projecting hugely.

But I would be very interested to see how this breaks down gender wise.

[John deBoer]

As a skinny boy who makes clothes, I can attest that it is difficult to describe anyone's size even in the most factual, impersonal way. When taking measurements, I try to keep the numbers out of sight. I know there are tailors who charge more for so-called "plus-size" clothes, because they use more fabric, but personally I'd much rather eat the cost than have that conversation.

But in a doctor-patient relationship, where manners should take back seat to health issues, it must be pretty sticky. Especially since there seems to be no real agreement as to what's healthy and what's not. Or am I wrong about that?

[Ellen1910]

I found these results interesting because they're exactly the opposite of what I would have predicted. L.B.

I'm surprised; I wouldn't have thought it.