The Healthy Lifestyle Rx

September 30, 2011 at 7:30 am 5 comments

As I mentioned last Friday, we have been learning a lot about obesity epidemic and the related health problems in my cardiovascular class the past two weeks. I shared some alarming stats that really made my jaw drop. To recap, more than half of all Americans are overweight, which predisposes them to high blood pressure, high cholesterol, coronary artery disease, diabetes, heart attack and heart failure, just to begin to name a few. In our lectures, we are taught to “counsel on lifestyle changes” as a first step in the treatment of many of these diseases, especially high blood pressure and cholesterol. However, few doctors seem to do this, and few of the ones who do seem to be effective. As a future physician interested in preventative medicine and primary care, I reached out to you for thoughts on why. I have loved reading the insightful feedback and have begun to formulate some deeper thoughts and opinions on the matter. I would to love to further the conversation on this subject and hear even more thoughts at the end of this post!

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So why don’t doctors address the issue of weight loss in a patient who is overweight and at risk for these chronic conditions?

  • Fear of sounding judgmental. It is true that no one wants to hear that they are fat, and our culture has become very sensitized to weight issues. However, doctors must breach many other sensitive subjects (sexual health, substance use, mental illness, etc.) without judgment and seem to do a better job managing to ask these questions. Why not use the principles of sensitivity and normalization learned from our training in these areas to address weight issues with patients?
  • Fear of not knowing the answer. We do not receive proper nutrition training in medical school. We learn that you have to take in fewer calories, follow a lower fat diet, and increase exercise, yet the details rarely move past this point. Many of my friends would be unable to talk to you about portion sizes, nutrition benefits of certain foods, relative amounts of food groups needed, and strategies for healthy weight gain/maintenance/loss. It is difficult to counsel someone on something that you have a poor understanding of yourself.
  • Fear of being hypocritical. Physicians themselves struggle with weight and leading a healthy lifestyle. We excuse ourselves for being busy, stressed, and overworked for not fitting in time to cook homemade, healthy meals or get the recommended amount of exercise. How is an unhealthy physician supposed to effectively counsel their patient on lifestyle changes?

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Many physicians do talk to their patients about weight loss, but yet are ineffective. It would be easy at this point to blame the patient, frustrated with the fact that they are doing nothing in the face of crushing medical problems. But perhaps there is something in the counseling approach that went wrong. My mom pointed out to me that her physician does advise her to lose weight, but simply moves on after addressing it. It is like writing a simple prescription for a problem that is not so simple, and then never checking the efficacy of that prescription. In an ideal world, a physician would not only inform the patient about the link between chronic health conditions and excess body weight, but would also help them brainstorm ways to modify their lifestyle. However, this leads back into many of the same points I mentioned before, specifically the lack of nutritional changes and the problems many health professionals have with their own lifestyle. The biggest problem in improving this “quick fix” approach is time. Patient appointments continue to get shorter, and counseling on any issue takes up a lot of the scheduled time. When you already have so many other factors to address within a 15-20 minute appointment, how do you make time for one more thing?

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My last hypothesis is from the patient perspective. Because so many Americans are currently on medication for high blood pressure, cholesterol, and diabetes, these problems are becoming normalized. It is easy to assume that taking daily pills as part of routine medical management removes all risk factors for more serious sequelae of the disease, when this is in fact untrue. Treatment for high blood pressure is still counted as a risk factor for heart disease, just as uncontrolled blood pressure is its own risk factor. We have become complacent with how good our medical interventions are, and as patients are therefore less likely to make major changes in light of something we don’t always view as a serious problem.
The more I study it, the more in awe I am of the human body, but especially of the heart. It is incredibly complex and is able to compensate for some major stressors that we place on it daily. It is a machine, and it holds up pretty well for the beating we put on it. I am more dedicated now than ever to taking care of my heart through a healthy diet and regular exercise – I want this pump to work for many more years to come!
Question: Do you have any more thoughts on this issue? Do you agree or disagree with any of my above statements?
Note: All pictures are Google stock photos, not my own work.

Entry filed under: Ramblings. Tags: , , , , , , , , , , , , .

WIAW While Sick Keeping It Simple

5 Comments Add your own

  • 1. Rufus' Food and Spirits Guide  |  September 30, 2011 at 11:45 am

    I hadn’t thought about the fear of being hypocritical. That’s a good one.

  • 2. IHeartVegetables  |  September 30, 2011 at 12:02 pm

    I think doctors do need to address the issue more. Even if a patient doesn’t want to hear it. It’s like we’re afraid to tell the patient bad news if it’s something the CAN control as opposed to something they can’t. It’s not about blaming them, it’s about pointing out the need for a change!

  • 3. Tara  |  September 30, 2011 at 8:56 pm

    It’s so sad that this issue has consumed the lives of so many people… and at the same time, it’s so sad that so many people ignore it. The problem isn’t going to fix itself! The obeesity epidemic needs to be addressed because the problems stemming from obesity are adding up and cause even more that we have to fix!

  • 4. Harvest Festival « homemadeadventure  |  October 2, 2011 at 9:15 am

    […] light of my recent thinking (see here and here) about the chronic conditions that plague so many Americans, it was exciting to see a community […]

  • 5. ilikestoscribble  |  October 3, 2011 at 12:01 pm

    this is a toughie to tackle! my doctor told me i needed to lose weight 5 years ago. i actually didn’t expect her to hold my hand all the way through the process, though. she was there to tell me what i needed. To me, it was my responsibility to take her advice seriously and make a change. there are nutritionists, dieticians, personal trainers and a plethora of online resources (such as your blog!) to educate someone on how to live a healthy lifestyle. i have heard other people say their doctors told them to lose weight; they just choose to ignore it, or don’t care enough to change.

    but there are so many other aspects to the widespread problem of obesity such as food prices, the sedentary lifestyle of full-time work, etc. so many underlying causes…


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