Many people who are overweight and obese either don't realize it or
are in denial -- and too few doctors are setting them straight,
according to a new study in the Archives of Internal Medicine.
Researchers
analyzed data on roughly 5,500 people who took part in government
health surveys between 2005 and 2008. One-third of the obese
participants and 55% of overweight participants had never been told by a
doctor that they were overweight, the study found.
If a doctor
did comment on a patient's weight, it seemed to make an impression.
Nearly 20% of obese people whose doctors hadn't brought up their weight
described themselves as "not overweight," compared with just 3% of those
whose doctors had addressed their weight. Obese and overweight patients
who discussed the issue with doctors were also more than twice as
likely to have tried to lose weight in the previous year.
"If
people are told by their doctor that they are overweight, it corrects
their perception," says the lead author of the study, Robert Post, M.D.,
research director of the Virtua Family Medicine Residency in Voorhees,
New Jersey.
Overweight is defined as having a body mass index
between 25 and 29, and obesity is defined as a BMI of 30 and up. (BMI is
a rough estimate of body fat based on the ratio of a person's height
and weight.)
Doctors may be reluctant to broach the subject of
weight for a number of reasons, Post says. For instance, busy physicians
might not want to fall behind schedule by adding another topic to their
list of things to discuss during an appointment. And many doctors have
negative attitudes toward their heavier patients, whom they see as
unlikely to stick to a diet and exercise program, he adds.
The
researchers weren't surprised by the high percentage of overweight
people who thought their weight was normal, as several studies in recent
years have found comparable -- or higher -- rates. A study published
last year that used similar data from government surveys showed that 23%
of overweight women and 48% of overweight men considered their weight
to be just right.
Post and his colleagues chalk this up to what
they call the "'norming up' of society." Roughly two-thirds of U.S.
adults are now overweight or obese, and as Americans have grown heavier,
the perception of what constitutes a normal weight has changed as well,
Post says.
In fact, most of the overweight study participants
accurately estimated their BMI. But many didn't see their weight as
unhealthy or recognize the need to shed some pounds.
Although
it might seem obvious that excess weight is unhealthy, being reminded
of this by a doctor can be an effective wake-up call, says Robert B.
Baron, M.D., director of the weight management program at the University
of California San Francisco.
In an editorial accompanying the
study, Baron notes that studies have shown that smokers whose doctors
remind them of how unhealthy the habit is and encourage them to quit are
more likely to do so successfully than those whose doctors stay mum.
Simple reminders and encouragement to lose weight could have a similar
effect on overweight and obese patients, he says.
Baron
proposes calculating BMI and entering it on a patient's chart at every
doctor's office visit, as is done with blood pressure and other vital
signs. "This is very, very easy to do," Baron says. "If it were required
or strongly suggested, it would not be very onerous.... We need to be
as aggressive as we were with smoking cessation."
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