July 7, 2021 – Kevin Gendreau, MD, a weight loss doctor at Southcoast Health in Fall River, MA, lets patients know he was once obese. He says this knowledge inspires and motivates them to lose weight.
After losing 125 pounds over 18 months, “I can empathize with your binge eating, distress, and plateaus on a very personal level,” he says.
Peminda Cabandugama, MD, an endocrinologist and obesity medicine specialist at Truman Medical Center, University of Missouri-Kansas City, has weighed between 180 and 240 pounds for the past decade. He now weighs 225 pounds and has a healthy lifestyle.
“I’ve had patients come to me and say, ‘I used to see another weight loss doctor who wasn’t difficult. But how can he understand what I’m going through? ‘”He says.
Cabandugama shares his weight loss problems with patients “to dispel the myth that weight management is as easy as simply overeating and not exercising. It’s a hodgepodge of emotions and hormones, some of which are within and beyond our control. I hope that this will allow me to get in more contact with my patients so that they know that even their healthcare professionals are going through the same challenges as you. “
“Patients are more likely to change their behavior when doctors are supportive and have similar experiences and share their stories,” said Wendy Bennett, MD, obesity researcher and associate professor of medicine at Johns Hopkins University in Baltimore.
Do patients respect obese doctors?
While Gendreau and Cabandugama have lost weight, some doctors trying to shed unwanted pounds have been unable to do so. How does this affect the patient?
Doctors sometimes have biased attitudes towards obese patients, but few studies have looked at whether patients are biased towards obese doctors. Results will vary and may depend on whether the patient is overweight or not.
A random online survey of 358 participants found that people, regardless of their own weight, had prejudices about the doctor’s weight gain. They found the overweight or obese doctors to be less trustworthy and credible, which could lead participants to decline their medical advice and switch doctors.
“Patients expect doctors who manage their health care to do all they can to take care of their own health and well-being,” said Pamela Peeke, MD, assistant professor of medicine at the University of Maryland in Baltimore.
“I’m a doctor who believes that words have to be followed – that the best teachers are the ones who live it,” she says.
“I don’t think, however, that from this one experimental study we can conclude that obese doctors interfere with patients’ efforts to change their behavior,” notes Bennett, who was not involved in the study.
“I think patients often want to get in touch with their doctors on a more personal level, but without the story of where the advice is coming from, patients can have trouble trusting a provider who seems to contradict the messages,” she says.
A study Bennett helped lead suggests that if patients need to lose weight, they are not biased against obese doctors. A national survey of 600 overweight patients showed that 87% trusted the nutritional advice of overweight general practitioners, compared to 77% who trusted the nutritional advice of healthy weight doctors.
“This shows that patients trust doctors who are more like them more, which can lead to better relationships. We know from race studies that patients often trust doctors of the same race more, ”says Bennett.
Gendreau says that when he was severely obese, some patients wondered whether to trust his weight loss advice.
“It was very uncomfortable when they turned to me and said, ‘What about you?’ I would reply that it is my job to educate them about the risks to their health, ”he says.
According to the 2021 Medscape Physician Lifestyle and Happiness Report, nearly half (48%) of doctors said they were trying to lose weight. As a result, many doctors may find themselves in the position of seemingly advising “do what I say, not what I do”.
Nearly 3 in 5 Americans are trying to lose weight, according to the results of the Gelesis survey published in December 2020.
Should doctors pay more attention to wellness?
Physicians have an ethical duty to maintain their own health and wellbeing so that they can provide safe and effective medical care. If they don’t have a healthy lifestyle, they’ll need to make adjustments, advises the American Medical Association’s Code of Ethics.
Peeke agrees with the AMA. “We are committed to it – we have to do everything we can to save ourselves time, even if it’s only 15 minutes of hiding and eating the healthy lunch we brought with us,” she says.
Gendreau suggests busy doctors do what he’s done.
“I started by bringing healthy snacks – small ziploc bags filled with mixed nuts and berries – and expanded from there. That way, if I was hungry or stressed between patients, I would have easy access to something nutritious, ”he says.
He and Peeke also suggest making low-sugar protein shakes or berry smoothies.
“These can keep you full for hours by sipping them between patients,” says Gendreau.
Convincing busy doctors to make lifestyle changes can be a challenge. 65 percent of respondents who responded to the doctor’s lifestyle and satisfaction report say they sometimes, rarely, or never focus on their health and wellbeing. Only 45% said they had a healthy diet and 65% said they did sport.
“For most doctors, self-care isn’t a priority because we’re taught to look after others and put them first,” says Gendreau. “Like many doctors, I had so many other priorities – family, friends, career. Plus, my final year of medical school was so difficult that finishing my degree was my priority. I put my health aside and told myself I can fix this later. “
According to David Eisenberg, MD, Associate Associate Professor of Nutrition at Harvard TH Chan School of Public Health, only about one in five medical schools require students to take a nutrition course.
“I didn’t get a gram of nutritional training, which is why I became a Pew Foundation Fellow in Nutrition and Metabolism. I had to get out of my traditional training, ”says Peeke.
“Doctors are not sufficiently trained to provide the necessary behavioral counseling and motivational interviews,” says Bennett. “We do a good job of diagnosing obesity based on body mass index and understanding how it relates to future health conditions. But most doctors struggle with both a lack of time and the skills to make significant changes in behavior. “
“The medical school curriculum focuses so heavily on the pathology and pathophysiology of obesity rather than how to prevent it through proper diet and exercise,” says Gendreau. “My doctor patients often tell me that there is a lack of their own nutrition training, which can affect their weight loss journey and what they teach their patients.”
Attributing his own path to weight loss as well as obesity medicine scholarship, Gendreau says his confidence in discussing weight loss with patients has increased.
Redefining obesity as a chronic disease
Instead of criticizing overweight people, including doctors, for their personal health choices, it’s better to think of weight or obesity as a chronic disease, Bennett says.
“When we understand that obesity is a chronic health condition that people are struggling with, we can empathize with them,” she says, recommending that more providers share their weight loss journey with patients whom they give lifestyle advice to. which can help treat and repair potential prejudices.
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Kevin Gendreau, MD, Weight Loss Physician, Southcoast Health, Fall River, MA.
Peminda Cabandugama, MD, Endocrinologist and Obesity Medicine Specialist, Truman Medical Center, University of Missouri-Kansas City.
Wendy Bennett, MD, MPH, Obesity Researcher, Associate Professor of Medicine, Johns Hopkins University, Baltimore.
Pamela Peeke, MD, MPH, Clinical Assistant Professor of Medicine, University of Maryland, Baltimore.
Gelesis: “New poll shows 71 million Americans gained weight during the pandemic.”
American Medical Association: “Code of Medical Ethics Opinion 9.3.1.”
David Eisenberg, MD, Associate Associate Professor of Nutrition, Harvard TH Chan School of Public Health.
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