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Physician, heal thyself: Tackling "globesity"

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Obesity is a growing problem worldwide. As an ever-increasing number of individuals exceed a healthy body mass index (BMI) -- and exceed it by an ever-greater percentage of body weight -- the global burden of chronic illness continues to rise. According to the World Health Organization (WHO), obesity has doubled worldwide since 1980. As of 2011, more than 40 million children under age five were overweight. Describing "an escalating global epidemic of overweight and obesity" that it dubs "globesity," WHO warns that

Obesity poses a major risk for serious diet-related non-communicable diseases, including diabetes mellitus, cardiovascular diseases, hypertension and stroke, and certain forms of cancer. Its health consequences range from increased risk of premature death to serious chronic conditions that reduce the overall quality of life.

Every physician in the world knows how dangerous obesity is for individuals, and how expensive for society. Why, then, does the problem continue to grow? A recent study of general practitioners (GPs) in the Netherlands attempts to answer this question.

In the current issue of BMC Obesity, researchers from Utrecht and Amsterdam in the Netherlands describe the results of a survey of 800 Dutch GPs conducted in December 2012. According to the researchers, nearly 83 percent of the 307 GPs who responded to the survey believe that "weight management is part of their responsibility for providing care." However, a number of factors prevent many family physicians from taking an active role in advising their patients about attaining and maintaining a healthy weight.

One major factor making it less likely for a GP to refer a patient to a dietitian is the physician's own weight. The Dutch researchers found that obese or overweight GPs (those with a BMI equal to or greater than 25) were "significantly related to an 11.6 percent lower referral percentage for obesity management compared to those with a healthy weight." Simply put, overweight doctors don't feel comfortable pointing out their patients' weight problems. Additionally, these overweight physicians may not understand or appreciate the ability of a dietitian to help an individual resolve weight problems.

Additional reasons for not speaking to overweight or obese patients about weight management include "already talked about weight in the past" and "not having enough time," cited by 76.9 percent and 59.9 percent of respondents, respectively. Although it is tempting to blame the patient for a lack of healthy weight management in situations in which the physician has already mentioned the importance of a healthy weight, it is important to note that GPs may not frame the issue properly when introducing it, thus limiting patients' chances for success. The Dutch researchers note that GPs surveyed report discussing patients' medication use, psychological and social problems, and environmental factors involved in weight gain only about one-fifth to one-third of the time.

The Dutch researchers highlight several opportunities for family physicians to help end the "globesity" epidemic. Chief among these opportunities are working with other medical practitioners, such as dietitians, to advise patients on attaining and maintaining a healthy weight; discussing weight management, including environmental and psychosocial factors involved, with patients who are early in their weight gain; and serving as "positive health role model[s] by having a healthy BMI themselves."



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