Are Overweight Doctors a Problem for the Profession?

Robert M. Centor, MD; Pennie Marchetti, MD; R.W. Donnell, MD; Roy M. Poses, MD

Disclosures

August 02, 2006

In This Article

Roy M. Poses: Adding Insult to Injury

Primary care physicians are increasingly demoralized. They are retiring at an increasing rate, while fewer young physicians are entering primary care residencies.[12]

The reasons are not hard to find. The compensation primary care physicians receive has not kept up with inflation, partially because reimbursement has declined. In particular, a report by the Center for Studying Health System Change[13] showed that primary care physicians' income dropped over 10% adjusted for inflation from 1995 to 2003, while Medicare reimbursement increases lagged inflation by about 8 percentage points during the same period. Primary care physicians are subject to ever-increasing paperwork and bureaucratic demands,[14,15] leading to decreased autonomy. Finally, they are bombarded with constant demands to do more about more problems, without being provided the funding, resources, or time to fulfill these obligations.

A clear illustration of the latter problem was provided by the analysis by Yarnall and colleagues.[16] On the basis of guidelines from the US Preventive Services Task Force, these investigators calculated it would take 7.4 hours a day for the typical primary care practitioner to accomplish all of the preventive services that were given the strongest recommendations (A or B level) by the Task Force. Keep in mind that the Task Force's suggestions are evidence-based and generally considered conservative. Thus, a physician dedicated to performing just the preventive services that have the strongest evidence in their favor would barely have any time left to take care of patients' acute problems, address their diagnostic and prognostic questions, manage their chronic and/or complex diseases, or handle their biopsychosocial issues.

However, Dr. Michael Dansinger wants to add to these obligations; he says physicians should exercise an hour a day, not just for whatever good it may do them, but for the good of their patients.[6] Dr. Dansinger did not suggest where we physicians should get that extra hour in the day to exercise. Should we cut some of those preventive services offered to patients, spend less time with our families, or just sleep less?

Furthermore, Dr. Dansinger begged the question of whether lifestyle change is an effective or realistic means of weight reduction, much less whether having physicians change their diet or exercise more would actually benefit their patients. Note that the systematic review by Douketis and colleagues[17] found no evidence that any weight-reduction program has long-term effectiveness. However, maybe an expert adviser to the television show "The Biggest Loser"[18] would find these questions awkward.

Finally, Dr. Dansinger chastised physicians for being overweight or obese. He charged not only that rotund physicians "fail to embrace lifestyle recommendations in our personal and professional lives," but that this failure leads to "a public perception that lifestyle change is ineffective or unrealistic." Worse, he alleged that physicians who "fail to heed lifestyle recommendations" also "fail to recognize and treat obesity." Thus, he suggested that physicians have in some sense "failed," are politically incorrect, or are morally at fault if they weigh too much. This is at odds with the compassionate way we should treat our patients who have not found it easy to lose weight.

Of course, I agree that primary care physicians should help their overweight or obese patients lose weight, eat well, and exercise sensibly. But blaming physicians for being too heavy will not help them help their patients in this regard.

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