Can Overweight Doctors Really Help Patients Lose Weight?

Neil Chesanow

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December 08, 2016

In This Article

The Pot Calling the Kettle Black?

Many patients are overweight. Many doctors are too. But can a doctor who is overweight or obese be authoritative and effective in advising such patients to shed some pounds?

Deep Ramachandran, MD, a critical care, pulmonary medicine, and sleep medicine specialist in Burlington, North Carolina, who has struggled with his weight, puts his finger on the problem. "How," he asks, "do we deliver a message that may be seen as hypocritical?"[1]

It's a fair question. Can overweight doctors advise overweight patients to "do as I say and not as I do"? Studies offer contradictory conclusions. Doctors are also divided on the issue, as are patients. But experts in obesity contend that the content of the message—and how it is delivered—are more important than the messenger, whether a doctor is overweight, thin, or somewhere in between.

Do Overweight Doctors Need a Special Approach?

Some physicians feel that doctors who are overweight or obese need to acknowledge that to patients before offering them advice on slimming down.

"You have to own your problems and communicate with patients in ways they can understand," Dr Ramachandran says.[1] He often tells patients that he too struggles with weight loss and knows how hard it is.

But experts in obesity disagree.

"Regardless of a doctor's own body weight, their communication with patients should be the same," says psychologist Rebecca Puhl, PhD, professor in the Department of Human Development and Family Studies at the University of Connecticut. "Doctors need to acknowledge and communicate that body weight is determined by complex factors; work with the patient to set realistic, measurable goals; and focus on supporting patients to engage in healthy behaviors. It's more productive to focus the conversation on healthy behaviors rather than on the number on the scale."

"Discuss what weight-related health behaviors the patient is currently engaging in," Dr Puhl advises. "Identify any barriers or challenges that might be interfering with those behaviors. And set concrete behavioral goals with the patient. For example, replace sugar-sweetened beverages with water. Be physically active 30 minutes each day. Increase your portions of fresh vegetables."

"The advice really shouldn't be different, or interpreted differently, on the basis of the body size of the doctor," Dr Puhl insists. "That shouldn't be relevant. A doctor's body size is not an indicator of his or her credibility, training, or bedside manner." 

Psychologist Sara Bleich, PhD, assistant professor at the Johns Hopkins Bloomberg School of Public Health, agrees. "I don't think you need a prelude that says, 'Well, I'm obese like you. And here's what I do.' I think that physicians need to offer practical advice that works, regardless of the patient."

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