What I Wish My Doctor Really Knew: The Voices of Patients With Obesity

Janyce Johnstone; Cherie Herredsberg; Les Lacy; Peg Bayles; Lynn Dierking; Arla Houck; Margaret Kilpatrick; Luanne Kramer; Karen Mason; Carla Mendez; Frank Schrotberger; Christie Befort

Disclosures

Ann Fam Med. 2020;18(2):169-171. 

In This Article

Our Experience

Our quest for help, whether we even want to talk about our weight, can begin or end based on our initial experience that either builds or erodes trust. It can be as early as our experience with the front desk staff or how our medical records have been reviewed. We know our weight is recorded and seen at each visit, and we worry that if our obesity is judged as a failing, our records might get a cursory or prejudiced review. We dread feeling judged or like a failure. So, we look for signs that we can trust you and your staff, that you will see us as people, as patients with the same amount of strengths and weaknesses as patients with "normal" BMI.

Because…

I have a doctor's appointment… which I dread. I am thinking, "Will you notice, or say something? Do I want you to? Do you realize I am desperate for help? Do you even really care enough to know me? Are you the right person for this?"
What exactly do I dread when I come to see you? Not making progress with weight loss, feeling like a failure, being judged, being exposed to my own desperation, sharing my personal information with someone I may not trust, wasting my time hoping to get help, thinking it's another day of fighting a battle I often don't believe I can win. If I have lost weight, the appointment will go well, but if I've gained weight, I worry you may be frustrated. At times I lose sleep because I really don't want to come in and get weighed and be told one more time "you need to lose weight." The dread can start days before the visit. I may avoid annual wellness visits for months or years until I've lost a few pounds. Or I may skip a mammogram or other screenings altogether because I don't want to step on the scale. I don't want to see the number, and I don't want anyone to write it down. I see pictures of myself; I already know.
The first thing that happens no matter what my appointment is for (it could be for a mole on my arm) is they take my blood pressure and have me step on the scale. It all starts with the black and white of the number on the scale that day. I can ignore and dance around my weight gain all I want… until I go to the doctor, step on my enemy the scale, and cringe at the number.
I understand my weight affects a myriad of medical conditions. My blood glucose, cholesterol, aching knees, lack of energy, snoring, and depression to name a few. You, as my physician, are brilliant, the top of your class. Years of education, college, medical school, residency—all to tactfully tell me to eat less and exercise. To tell me I am obese. It really is the elephant in the room. I hear you say, "You should drop down to about 2,000 calories, you're clearly eating more than that, and you need to walk a mile a day." And I'm thinking, "That sounds like a great idea. And I don't know how I'm ever going to get it done. I have already tried diet books, expensive meal plans, supplements, and memberships." You tell me to come back in 6 months, and I'm thinking, "what good is that going to do? I'm going to be in the same position if not worse in 6 months." That's when I feel the dread already start for the next visit.

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