Doctors blame everything on weight

You might be wondering why this section is included here among the social issues, rather than in the medical section earlier in the book. I think that this is more of a social problem, because the medical position is clear. There are very few doctors who don’t know that obesity is harmful, although I get the impression that a lot of doctors underestimate how harmful it actually is. During all the years I was moving further and further towards a state of severe morbid obesity, I don’t ever remember a doctor mentioning my weight. Probably the closest anyone came was to mumble ‘your organs are hard to find’ during an abdominal ultrasound examination.

When I asked my family doctor a few years ago about the possibility of a stomach reduction, he gave me a referral without hesitating. When I asked him what he thought about it, he said that it would certainly make sense to lose weight if I wanted to have a baby. It would make pregnancy easier. Not a word about the fact that being overweight also had a direct impact on my life, or that I was running a much higher risk of diabetes, a heart attack, joint problems, or premature death.

A recent study by Turner et al. (2014) found that the BMI of only 22 per cent of patients in Britain’s National Health Service were documented. In some cases, it hadn’t even been recorded for patients with problems directly related to weight. Among diabetics, it was missing in half the cases, and was only documented for 38 per cent of patients with cardiovascular disease or hypertension.

Galuska et al. (1999) asked more than 12,000 obese patients whether their doctor had advised them to lose weight. It was the case for fewer than half (42 per cent).

In an article in The Sydney Morning Herald (2015), a doctor complained of precisely this problem from her own practical experience: ‘I see plenty of women who come for scans because they have lower limb problems that I know would be eased if they weren’t so fat, but no one seems willing to confront them with that.’

This definitely goes both ways, as a lot of doctors have often seen their weight-related interventions ignored or quickly abandoned by patients. Nevertheless, even during my weight-loss process, I found it demotivating to find that almost every medical expert apparently assumed that ultimately I wouldn’t succeed in losing weight. When I asked my orthopaedic surgeon after several months on 500 kcal, and having already lost 30 kg, if it was okay with my knee problems to consume less than 500 kcal a day, he just gave an amused snort and said, ‘Of course you can do that, but you’ll never keep it up!’ My impression was that he thought he could tell at first glance that for a woman weighing 120 kg any attempt to make a change was doomed to failure anyway.

As I described in the previous chapter, the only weight-related criticism I have received from a medical professional so far has been about my target weight — which is within the normal weight range.

I don’t know how typical my personal experience with doctors is, in this respect. As I’ve had to move house frequently over the last ten years, I came into contact with many different doctors, but that’s still only a tiny selection. There may be doctors who focus more on weight and aren’t afraid to discuss it with their patients. And different people might have different impressions about whether too much or too little attention is paid by doctors to body weight.

One reader wrote an interesting review on Amazon:

The day after reading this book, I went straight to see my lung specialist and told her that she needed to change the weight registered in my medical record. For years, I answered ‘no’ to the question ‘Has your weight changed?’ I didn’t know what my weight was because I hadn’t weighed myself for three years. But my doctor should have noticed that I’d gained 40 kilos in those three years. After all, I see her quite often because I can only get the prescription for my medication from her, and I have to do lung tests regularly as part of a disease management program. I didn’t weigh 96 kilos, as was recorded on her computer, but almost 134 kilos. Such a massive change in weight has an immense impact on my medical data, and she should really know that. But I had to ask her directly, twice, to change the weight in my record. She seemed completely overwhelmed by the fact that I was speaking so openly and directly about my weight problem and asked me several times in confusion what it had to do with her. Tests also showed I had high blood pressure, which she called ‘normal’. Sure, high blood pressure is definitely ‘normal’ for someone of my weight, but it’s certainly not ‘normal’ in the sense of being medically healthy.

How many doctors possess the motivation to address such a potentially unpleasant issue and risk annoying their patients? Especially when they know from personal experience that very few patients will actually lose weight permanently? In this way, a self-fulfilling prophecy is gradually built up among doctors as well. Even before broaching the subject of losing weight, they feel it will be pointless anyway. So, if there is a ‘grey area’, where weight is perhaps only one of several causes of ill health, doctors will prefer to focus on the other causes, in the knowledge that doing that will get a better reception from patients.

If weight is obviously the cause of an illness, doctors may address it, but in a rather bashful and casual way — like when I was told that my organs were difficult to recognise in an ultrasound exam — and they will hope that the patient will understand what is meant. When doctors do address the weight issue directly, it’s usually with a sense of resignation and an attitude that doesn’t motivate the patient. Very few patients then take this as an opportunity to actually make a change, and the doctors’ resigned attitude is reinforced.

Another problem is that doctors don’t live in a vacuum and so they are also affected by the general shift in perception of body weight. In a recent study by Robinson et al. (2014), doctors were asked to assess the photographs of normal-weight, overweight and obese people. The greater the weight of the person in the photo was, the more likely the doctors were to underestimate it. Overweight people were identified as overweight in fewer than half the cases, and the obese people were recognised as obese in only about one-third of the cases. Two out of three obese people weren’t even identified as such by the doctors. At the same time, a physician’s perception was found to have a major influence on whether he or she was prepared to address the subject of weight with the patient at all.

I think this development is very alarming, because doctors are still our most important point of contact when it comes to health issues, and even in these times of Google self-diagnoses, the word of a doctor still carries a lot of weight for most people. In the study by Galuska et al. (1999), patients who had been approached by their doctor regarding weight loss were 179 per cent more likely to actually lose weight afterwards. A new study (Bennett et al., 2015) also showed that a good physician–patient relationship was closely related to successful weight loss, especially with regard to weight management. On average, obese patients who experienced their doctor as supportive lost around 50 kg in the two-year study period. The patients who did not evaluate their doctor as helpful, on the other hand, lost only around 2 kg. Of course, perception of the doctor–patient relationship is not a one-way street that depends solely on the doctor, but it does show how great the part that the doctor plays in this process can be.

Doctors can exert a great deal of influence, and I believe they should do so. Patients are affected not only by what doctors say to them, but also by what they don’t say. If her doctor doesn’t say anything about her weight, a patient interprets it as: ‘My doctor doesn’t think my weight is a problem.’ And if her doctor is motivated to address the issue, the patient can simply dismiss it with, ‘My five previous doctors didn’t think my weight was a problem. This one here is just incompetent and doesn’t want to deal with the real causes, so he’d rather blame everything on my weight.’