Managing the Elephants in the Room

October 31, 2018

I recently watched a video clip of a comedy routine, and it began like this: “You know the joke; a guy walks in to a doctor’s office and says to the doctor, ‘When I move my arm like this, it hurts.’ And the doctor says, ‘Well, don’t do that.’ The comedian follows with; ‘Well, I walked into my doctor’s office and I told the doctor my arm hurts, and the doctor said, “You have to lose some weight.”’’ The comedian then launched into a diatribe shaming doctors and various other health care providers for bringing up weight in healthcare interactions.

The elephants have multiplied! The unseen elephant in the room that we have to worry about is the pachyderm of politics. We, as health care providers, (Doctors, NP’s PA’s Nurses etc.) are somehow beholden to political correctness at all times. Right? Wrong!

The other elephant that we have to talk about is the elephant himself, (let’s leave gender political correctness out of this conversation).  And that elephant has multiplied as well: According to the National Center for Health Statistics, in the United States, among people aged 20 years old or older, the prevalence of obesity rose from 19.4% in 1997 to 31.4% in 2017. And yes this is related to a myriad of healthcare problems that can maim or kill us early. If I can borrow a phrase from Bernie Sanders, “that’s UUUUGE.”

In medicine, we have to tell it like it is. Weight must to be talked about and health care providers are the ones to do it. Furthermore, we need to talk about it without fear of insults, anger, or doctor-shaming comedians. Keep in mind that weight-relatedness of many conditions may not be immediately evident to some, and like smoking, health care providers must keep hounding until the elephant gets under control.

Now that we’ve identified the herd it’s up to us to do something about it. I submit that doctors, nurse practitioners, nurses and PA’s simply can’t always be politically correct when it comes to our patient’s health. We have to tell it like it is. I’ve had to tell people their family members have died countless times. There are few effective ways to sugar coat it. I’ve also had countless interactions in the emergency department when I have a chat about something that seems tangential to the visit itself – yet may save the patient’s life: helmet use, smoking or drug use, and yes–weight, to name a few.

Sometimes these frank discussions have been met with anger. “Why are you talking with me about smoking when I came for an ear infection?” I have to respond: “Well, actually, upper respiratory infections are associated with smoking.” But it seems that there’s nothing like the PC rage these days than that which seems to be ignited by broaching the subject of a patient’s weight.

Now that I’ve got that weight off of my chest – what can we do about the herd? First, if you are a patient, be receptive to that health care provider who is talking to you about the weight, even if you’ve come in for arm pain, and even if you’ve heard it before. The doctor isn’t interested in shaming anyone. She (excuse the pronoun, I’m still not going to be PC on that one for now either) just wants to save your life.

People often ask what to do to lose some pounds. I am not, nor do I claim to be a weight loss specialist. As a physician who’s been in the business three decades, I can identify some things that will get you on your way: Portion control – buy some smaller plates. Yes, studies have shown that smaller plates are associated with smaller portion size, and smaller portion size helps. And here’s some basic (not common-core) mathematics: decrease caloric input and increase your caloric use or activity. It works. Count those calories; identify the areas where you can effectively cut them. Dump sugar-containing drinks. Drink coffee? Cut out the cream, eliminate the sugar and downsize your cup. Eat a diet that’s primarily plant-based and use fish, nuts and legumes as your major protein source. And, don’t fly in the fog without instruments. Get a scale and use it every morning. Start an exercise program after you visit your health care provider and determine what’s safe and realistic for you. Even if you start with ten minutes a day working with tiny barbells in bed and work up to an hour a day in the gym. Do something active every day and stay on a program.

Finally, as you trim the pounds away there are ways to tighten up and look great in that bathing suit you haven’t worn in a couple of summers. Venus Versa Diamondpolar and Octipolar treatments can safely and effectively tighten loose tissue on your neck, abdomen and other areas, and can help eliminate cellulite. Have that pocket of fat under your chin? Kybella is a wonderful way to loose it for good!

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