Anyone who reads this
blog knows that I have profound respect for doctors. That said, I find it disheartening
when I encounter large ads for hospitals and medical practices that feature
photos of very overweight doctors. I am sure that these individuals have
impossible schedules, lots of stress, and little opportunity to exercise or
seek out healthy food options. On the other hand, there is such a thing as
leading by example. If the intelligent, well educated, highly respected doctor believes
it’s OK to live this way, she or he is unlikely to succeed at persuading
patients to do otherwise – and, in many cases, doctors don’t even try.
How much do medical
schools teach doctors about diet and exercise? Not much, is my impression. Do
medical schools ever talk to their students about how they should take care of
themselves? I doubt it. So doctors who weren’t already a fitness buffs (not too
many of those) are left in the position of trying to coach patients in areas
where they are quite ignorant themselves. Most doctors don’t understand how
exercise works and the way exercise works goes against the grain of the way
doctors are taught to approach patients. Because their time with individual
patients is quite limited, doctors tend to group patients by category, lumping
people together by age, sex, and so forth. Yet each individual body is unique; what
works well for some may be useless or even harmful for others. This is
especially true with diet and exercise. If you want to get into shape you may
have to try a number of different approaches until you find what works for you.
And what works for you for a while may eventually stop working, so you have to
start looking all over again.
Doctors don’t have the
time – and often not the educational background – to supervise this sort of longtime,
unpredictable process. Instead, they take shortcuts. Rather than broach the
awkward subject of the patient’s obesity and poor living habits, they prescribe
medication. Controlling your diet and pursuing a successful exercise program
take planning, persistence, and hard work. After talking to their doctors,
patients are likely to come away with the idea that all this effort is really
unnecessary because a pill will produce the same results. For example,
individuals who take statins may think of the medication as a license to
overeat. In a study recently reported in JAMA, statin users increased their fat
and caloric intake over eleven years, while nonusers saw no such increases. Prescribing
medication for conditions that could and should be treated with diet and
exercise may actually steer people away from making healthy lifestyle choices.
Medications do not produce the same
results as diet and exercise. In addition, they are costly and may have harmful
side effects.
It is time to bring
accurate, individualized information about diet and exercise into doctors’
offices. Some hospitals and medical practices have started using health coaches
to work with individual patients and support their efforts to improve their
fitness. With the help of a coach, patients can gain a better understanding of their
particular strengths and weaknesses and their individual needs. This, in turn,
will improve their ability to communicate and work with their doctor.
