Tuesday, May 6, 2014

If More Doctors Believed in Diet and Exercise, Maybe Patients Would Too

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.

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