Weighty discussions

I always count on Tara Parker-Pope at the New York Times' “Well” health blog to have some juicy, of-the-moment medical news. Parker-Pope often covers nutrition, a topic dear to my heart, and other popular health stories. Especially nice is the fact that she often includes links to the studies or items she's covering.

A health economics story this week about the financial toll of obesity caught my eye. Parker-Pope's headline announced, “Obesity More Expensive for Women.” Aside from the plainly fascinating gender angle to the story, the facts and figures contained in the George Washington University report are gripping. The tangible annual costs of being obese in America tally in the thousands -- nearly tenfold the cost of being overweight. The report quantifies the impact of medical costs, job-related costs, and other insidious financial drains on the obese. A very compelling read.

Money and weight -- everyone's favorite items to talk about, right? Awkward to discuss with friends, awkward to discuss with family, and awkward to discuss with patients for sure. Really, I don't even like to talk with myself about my own money or weight.  

While financial issues may or may not be appropriate terrain for health care providers, weight surely is. In fact, it's a crucial one. Just as we mentioned a few weeks back, an important part of our job is swallowing our own social boundaries in favor of our patients' welfare.  

Many NPs and PAs worry that bringing up weight issues can alienate patients or make them feel judged. The stigma of being overweight or obese in America is certainly formidable, and it's an understandable concern.  I had an excellent nursing professor in nursing school who argued that this conversation needn't be painful and suggested various strategies for bringing up weight in a nonjudgmental, non-offensive manner. Basically, he advocated that less is more. No hemming and hawing. No talking around the subject. Just a simple, direct, open-ended query -- for example, “Let's talk about your weight,” or “What are your thoughts about your current weight?” Generally speaking, patients know when they're tipping the scales, and they don't need you to tell them.    

Being equipped with resources (no, telling patients to cut calories isn't good enough) will help you feel more comfortable broaching this topic. Referrals to weight-loss groups in your town (the classic: here), specific nutrition suggestions, handouts, Web sites, ideas for physical activity, helping to set realistic goals, and, of course, compassion and patience will go a long way in creating positive change in this messy terrain. And in the meantime, fidget or stand or pace while you read this blog or Parker-Pope's; remember, small change adds up.
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