I went to a new doctor today. Didn’t love him, probably won’t go back (though I didn’t say that to the coworker who recommended him, of course). He was fine, but he did that particular doctor thing where they tell you to stop doing something without asking first whether you do it or not. Honestly, I’m probably never going to get along with a doctor who can’t bother to ask me about my habits before telling me to change them.
But he was pretty good on the subject of weight. He did bring up weight when he thought it was relevant to my complaint, and was overly dogged when I explained why it wasn’t, so points off for that. But I really appreciate that he didn’t berate me, or try to sell me on the Celery and Oxygen Diet.
Less appreciative is Dr. Sanjay Gupta, writing in Time. He reports that too few doctors are emblazoning their patients with what he calls “the scarlet O”:
Researchers at the Mayo Clinic in Rochester, Minn., recently released the results of a survey of more than 2,500 obese patients who went to their doctor for a regular checkup over the course of a year. The investigators found that the charts of only 1 in 5 of those people listed them as obese. What isn’t on the charts is probably not communicated between doctor and patient either, and that means trouble. Those in the study who got the diagnosis were more than twice as likely to have developed a weight-management plan with their doctor than were the other obese patients.
Dr. Gupta is quick to invoke the universal and totally unchallenged conventional wisdom about fat; he only takes a couple of paragraphs before he nods sagaciously, taps his nose, and pronounces: “Obesity, of course, means a higher risk of heart disease, diabetes, hospitalization and early death.” Of course. And yet all these doctors, who presumably know that OF COURSE you shouldn’t let a fat patient walk out of your office without a meal plan, are declining to diagnose “obesity” on their charts.
Gupta flails around a bit, trying to guess why this would be. He can’t really come up with anything beyond “doctors don’t want to embarrass their patients,” which is handily conflated with “doctors don’t want to give their patients eating disorders.” The two are, of course, indistinguishable; an eating disorder is just a particularly acute form of embarrassment! This can be avoided, Gupta tells us, by saying that a child has “a weight problem” instead of that she’s “obese.” Why, of course.
One doctor quoted in the article points out that it can be harmful to scare patients away from the medical profession. Gupta follows this up with a non sequitur worthy of Miss South Carolina:
“You don’t want to make people feel embarrassed and not want to come back to you. You want them to get treated,” he says. Jacobson stresses that every pediatrician should determine a child’s body-mass index (BMI)–a figure arrived at by factoring weight and height to produce a two-digit number that roughly diagnoses obesity.
Of course, you don’t want people to stop getting medical treatment. You just want to slap a number on them that calls them “diseased.”
Here’s my theory, and I ain’t got no medical degree like Mr. Every-Byline-Must-Say-”M.D.”-So’s-Nobody-Thinks-I’m-Just-Some-Reporter. I think that doctors “diagnose” things that are medical issues. Regardless of conventional wisdom, regardless of the fact that of course Dr. Gupta knows that obesity will kill you, if they see a patient come in who is in good health, or whose health problems are not correlated with obesity, or whose health problems are correlated with obesity but whose habits are good (say, they’re fat and diabetic, but managing their blood sugar beautifully), some doctors are going to be too sensible to diagnose them with a spurious disease.
If I went in to the doctor for a cough, and the doctor looked at me and said “fair skin and moles are risk factors for skin cancer, I recommend you have them removed, and let’s start you on a sun-avoidance program,” I would be not only offended but horrified. I can’t see any difference here. If I go in for an illness, or a broken arm, or an STD test, or when my kidneys finally fail from the genetic disease I’ve almost certainly got, I don’t expect my doctor to point out everything about me that might plausibly be correlated with other diseases I don’t have. I consider the doctors Gupta mentions to be eminently responsible, and I’m encouraged to hear about them. In fact, I don’t think there are enough of them. The Mayo study said that only 1 in 5 patients had “obesity” listed on their charts; I’m not at all convinced that 1 in 5 people going in for a regular checkup had illnesses even remotely correlated with fat, let alone caused by it.
Why are doctors not “diagnosing” obesity? It is plausible that once, long ago, they read the Hippocratic Oath, whose modern version includes avoiding overtreatment and considering your patient as a human being. Dr. Gupta would be wise to do the same.
(Thanks Zuzu for sending Kate the link!)