Motivating overweight patients to lose weight and improve their health is among the most difficult challenges facing the healthcare system. In recent years, studies have examined the doctor-patient relationship, where many conversations about weight loss first occur. These encounters may set the course for an overweight person's overall experience with the healthcare system. In fact, a new survey from Johns Hopkins found that 21% of overweight patients felt judged by their primary care doctor and were less likely to trust that person's advice.1 To understand how such an encounter can affect an overweight patient-and what it takes them to change-Evidence-Based Diabetes Management invited Tory Johnson of Good Morning America and author of The Shift to share her experience.
My doctor spent an hour with me on that hot summer afternoon. She knew I was nervous since my palms were sweaty in the airconditioned room. During her exam, she calmed me by talking about work, motherhood, and careers. At the end, she told me to get dressed and said she’d be back in a few minutes.
Whew, I thought, I’d dodged the weight bullet! Not a single word during the exam. But then we had The Final Chat and she oh-so-gently recommended that I see her colleague who specialized in obesity. He’s great, she said, slipping me a piece of paper with his name and number.
My face flushed and a feeling of intense humiliation surged through my body—even though she could not have been kinder or gentler with me. Don’t be a stranger, she said, and I nodded numbly: of course not.
Not only did I not go see her colleague, but I avoided her for the next 10 years. No mammogram, Pap smear, blood tests for cholesterol—all keys to women’s health. Even though I had health insurance, I’d reached a stage where I was so terrified at being called fat that I avoided going to the doctor for an entire decade.
Just the thought of it makes me more determined than ever to make sure that my kids never retrace my footsteps. That they never fear time with a medical professional. What finally got me to that place was losing weight—a lot of it. It took a very candid conversation to get me there.
As a weekly contributor on ABC’s Good Morning America, I had always thought in the back of mind that it was just a matter of time before my size became an issue. But no anchor, producer, or executive ever said a thing for years. I got the false sense that my work was so good that it trumped any issues with my girth.
Then one day, Barbara Fedida, the executive in charge of all on-air talent at ABC News, asked me to coffee. Uh oh, I thought, the jig is up. After 45 minutes of polite chitchat, it was. She said I didn’t look my best, my clothes didn’t do me justice, and she wanted to send me to a stylist. Once again, like that day in the exam room, my palms became drenched in sweat. My heart began to beat fast and my head got fuzzy.
Barely, just barely, I managed to force these words from my mouth: Of course! I’d be happy to see your stylist! Thank you!
As I fled the building and walked out onto the street, I felt an incredible sense of relief. I knew my life was about to change. Someone had finally told me directly what I needed to hear in a way that suited me just fine. Barbara didn’t put me on the spot, embarrass, or humiliate me. She did not threaten me or say I had to lose weight. And the word obese never came up.
But I’m no dummy, and I took her words as they were intended: Tory, TV is a visual medium and you must lose weight. Exactly 1 year later, on my own, I had lost 62 pounds. I did it by realizing that what I put in my head is far more powerful than what I put in my mouth. That pills and potions are no match for patience and perseverance.
I wrote about my journey in The Shift, which became a No. 1 New York Times bestseller, out in paperback with new updates this month. Thanks to The Shift, I got to show off the new me on Dr. Oz. I told him that the fear of the scale—the specter of being weighed by a nurse in a doctor’s office during a routine visit—was enough to keep me away my whole life.
He nodded in agreement and said he encourages physicians not to put women on a scale: any good doctor can look at a patient and know if they have a weight issue. No need, he said, to embarrass someone on the terrifying scale. This is why viewers love you, I thought. I’ll come back on your show anytime!
Research shows that my experience at the doctor’s office is not unique, and it may be doing harm. Klea Bertakis, MD, MPH, of the University of California at Davis, studies doctor-patient relationships and has found that when an obese patient sees the doctor, more time is spent talking about weight, with less time spent on general health.2
Another study from Johns Hopkins found that overweight patients are more likely to repeatedly switch doctors, and researchers believe that off-putting comments or unsolicited weight advice play a role. Compared with normal-weight patients, these “doctor shoppers” are 85% more likely to end up in the emergency room.3
Incidentally, I had pledged to myself that I’d return to my doctor when I lost weight—and I did. She was happy to see me—and thrilled with the new me. All my tests were good.
Don’t be a stranger, she said. I won’t, ever again.References
1. Gudzune KA, Bennett WL, Cooper LA, Bleich SN. Patients who feel judged about their weight have lower trust in their primary care providers [published online July 7, 2014]. Patient Educ Couns. doi:10.1016/j.pec.2014.06.019.
2. Bertakis KD, Azari R. The impact of obesity on primary care visits. Obes Res. 2005;13(9):1615-1623.
3. Gudzune KA, Bleich SN, Richards TM, Weiner JP, Hodges K, Clark JM. Doctor shopping by overweight and obese patients is associated with increased healthcare utilization. Obesity. 2013;2(7):1328-1334.