Adila Reddy
Would you let a bankrupt investment banker manage your money? Would you go to a nail technician with bad nails? Would you visit a dermatologist with bad skin?
Cardiovascular disease is the leading cause of death in the UK, India is the diabetic capital of the world, and 1 in 3 people are obese in the US. Today more people are obese than underweight in every region except sub-Saharan Africa and Asia.
So, what is obesity?
According to WHO, Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health. A body mass index (BMI) over 25 is considered overweight, and over 30 is obese.
Obesity is linked to hypertension, coronary artery disease, diabetes mellitus, certain types of cancers, osteoarthritis, stroke, gallbladder diseases, stroke, sleep apnea, mental health problems, and so on. The list is neverending. Even the COVID-19 mortality rate is higher in obese individuals.
WHO figures state that 1.9 billion adults are overweight or obese worldwide. That is 1/4th of our population. Clearly, we have a problem. Physicians, unfortunately, are no exception. According to the 2007 Physicians Health Study, 40% of the 19,000 doctors were overweight and 23% were obese.[1]
Supple skin, glossy hair, and an ideal physique are and have always been markers of health. They are used every day in clinical practice to look for a variety of diseases. Weight and height are routinely noted down as a part of the health profile.
When physical markers form such a huge part of healthcare, should physicians be held to higher standards than the general population? Should clinically unhealthy people promote a healthy lifestyle?
Effect on Patient Care
Poor Compliance: Does an overweight physician advising weight-loss to an obese patient inspire the same confidence as an non-obese physician? Would the patient find it hypocritical? A research paper from the International Journal of Obesity confirmed the same.[2] Obese physicians are viewed as incompetent and as those ‘who should follow their own advice’. The situation gets dire, as even normal weighing patients do not have much confidence in overweight physicians; “How can a person who is unable to treat his own medical condition, adequately treat mine?”
Treatment Plan: Lifestyle modification is always the primary choice of treatment over pharmacological drugs or surgical management. In 2012, Johns Hopkins Bloomberg School of Public Health found that obese doctors are less likely to talk to their patients about weight loss: 18% of obese doctors talked to their patients about weight whereas 32% of normal weight doctors covered the same topic.[3] Could obese doctors be overprescribing pharmaceuticals? I don’t know. I couldn’t find a study exploring the same.
Empathy: In direct contrast, some obese patients said they felt understood by their overweight doctor. They claimed that they felt ‘less judged’ and were more likely to discuss a weight-reduction plan.[4]
Effect on Healthcare:
Doctor Shopping: Obese patients are more likely to repeatedly change their primary care physician. But did you know that patients, regardless of their own body weight, are more likely to change their physician if he was overweight? This not only leads to the overuse of medical services but also negatively affects the continuity of care.[5]
Compassion: Patients were found to be more sympathetic and understanding towards their doctors with normal BMI and less compassionate towards doctors with a higher BMI. This leads to unnecessary patient-doctor conflicts and increased mistrust between patients and doctors. [5] Again, directly affecting the quality of care and treatment compliance.
Overweight physicians are vulnerable to biased attitudes from patients and are negatively affected by patients’ perceptions of their credibility, level of trust, and have poor patient compliance.
Practical considerations
It is incredibly hard to lose weight. Despite hours of dedication, discipline, diet change, and rigorous exercise, sometimes you simply can’t see a change. When it comes to obesity, prevention is the best cure. And thankfully, the trend is changing. More people are signing up for gyms and choosing healthier food alternatives. But, are doctors also doing the same? Do doctors have the time to do the same?
Despite the labor laws and work hour regulations, the amount of time a doctor spends in a hospital is long. Personally, I worked on average about 70hrs/week, pulling one 31 hr shift per week. That said, I also had to occasionally work for 120-130hrs/week. I would imagine the picture is pretty similar worldwide. Weekends don’t exist for interns, residents and fellows. Any time that we are not in the hospital is spent sleeping, studying or moonlighting at a clinic. This doesn’t leave a lot of time for diet and exercise.
Individual Changes to Make:
It takes a complete overhaul of your lifestyle to get healthier. And like everything valuable in life, it takes effort and discipline.
So let’s explore what changes ‘we’ as healthcare workers can make to actively prevent and hopefully treat existing obesity. These are also just good practices for our general health.
- Exercise:
HICT/HIIT Apps: There are many High Intensity Circuit Training (HICT) and High Intensity Interval Training (HIIT) apps available on the market right now. These apps are designed to be used in small spaces with no/minimal equipment. Consider them as an alternative to gyms when you simply do not have the time or space.
Invest in a wearable: I swear by my smart band. Not only does it count my steps and the calories I burn, but it also keeps track of my sleep schedule, helps me look at any emergency alerts while wearing gloves and is waterproof (hospitals have a lot of fluids). It keeps you accountable, makes sure that you keep moving and compares your progress to that of your friends.
Get active: Start cycling to work or practice swimming. Learn to dance or join a sports club. Go hiking, trekking, or mountain-climbing. Exercise is not limited to one form. You can do anything that suits you. You can always mix it up and try to do all of the above. The trick is to find something you enjoy.
- Diet:
‘What’ you eat matters. ‘When’ you eat matters. ‘How much’ you eat matters.
The best way to have a balanced diet is to make your own food and eat it at standard meal times. Easier said than done, I know. So, instead, you can make these changes:
Choose healthier options: Choose a salad or a fruit bowl instead of a pizza. Complex carbs are better than simple sugars.
Drink more water: Adequate intake of water has shown to improve with weight loss. The same part of your brain is responsible for interpreting both hunger and thirst signals, this often results in mixed messages. When you think you are hungry, you’re probably just thirsty. So, carry a reusable water bottle around with you.
Avoid sodas, energy drinks, and processed juices: If you’re used to consuming sodas or energy drinks, it will take a lot of will-power to break that habit. I would recommend that you slowly switch over to unsweetened iced tea, fresh juices or flavored water to quench that craving. Furthermore, limit the number of refills you get yourself to one.
Quantity of food: In my view, it is not always the quality of the food to be blamed but rather the quantity of food. My experience with American restaurants pretty much solidified that opinion. You are served enormous quantities of food. And I understand how difficult it is to leave behind some food on the plate. It is wrong to waste food, right? So, take the leftovers home.
Fad diets: I have mixed opinions when it comes to fad diets. While I largely don’t recommend them due to their lack of sustainability and possible long term effects, I will have to acknowledge that some people find them very effective. I invite you to make your own opinions on this.
- Medical checkup:
Obesity is commonly associated with multiple underlying comorbidities that can be fatal. Exercise and diet alone cannot fix morbid obesity and its associated diseases. You will need some medical help.
Get a health checkup: There may be an underlying medical issue that needs to be addressed for you to lose weight. Hypothyroidism, abdominal masses, Cushing’s syndrome, and PCOS all contribute to obesity.
Pharmacological drugs: If your GP recommends you be on some anti-obesity medication or statins or thyroid medication, adhere to the routine. They help in reducing morbidity, mortality and, when combined with lifestyle changes, help you get results faster.
Bariatric surgery: If you’re suffering from morbid obesity that is adding considerable risk to your life, this is an option you should consider. There are many different types of bariatric surgery, some of which are minimally invasive. It is recommended that you consult with a surgeon to know if you’re eligible.
- Mental health:
Obesity may be a sign of some underlying mental health problems. Depression, alcoholism, bipolar disorder, binge-eating disorder, OCD, and ADHD have all been associated with obesity.
Get help: Obesity due to psychiatric causes needs professional help. Mental health is important to stay physically healthy. So, visit a psychiatrist or a psychologist.
Avoid undue stress: Be careful to not put excessive pressure on yourself to lose weight. Everything takes time. Manage your anxiety and vent whenever necessary. Manage your responsibilities properly.
Positive environment: It is important to surround yourself with generally positive people. If you’re in a position of power, do your best to make the department’s atmosphere a positive one.
Invest in art: Buy a painting for your room, play your favorite music while working, have a novel in your bookshelf right next to the medical textbooks, or have some fresh flowers in your room. Have something in your office room that makes you happy.
Some Advice to the Hospitals
There are some changes hospitals should make to their policy that would help benefit doctors. I would encourage you to speak about the same to the management should the opportunity arise.
Hospital Gym: Since I worked at a teaching hospital on a college campus, they had a 24 hour gym. I cannot stress how much easier it was to just pop into the gym before or after work. If there is no existing facility similar to this, work with your hospital to create a 24hr gym for all healthcare staff. It could be as simple as tucking a treadmill or a few basic weight machines in an unused corner.
Healthy cafeteria options: This seems obvious, but you would be surprised by how many institutions offer few or no healthy food. What I am suggesting is for hospitals to take it a step further and provide only healthy, nutritious, dietician approved meals on weekdays. These rules can be relaxed on weekends to improve the sustainability of this diet.
Deliver food to staff: To maintain a proper weight, the schedule of your meals is important. This is challenging for doctors. Personally speaking, I can count on two hands the number of days I had all my meals at the right time while at work. So, it would make doctors’ lives easier if meal boxes could be delivered to the department at mealtime. It is easier to eat in your room in 10 minutes than to go to the cafeteria, stand in the line, eat your food, and make it back to the patient in 10 mins.
24-hour cafeteria: Some days it is impossible to eat at the right time. Especially for surgeons. So, instead of skipping meals and ordering fast food, an open cafeteria serving hot meals is an easy choice.
Conclusion
It is not easy to suddenly make major lifestyle changes to your daily routine, so take one step at a time. Make one change a week. But understand why this is important. Not only does it negatively affect your job but it adversely affects your health. Your health is most important only to you. So, take care of yourself.
References:
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4268640/?report=classic
- https://rdcu.be/b5zE7
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3645927/
- https://www.medscape.com/viewarticle/872239_3
- https://www.nature.com/articles/ijo201333.epdf?sharing_token=S6pMYo_lJKCDw2v8anFjWNRgN0jAjWel9jnR3ZoTv0Nn9iCksT42b_C34xGcglgGkFwPcl9Nsb94mYl4am-0JTrXtLHGQlbpK7YZuL9AOFvk0PdqHKzZKJeVizJcIoUbjuYAONGpwf82Y3W6x71YOg%3D%3D