Strong Medicine

Article excerpt

Byline: Claire McCarthy, M.D.

Doctors must do more to help patients battle the bulge.

For years, I had a straightforward approach to dealing with overweight children in my practice: at well-child visits, I would tell the family that the child was overweight, and we would discuss healthy eating and exercise habits. Off they would go, until their next well-child visit.

The thing is, it didn't work. They came back fatter the next year. We'd have the conversation again. And again, year after year. With a third of American children and two thirds of American adults overweight or obese, I'm not the only doctor out there failing.

I've been thinking recently about the definition of insanity attributed to Albert Einstein: doing the same thing over and over again and expecting different results. The way I was treating obesity definitely qualified as insane.

Obesity comes down to a simple energy equation: if you eat too many calories, or you don't burn off enough, or both, you gain weight. People know this. So why is everyone getting fat?

After talking with lots of overweight people, I think that there are four major reasons--the four "D's":

DENIAL. This is probably the main reason. People think that they, or their kids, aren't overweight (so many people are overweight that unless you are really obese, you don't stick out). They let themselves think that their diets aren't that bad, or that walking to the car from the store is enough exercise.

DELAYING. Next week they'll start the diet, or stop buying chips for the kids. Things are too nuts at work (or at home, or at school) right now. In the spring they'll join a gym or sign Junior up for soccer. It can wait (there's the denial again).

DISCOURAGEMENT. The hard truth is that losing weight takes work and time. It's easy, and understandable, to get discouraged and start thinking, why should I make myself miserable eating carrots and going to the gym if it's not doing anything anyway? Why should I make my kid miserable if he's not losing weight?

DIFFICULTY. For many people there are real obstacles. Healthy foods are more expensive and not always easily available. Gym memberships can be expensive, too--as can fees for sports teams for children. Many families live in neighborhoods where playing outside isn't safe. …