Why do doctors put so much focus on weight?

JUDDDing

Whenever I go in to my annual exam, they take out the height/weight chart and give me a lecture- because based on my height/weight, I come in at like 36% BMI, if they took the time to actually test me, I'm at 33% BF...the high end of the normal spectrum (right now). I wouldn't have to go through that "you're obese" lecture every year if they took the time to listen to me/test me instead of depending on the chart.

What scale are you using? Any reference I can find, male or female, has > 30% = obese.

And 25-30% as "Overweight" (which also seems like something to address).

Richie2shoes

"You know, I've managed to keep the same weight for almost 60 years. First eat breakfast, always break your fast. That's very important... break your fast. Your body needs that energy to start the day. Then a sandwich and soup or salad for lunch, maybe a piece of fruit. Eat a sensible dinner but skip the bread and skip desert. Keep some cut up celery or carrots in the fridge if you want a snack at night."

I hear this same speech from my doctor every 3 months. Then he recommends gastric by-pass.

cwolfman13

GPs are like General Contractors...they have a pretty wide breadth of knowledge....but when it comes down to it, if you need a plumber, you need a plumber...if you need an electrician, you need an electrician...but it's good to have the GC around to oversee everything and monitor progress or lack thereof.

3dogsrunning

GPs also do not give you dental advice, as they are not trained for it. It's simply a matter of going to the right professional.

That's a specious response. The health of your teeth is not as tightly correlated to your health in general as your weight is, and failure to brush your teeth is unlikely to land you in the doctor's office.

Most people do not have a nutritionist, and will not be referred to a nutritionist until they are already morbidly obese with serious health issues.

This is a very real, and very serious gap in preventative care. You don't get professional help with nutrition until you've already done serious damage to your body. I doubt even my insurance would pay for me to be referred to a nutritionist unless I was showing serious health problems related to my weight - even though it was plainly obvious that that was the trajectory I was on. Instead I'm just told 'lose weight', and left to my own devices. Surely it's better to address issues when people are 10 pounds overweight and still healthy, than when they are 200 pounds over weight and knocking on death's door?

Maybe where you are. I've requested a referral to a nutritionist with no issue and I wasnt even overweight. My father and husband both have been referred for high blood pressure.
There are a number of doctors in my community that support and encourage physical activity for all ages. They sit on committees like an active living strategy committee, coach sports and their association sponsor local runs and programs like the youth running club and race series, healthy ambassador programs, etc. Our local triathlon/running/swimming/cycling community, huge for a small area, would be no where if it wasn't for two of our local doctors.
Are all doctors like this, obviously not. But there are many who do a large part to address this issue. It doesn't have to be just sitting in a office preaching.
I also don't think it's fair to lump all doctors together and say that keeping people unhealthy = more money. Like anything else, there are the good and the bad. The ones that keep up to date, who care and those who don't.

As for referrals to specialists, that's a healthcare/insurance issue.

ETA - my best friends (both in dentistry)would disown me if I failed to mention the importance of dental health and the links to health issues for lack thereof.

stumblinthrulife

Whenever I go in to my annual exam, they take out the height/weight chart and give me a lecture- because based on my height/weight, I come in at like 36% BMI, if they took the time to actually test me, I'm at 33% BF...the high end of the normal spectrum (right now). I wouldn't have to go through that "you're obese" lecture every year if they took the time to listen to me/test me instead of depending on the chart.

What scale are you using? Any reference I can find, male or female, has > 30% = obese.

And 25-30% as "Overweight" (which also seems like something to address).

Remember that women have a much higher acceptable body fat range than men. 33% is the top of the healthy range for women. 'Cos boobs.

jadimasi79

Doctors get two weeks nutrition in med school and don't feel qualified. Most would like to refer patients to a dietitian but insurance won't cover seeing a dietitian so they rather say lose weight since they don't know how. They are also required by insurance companies to go by numbers for reimbursement.

erinsueburns

My doctor knows jack sh1t about weight/ exercise and stuff like that.

Since weight is the number one predictor of health related issues, as has been pointed out by ninerbuff, shouldn't that be a massive concern?

In the western world, obesity is increasingly rampant. Shouldn't it be on the priority list of every doctor in the developed world? Shouldn't they all be able to at a bare minimum guide people through something similar to the 'in place of a road map' thread put together by a lay-person on an internet forum?

Should I really have to consult webpages and internet forums to get healthy weight-loss advice? Shouldn't it be part of my doctor's tool box?

Nope, it won't happen because there is no reimbursement for it in a GP's office.

Follow the money. I should know that one as well as anyone. Guess I'm having an idealistic day.

Ok then, let's take this to it's logical conclusion. Who pays my healthcare bills? I have excellent insurance, so 99% it's my health insurance. Perhaps they should be compensating for better nutrition advice at the GP. Perhaps there needs to be a basic "Nutrition and Exercise Pack", distributable by GPs, which is comped by Insurance. It seems almost a foregone conclusion that people of nominal weight and fitness are going to be a lower long term cost to insurance companies than overweight, obese and morbidly obese people.

It's hardly a secret that most health problems in the Western world are caused by out excess consumption and lackadaisical attitude to nutrition and activity. So why isn't it a central pillar in our health strategy?

I'll agree that in a "HEALTHCARE" system, that would make the most sense, but that isn't what most countries, particularly in the US have. We have a pharmaceutical and devices system. Hell, I'm an audiologist, and I know that the counseling and Aural Rehab make as much difference to a person's functional gains as the hearing aids themselves do (and because I work non-profit we do quite a bit of it), but insurance pays nothing for it and very little for devices, and patient's aren't willing to pay for the aural rehab because it is not tangible.

JUDDDing

Remember that women have a much higher acceptable body fat range than men. 33% is the top of the healthy range for women. 'Cos boobs.

Huge fan of boobs...

But where are you getting this 33% number from? I'm admittedly just googleing, but body fat or BMI, 33% is listed as obese for a female too.

cuterbee

GPs also do not give you dental advice, as they are not trained for it. It's simply a matter of going to the right professional.

That's a specious response. The health of your teeth is not as tightly correlated to your health in general as your weight is, and failure to brush your teeth is unlikely to land you in the doctor's office.

This is actually incorrect. There is a direct link between gum disease and heart disease (bacterial endocarditis). Your dentist will catch gum disease early when your gums bleed during teeth cleaning (providing you actually go). Your MD/DO might not notice until your gums start receding from your teeth. Many facial tumors are actually caught by dentists rather than physicians.

In addition, it's unlikely your MD/DO will ever tell you to brush twice a day and floss every day, which is what you need to do to avoid gum disease (and this is a very simple self-care routine).

stumblinthrulife

GPs also do not give you dental advice, as they are not trained for it. It's simply a matter of going to the right professional.

That's a specious response. The health of your teeth is not as tightly correlated to your health in general as your weight is, and failure to brush your teeth is unlikely to land you in the doctor's office.

Most people do not have a nutritionist, and will not be referred to a nutritionist until they are already morbidly obese with serious health issues.

This is a very real, and very serious gap in preventative care. You don't get professional help with nutrition until you've already done serious damage to your body. I doubt even my insurance would pay for me to be referred to a nutritionist unless I was showing serious health problems related to my weight - even though it was plainly obvious that that was the trajectory I was on. Instead I'm just told 'lose weight', and left to my own devices. Surely it's better to address issues when people are 10 pounds overweight and still healthy, than when they are 200 pounds over weight and knocking on death's door?

Maybe where you are. I've requested a referral to a nutritionist with no issue and I wasnt even overweight. My father and husband both have been referred for high blood pressure.
There are a number of doctors in my community that support and encourage physical activity for all ages. They sit on committees like an active living strategy committee, coach sports and their association sponsor local runs and programs like the youth running club and race series, healthy ambassador programs, etc. Our local triathlon/running/swimming/cycling community, huge for a small area, would be no where if it wasn't for two of our local doctors.
Are all doctors like this, obviously not. But there are many who do a large part to address this issue. It doesn't have to be just sitting in a office preaching.
I also don't think it's fair to lump all doctors together and say that keeping people unhealthy = more money. Like anything else, there are the good and the bad. The ones that keep up to date, who care and those who don't.

As for referrals to specialists, that's a healthcare/insurance issue.

ETA - my best friends (both in dentistry)would disown me if I failed to mention the importance of dental health and the links to health issues for lack thereof.

You don't mention where you are. I'm in Missouri, which isn't exactly known as being a center of excellence for health and fitness. Prior to that I was in California, but at that point I was in reasonable condition, so the issue never arose. It may be reasonable to assume that my experiences in California may have been much different.

Prior to California, I was in England, and experiences were similar to Missouri. When I was a little over weight I'd be told 'lose weight' with little to no further advice. Not even direction to good resources on healthy ways to lose weight.

I guess that's my point, which perhaps I'm still not articulating well. I'm not expecting my GP to be a nutritionist or a personal trainer. But there are some incredibly basic things that could exponentially increase people's chances of success, and it doesn't take 5 years of school to learn them -

1. Calculate your TDEE. {doc suggests some sites to do this}
2. Create a moderate calorie deficit. Don't go overboard, your body needs a certain number of calories just to run.
3. Track what you eat, and learn what a portion looks like. {doc suggests something like MFP}
4. Resistance training helps you lose fat instead of muscle, it's not just for muscle heads.
5. However you set up your diet plan, make it sustainable for the long term.

I have kidney stones, and my urologist sent me a list of foods to avoid, and yet he's not a nutritionist.

When my cholesterol levels came back high, my doctor suggested foods to eat/avoid to lower it.

I don't see this as being any different. It's a reasonable follow through to increase the chances of someone actually taking advice. If my urologist just told people 'avoid foods high in oxalate' and left it at that, how many people do you think would go away and put themselves together a low oxalate diet plan?

cuterbee

Doctors get two weeks nutrition in med school and don't feel qualified.

I think the ones at my teaching hospital get a little more, but really, it's not enough for them to feel comfortable teaching a patient. And they have enough to do as it is, and most people will blow them off anyway if the MD/DO says "Lose the weight."

It is not asking people too much to have them do their own research and find and then OWN their own solution. While it takes time to sort through the crap that's out there...a lot of people start this journey trying quick fixes first. Most people won't hear you when you tell them there are none, it's something they have to discover for themselves (and just look at these boards -- even here, people promote cleanses and fads!).

141by2016

I am in med school right now, so I feel the need to weigh in on this. The future of healthcare is changing and these conversations are going to be part of that change.

First, I go to DO school, which makes my perspective different from most Allopaths (MDs) you are likely to encounter. Basically we are the other type of fully licensed physicians in the United States. Doctors of Osteopathy work in a holistic framework, including the mind, body, and spiritual/social component of the individual. We believe that the body has the tools to be healthy and our job is to support health (through lifestyle, somatic adjustment, or medication). When you see a DO for back pain, they may give you pain killers, but they are more likely to ask about your work environment, your exercises regime and may apply OMT (like chiropractic manipulation, but with science!). Most MDs have not been trained on how to even bring up the obesity issue, let alone counsel on it.

Second, with the new guidelines, the AMA is considering making obesity a disease, so we CAN do nutritional counseling and refer to PT for exercise counseling. In the next 3 years we will be able to prescribe exercise! And when Obama Care goes into full effect, we will be able to bill for obesity and lifestyle counseling, so I think you will see more Docs getting re-certified with diabetes and obesity educator credentials. With the increased use of the medical home model we will see more coordinated care for obesity.

At my school, we believe that EVERYONE should be getting 30min+ of strenuous activity per day. I attend extra workshops in nutrition so when I graduate I will have an added dietetics endorsement, and we learn a lot about sports physiology. Part of my reason for starting this journey is that I don't want to be the fat Dr. telling people to lose weight and be healthy. I am far from perfect, but by the time I start seeing patients I will be able to support their efforts through both knowledge and experience, and I hope I can help change peoples' lives by showing them it is possible and helping them navigate the confusing health landscape.

That is my point of view, and I know it is different, but I can hope that in the near future people will be able to find appropriate support for living healthy (not just disease-free) lives.

concordancia

Remember that women have a much higher acceptable body fat range than men. 33% is the top of the healthy range for women. 'Cos boobs.

Huge fan of boobs...

But where are you getting this 33% number from? I'm admittedly just googleing, but body fat or BMI, 33% is listed as obese for a female too.

I have the same question. I did find one chart that claimed to be based on WHO and NIH, but was on a low carb site. Everywhere else put 33 firmly into overweight in all cases, and usually obese. After all, BMI is just a guesstimate of body fat percentage based on wide sampling. So yes, it is possible or the guesstimate to be off if you are particularly muscular, but the numbers that define the categories don't change.

dhakiyya

Whenever I go in to my annual exam, they take out the height/weight chart and give me a lecture- because based on my height/weight, I come in at like 36% BMI, if they took the time to actually test me, I'm at 33% BF...the high end of the normal spectrum (right now). I wouldn't have to go through that "you're obese" lecture every year if they took the time to listen to me/test me instead of depending on the chart.

What scale are you using? Any reference I can find, male or female, has > 30% = obese.

And 25-30% as "Overweight" (which also seems like something to address).

Add 5 or so to those numbers for women. Men and women don't store fat the same way,, and women have more essential fat than men. Essential fat for men is about 3-5%, for women it's about 8-12%. So a man at 10% body fat is equivalent to a woman at 15-18%.

Also age makes a difference, as you get older the way the body stores fat changes. Two women with the same skinfold measurement at different ages will not have the same body fat percentage. My skinfold (with accumeasure calipers) puts me at 23% body fat, yet the same skinfold measurement in a 20 year old would be about 20%

For young women (late teens, 20s) 18-25% is the normal/healthy range, for older women 40s+ it's more like 21-28% - overweight is a few percent above this, then obese would be significantly above this range. The usual figure I've seen quoted for women is 35%+ is obese.

For men all these figures would be lower, as men have less essential fat. 25% for men would be too fat, but for women this would be in the healthy range.

stumblinthrulife

Huge fan of boobs...

But where are you getting this 33% number from? I'm admittedly just googleing, but body fat or BMI, 33% is listed as obese for a female too.

I have the same question. I did find one chart that claimed to be based on WHO and NIH, but was on a low carb site. Everywhere else put 33 firmly into overweight in all cases, and usually obese. After all, BMI is just a guesstimate of body fat percentage based on wide sampling. So yes, it is possible or the guesstimate to be off if you are particularly muscular, but the numbers that define the categories don't change.

But we aren't talking BMI. We are talking body fat. The lady in question is saying that although her BMI puts her in the obese category, her Body Fat %age puts her in the acceptable range. Even an olympic athlete could be considered obese when considering BMI alone, because of their greater weight due to muscle mass.

Jackson and Pollock body fat percentage table -

http://cdn.builtlean.com/wp-content/uploads/2010/08/Ideal-Body-Fat-Percentage-Chart3.jpg

You'll see that from age 36 onwards, 33% is in the average range for women, if not ideal.

JNick77

The amount of weight you carry whether you're 10% BF or 30% BF is still poundage that your body has to carry and your heart has to support.

stumblinthrulife

I am in med school right now, so I feel the need to weigh in on this. The future of healthcare is changing and these conversations are going to be part of that change.

First, I go to DO school, which makes my perspective different from most Allopaths (MDs) you are likely to encounter. Basically we are the other type of fully licensed physicians in the United States. Doctors of Osteopathy work in a holistic framework, including the mind, body, and spiritual/social component of the individual. We believe that the body has the tools to be healthy and our job is to support health (through lifestyle, somatic adjustment, or medication). When you see a DO for back pain, they may give you pain killers, but they are more likely to ask about your work environment, your exercises regime and may apply OMT (like chiropractic manipulation, but with science!). Most MDs have not been trained on how to even bring up the obesity issue, let alone counsel on it.

Second, with the new guidelines, the AMA is considering making obesity a disease, so we CAN do nutritional counseling and refer to PT for exercise counseling. In the next 3 years we will be able to prescribe exercise! And when Obama Care goes into full effect, we will be able to bill for obesity and lifestyle counseling, so I think you will see more Docs getting re-certified with diabetes and obesity educator credentials. With the increased use of the medical home model we will see more coordinated care for obesity.

At my school, we believe that EVERYONE should be getting 30min+ of strenuous activity per day. I attend extra workshops in nutrition so when I graduate I will have an added dietetics endorsement, and we learn a lot about sports physiology. Part of my reason for starting this journey is that I don't want to be the fat Dr. telling people to lose weight and be healthy. I am far from perfect, but by the time I start seeing patients I will be able to support their efforts through both knowledge and experience, and I hope I can help change peoples' lives by showing them it is possible and helping them navigate the confusing health landscape.

That is my point of view, and I know it is different, but I can hope that in the near future people will be able to find appropriate support for living healthy (not just disease-free) lives.

Nice to hear from a future medical professional. And heartening to hear that obesity discussions are happening.

People are simply so overwhelmed by the BS they see on TV, and are sold by marketers of both junk food and faux 'health foods' that they need more support from their GP. Most people simply aren't going to to seek out nutritionists or do their own research. For that matter, many will just assuming that all their doc says is 'lose weight' then that's all there is to it. I'm a pretty educated chap, and I will admit that I'd never even thought about differentiating lean body mass and body fat when losing weight.

Further to the personal responsibility issue raised by another poster - if obesity were just impacting them, that would be one thing. Personal responsibility and all, yada yada. But the Western world has a massive problem with healthcare costs spiraling out of control mostly due to completely dietary issues. So assuming you don't like your health insurance and taxes going up and up, it's everyone's issue, whether you are obese or not.

JUDDDing

But we aren't talking BMI. We are talking body fat.

No, I got that. It's just I can't find any source that says that 33% body fat (or BMI for that matter) is ok.

You'll see that from age 36 onwards, 33% is in the average range for women, if not ideal.

The poster is 26. So, above average right? (Whatever average really means in a fattening population).

Nobody seems to use body fat for a measure any more. But... Here's a couple examples.

"Women should have 14-20% essential body fat weight and males should have 6-13% essential body fat weight. The “acceptable” range is 25-31% for females and 18-25% for males. 32% or more for females is considered obese and 25% or more is considered obese for males."

http://www.fitday.com/fitness-articles/fitness/weight-loss/percentage-body-fat-weight---whats-normal.html#b

Obesity is defined as an excess amount of body fat. The normal amount of body fat (expressed as a percentage of body weight) is between 25-30% in women and 18-23% in men. Women with over 30% body fat and men with over 25% body fat are considered obese.

http://www.medicinenet.com/script/main/art.asp?articlekey=46582

This is the closest, if she were 40 then 33% would be ok: http://www.shapeup.org/bfl/basics1.html

Up to age 40, here 33% is "Well below average" (Top 10% highest body fat for white college educated women): http://tpm.scgov.net/ssDocuments/1140/Wellness program/H & F Screening/All screening results.pdf

Not that any of these are awesome sources or anything....

Nor does it matter... It just doesn't seem like an injustice that she'd get the obese lecture.

stumblinthrulife

Here is a Mayo Clinic article about "normal weight obesity" -

http://www.mayoclinic.com/health/normal-weight-obesity/AN02007

Seems I wasn't far off the mark when I said about being concerned about going from being a big guy with too much body fat to being a not-so-big guy with too much body fat.

ninerbuff

Because weight is the NUMBER ONE predictor of health related issues. You can still be overfat without being overweight.

A.C.E. Certified Personal and Group Fitness Trainer
IDEA Fitness member
Kickboxing Certified Instructor
Been in fitness for 28+ years and have studied kinesiology and nutrition

A fair comment, from someone obviously much more qualified than me. But surely the underlying sentiment remains valid - doctors will always say 'lose weight', but will rarely provide or suggest the best ways to lose weight, or tools to aid in it.

This isn't a 'down on the establishment, doctors know nothing' kind of thread, by the way. I have massive respect for my doctor, and most doctors in general, and I follow the advice given closely. I just noticed that weight loss is an area where doctor's advice has been sorely lacking in my experience.

That's usually because most doctors only engage in nutrition for a couple of weeks or so. They will tell you to eat less fat and exercise. Very basic nutritional information.

A.C.E. Certified Personal and Group Fitness Trainer
IDEA Fitness member
Kickboxing Certified Instructor
Been in fitness for 28+ years and have studied kinesiology and nutrition

Sycoholic

I went for my physical for my job. I got the results of all the tests and it shows me at a 32% bodyfat. It's only based off height and weight. Just like Wii shows me as a fat guy. Well the doctor was nice enough to include stuff about me losing weight and how detrimental to my health my body fat percentage is. I didn't realize he had his eyes closed when he examined me.

numsquat

Easy calculation and tracking. You can track weight easily with an inexpensive scale at home. Easy conversion to a BMI chart (which as a whole is very accurate but breaks down as you move to the individual level). The BMI is the still the standard for the medical field and insurance companies.

Luckily my doctor is more about BF% than weight and works with me on this. My medical insurance uses a separate company to track and promote wellness. My bloodwork is all good, my BF% is in a healthy range (15.5%) but my BMI is still "overweight" and I get dinged on the BMI every year. Sucks but even with my doctor telling them my weight is healthy the BMI still reduces the discount I can get on my insurance.

I do have to wonder how you're measuring your body fat mass.

InBody 230 http://www.bvtack.com/2012/10/03/new-body-composition-machine-available-to-students/