Weighing in on Doctor Refusing 200 Pound Patients

As I turned on the morning news the other day, the attention grabbing “teaser” headliner was about a physician in Shrewsbury, Massachusetts who refused to treat anyone weighing more than 200 pounds (link below).  If you haven’t heard it, the recap is that an internal medicine physician has decided to reject all new patients weighing over 200 pounds. She indicates that her staff has been “hurt” by handling these heavier people (not sure what she means by this), and that those patients already in her practice and weighing 200 pounds were grandfathered in.  She further notes that some of these grandfathered patients proceeded to lose weight after her office policy was implemented. The physician further states that there is an excellent university affiliated medical facility nearby which is much better suited to being able to handle very large patients. This scenario seems to beg the question, “is this a new trend in the medical profession?”  Will the United States evolve to medically managed weight loss centers for all people classified as obese?

Mayor Bloomberg restricts soda pop, Michelle Obama encourages us to plant vegetable gardens, but what can individuals and society really do to take responsibility?  This will become even more pressing of a concern to individuals if primary care physicians begin to refuse treating heavier patients on a wider scale.  If those heavier people are required to find access to health care in settings equipped to handle their special needs, this could also potentially handicap the weight loss process even more-if possible.  Right now, we are failing in managing our weight as a nation, just as we are failing at balancing our national budget.  We did not come to this point because of one problem.  We are a society that is not generally inclined to move:  we stay inside for safety reasons (like dodging bullets), we sit in front of computers all day, we play video games rather than dodge ball, and we eat out constantly.  While eating out is a great treat, doing so too often really insures your energy intake is too high which translates to weight gain.  Unless you are training for a marathon or triathlon, you still need to critically manage your energy intake if you are going to manage your weight.  All too often, those that workout regularly still forget the energy content (meaning calories) of the food they consume.  So, again, what are some solutions?

I do not have a simple solution because there is not necessarily a simple solution to a laundry list of factors causing this national crisis.  Our current societal complexities seem to set us up for obesity at this point.  Both physicians and patients need to take responsibility for slimming down the nation.  Apparently, it is perfectly legal for this physician to screen her patients according to weight limits.  If this is her prerogative (and it’s her practice), she should make a point of offering some other options to her patients.  While she was relying on a nearby medical facility affiliated with a teaching hospital, she and other physicians should have business cards of dietitians, therapists, and trainers and refer to those professionals!  And, patients need to take responsibility as well.  There is no magic solution here.  The message to move more and eat less is perceived as “boring” by many.  And to many, this simple message is not really simple.  After all, how much should one really eat and move in order to both prevent and manage obesity?

What can we do as a nation?  Please provide input to this question directly on my blog.  I look forward to your comments.




A Dietitian’s Commentary: Are You a Nutrition “Purist” or “Realist”?

It seems as though these days everyone has an opinion about the field of nutrition.  There is a an old saying that “some people think they are experts on eating, because they eat.”  So, that could mean that potentially the whole human race could perceive themselves as nutritional experts!  Of course, some of those people are experts with years of college level education under their belts, but some are simply uninformed, uneducated, or misdirected, but very interested in the field of nutrition.   What I know for sure is that more people in more and varied fields are now providing nutritional advice to the American consumer.  And, more nutritional advice is rapidly and readily available these days at the touch of our fingers as well as from “doc google.”  So, this blog is about how those of you that give nutritional advice handle the words you choose while guiding those you are attempting to help with nutrition.  It is also meant as food for thought for the consumer who is seeking nutritional guidance.

It seems as though some of those disseminating nutritional advice are best described as purists.  A purist could be described as a person “who insists on great precision and correctness” in a particular discipline, nutrition in this case.  It seems that, more and more, those that are guiding consumers are often leaning to what I call this purist mentality.  This purist mentality is along the lines of “the diet must be perfect, no junk, no sugar, no fat, and so on.”  I must add at this point that I would love my clients to eat only at home, only what they know to be good for them, only whole unprocessed foods, and only in the correct portion sizes.  With that stated, my experience tells me the purist mentality does not necessarily fit all people.

A realist could be described as “a person who accepts the world as it literally is and then deals with it-realistically.”  This appears to be the case, in particular, for those practitioners who have counseled for a long time and been “around the block a few times,”  as I like to describe myself with regard to my life-professional experience.  I tell my clients that I can design what I feel to be the  “perfect” eating plan, but if they cannot follow it long enough to help their health, then what good is it?  I would call myself a realist.  I would be happy to have my clients switch to a flavored green tea rather than a high fat Starbucks Frappuccino or big serving of soda!  That’s right, the flavored green tea might not have the same nutritional edge as plain green tea, but it’s a start in the right direction!  That’s what I want from my clients-to move in a better dietary direction.  One size does not fit all, especially when telling people how to eat.  And, the concept of tailoring a diet to an individual can also mean that like a pair of slacks or suit, the “diet” can be tailored with time as the person’s nutritional requirements and acceptance of dietary change evolve.

How do you choose to counsel your clients?  And consumers, what nutritional guidance has worked for you?