Every year I go for my annual checkup and every year I come out of the office ticked off that my doctor has not told me I’m fat. I know I’m in the minority here, but I want my doctor to talk to me about my weight.

June 21, 2013

Every year I go for my annual checkup and every year I come out of the office ticked off that my doctor has not told me I’m fat. I know I’m in the minority here, but I want my doctor to talk to me about my weight. That’s because I want him (or her) to be my full partner in my pursuit of health—and ignoring the fact that I’m obese is not helping me.

My doctor makes sure I get my regular colonoscopies because of my family history of colon cancer and keeps up on the latest news about statins. But in spite of the fact that I repeatedly bring up that I want to lose weight, he shrugs it off. I wear my fat pretty well (and the Spanx don’t hurt either), but this person sees me nearly naked and obviously is capable of calculating my BMI. And, yet, no weight-loss advice has ever come out of his mouth, even when solicited.

I’m hoping that’s about to change, thanks to the American Medical Association’s recent vote to classify obesity as a disease. Here’s why I think that decision will be good for those of us who could stand to lose some weight.

1. We won’t be alone in our weight-loss attempts.
In the past, weight-loss programs have been mostly consumer-driven, says Paul Terpeluk, DO, medical director of occupational health services at Cleveland Clinic. “You joined a weight-loss program—that was between you and Jenny Craig,” he says. But now that will change, he says, as your physician, employer, and insurer may all get more involved.

In fact, Cleveland Clinic could be a poster child for what weight-loss partnership could look like. Since 2007, Dr. Terpeluk and Cleveland Clinic have integrated wellness programs into their health insurance plans. Employees and their insured dependents are incentivized to make healthy choices for themselves by enrolling in five wellness programs tied to premiums. In 2008, obesity became one of the chronic diseases (in addition to hypertension, smoking, high cholesterol, and diabetes) that patients could volunteer to manage in exchange for an incentive.

“If they enroll in our obesity disease management program we reward them with a lower insurance premium,” says Dr. Terpeluk. “And, finally, you have a doctor and a patient in the room talking about the issue of weight. They’re talking about BMI and all of the chronic issues associated with obesity, just like they should be,” he says. “They are talking about it and they are acting on it.” In addition, participants receive free Weight Watchers classes and Curves classes.

Programs like Cleveland Clinic’s not only help the obese person feel like they’re not alone, they get financial and health insurance support for their weight-loss and health-seeking efforts—and if they follow through with the program are likely to have an improved quality of life. And, in the end, employers like Cleveland Clinic save money.

2. Quackery won’t cut it.
If you’re like me, you’ve tried more than one ridiculous weight-loss product with little more to recommend it than a talk show host (raspberry ketones, anyone?). I’m guessing that there will be less of that once doctors, employers, and insurers are involved in the weight-loss biz. Of course you can still pick up whatever you want at the corner drug store or online, but if you’re going to be working with your doctor, employer, or insurer, the scene changes.

“It will bring some legitimacy to weight-management products,” says Dr. Terpeluk. “Once you move into the employer realm, they’re only going to pay for what works and that means products or programs that are evidence or science based.”

The people at Weight Watchers see this as a good thing. As a well-known weight-loss method that’s often recommended by doctors, it may benefit both from the AMA’s classification of obesity as a disease and the new harder look at what programs really work. Weight Watchers has been well researched, and is a safe, non-gimmicky program that emphasizes healthy basics like counting points or calories, moderate exercise, and social support.

3. Less stigma = less blame. And maybe less emotion?
Don’t let anybody tell you that some people don’t think less of people who are overweight or obese. A recent study of human resource managers proved that (once again). Having obesity designated as a medical condition instead of a “behavior problem” may make it easier for a doctor to treat it and easier for a patient to have it treated.

And maybe it will strip away some of the emotional baggage that gets in the way of dealing with it? “I think that’s exactly what will happen because obesity has been put in the world of beauty,” says Dr. Terpeluk, “when it should be in the world of medicine.” He says many people deal with obesity by pretending they don’t have it. “They look in the mirror and don’t view themselves the way they are because they have a built-in denial system. They don’t want to talk about their weight because it’s personal and it’s emotionally upsetting because they are thinking of it in terms of beauty instead of in terms of its association with medical risks.” That makes it awkward to talk about it with their friends and even at the gym, he says. But now it should be easier to talk about it with the doctor.

I’ve been trying to come out of the closet as a fat person seeking help from my doc for years. Maybe this AMA re-classification will make my doc listen.

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