Fat Arguments on Thin Ice

Via Kevin, MD comes news of MedGenMed's latest video (registration required), featuring Dr. Michael Dansinger, excerpted below:
Is that white-coat feeling a little tight? Many physicians are overweight or obese for the same reasons our patients are.[1] Many of us do not eat right and get enough exercise.[2] We work long hours, making it seemingly impossible to squeeze regular exercise into our busy daily routines. We eat on the run and unhealthy food (often served in our own hospitals) is commonplace.

Physicians rally against obesity, and yet, we are not doing all we can. Sadly, those of us who fail to embrace lifestyle recommendations in our personal and professional lives promote a public perception that lifestyle change is ineffective or unrealistic.[3] Despite dramatically increasing obesity rates, we have failed to improve our dismal obesity counseling rates.[4] The physicians who fail to recognize and treat obesity are often the ones who personally fail to heed lifestyle recommendations,[5] and these doctors may sometimes lose credibility with their own patients.[6]

I know we can do much better. First, we must recognize that the human body needs at least an hour of exercise daily for optimum health, and every able-bodied physician should strive to achieve this...

Sigh. Does anyone keep track of all these mandates, to sleep more, eat better, exercise an hour a day, build strong, healthy relationships, etc? Because it adds up to about a 33-hour day, by my calculations.

Go look at the comments to my earlier post -- the physicians who wanted me studying on a Saturday night in residency, rather than having a beer with my new colleagues. Maybe they would allow me an hour a day to exercise -- not for my health, of course, but so I can better counsel my obese patients. I'm guess I'm fortunate we live in an era where I can listen to lectures on my music player at the gym (and, by the way, I drink lite beer when circumstances warrant).

Anyway, back to the video -- I'm not impressed with Dansinger's citations. #5, for instance, seems to imply that doctors with obesity issues are less likely to bring those same issues up with patients. Well, it's based on a mailed survey to 355 pediatricians (!) in North Carolina. If I were a fat pediatrician, I might be a little reluctant to counsel a fat child, myself, because, you know, little kids can't abstract like adults can. But then again, maybe Dr. Dansinger was hoping his viewers couldn't abstract, either.

The important study that Dansinger cites, #6 -- the lynchpin to his whole argument -- is this small survey study from three years ago. Patients from five (5) doctors in Georgia were surveyed about their counseling and recommendations. Two were obese. The patients from the two obese physicians had less confidence in their recommendations about illness and health advice. Fine. What's interesting, and invalidates Dansinger's whole argument, is that there was NO significant difference in patient's confidence on their obese doctor's weight and fitness advice.

Kevin MD's commenters said it best:
I would rather have an overweight Dr. try to educate me about obesity, than some litle skinny guy who never had to watch anything he has eaten in his life.

...Well, who can better explain obesity than one who is suffering?

I don't know many obese physicians, but all of them are working on losing weight. Accusing these struggling doctors of somehow hurting their patients, by citing some ridiculously underpowered and inappropriate studies, is completely unwarranted.

I think Medscape treated this complex issue with more sophistication when they ran my Pre-Rounds interview with Fat Doctor. Yeah, it's anecdotal evidence, but it's honest in a way that Dr. Dansinger's video is not.