Shocking!

I saw a woman in consultation last week for the sudden onset of a blood disorder. Very treatable but requires large doses of steroids. As I was taking her medical history, I asked her how long she had been obese. She was stunned that I would ask, but she told me that she knew she weighed over 400 lbs. 10 years ago but was too large for any scale now so she wasn't sure how much she weighed. She related how she had been a regular size 10 and began overeating.

What amazed me was that she is very intelligent, well groomed in spite of her size, meticulous about tracking her blood sugar ( she has diabetes) watching her blood pressure ( has high blood pressure, too) and has been going to the same doctor for many years. He is an excellent physician. But according to her, no one has ever really talked to her about her weight. She said "You are very brave to bring it up." Brave? I think it is my job. If I did not address a life threatening blood sugar or elevated blood pressure, it would be malpractice and I could very well be sued. But physicians are afraid to discuss weight because it is politically incorrect to point out a personal "flaw". I think we need to address this issue in a non- judgemental voice as we would any other medical issue. But it must be addressed. This is not the first patient to express surprise that I would use the word obese in our discussion. Oprah can talk about it on her show and the audience applauds, but when the doctor points it out to the patient we are labeled insensitive. Let's treat obesity as we do all other medical conditions and stop avoiding a serious national health crisis.