Summit looks at doctors' roles in battling obesity epidemic

Physicians should assess their patients for weight problems, although it is unclear whether body mass index, waist circumference or even dress size is the most useful and easy-to-communicate indicator. And what should physicians' roles be in transforming communities to be more conducive to healthy lifestyles?

These are some examples of the issues considered in Chicago last month at the AMA's National Summit on Obesity -- a meeting that gathered together experts and clinicians in an attempt to craft solutions to the nation's obesity epidemic.

"It's a very rare part of medicine that is not impacted by obesity. The time for hand-wringing is over," said Melvyn L. Sterling, MD, summit moderator and chair of the AMA's Council on Scientific Affairs.

Attendees said the first challenge for most physicians was to focus attention on who among their patients was overweight or obese and communicate this information to the patient in a meaningful way. The BMI is used as standard in most scientific research, and summit members considered it a "fifth vital sign." Still, some physicians said patients didn't always understand what it represents.

"Is it really worth devoting our time and resources to explaining the BMI to patients?" said Dr. Sterling. "Or is it more effective to focus on waist circumference? We have got to give patients something they can relate to."

But what to do with a patient after a diagnosis is also a mystery. Several studies have shown that a physician simply telling a smoker to quit is enough to increase the number of people who try to kick the habit. Losing weight, though, is an entirely distinct proposition.

"Weight management is very different, and all of us appreciate how difficult it is to facilitate change in a 15-minute visit," said Robert Kushner, MD, medical director of Chicago's Northwestern Memorial Hospital Wellness Institute.

Summit members agreed that patients needed simple messages and were confused by the many, often conflicting recommendations about physical activity and nutrition delivered by health experts. Advocates called for a more unified front.

"You can fight behind closed doors," said David L. Katz, MD, MPH, director of medical studies in public health at Yale University. "But when you open the door, we should link arms and sing 'Kumbaya.' "

Those in attendance also acknowledged that most patients knew what to do, but the promise of good health over the long term was not enough to convince them to alter their lifestyles.

Attendees debated whether patients should be rewarded in some more immediate way if they lose weight.

"I get $75 for changing my phone company in a quick three-minute phone call," said Michael Parkinson, MD, MPH, chief medical officer for Lumenos, a provider of consumer-driven health care based in Alexandria, Va. "People are busy. Pay real money and let's act as if behavior change is very important."

Walking the walk

Several new recommendations emerged from the summit, recognizing the physician role in mediating the epidemic, either by taking the healthy eating and physical activity message to schools, by becoming activists lobbying their communities for changes that will make them healthier, or by becoming fitness role models.

"Can you imagine a physician who looks like Jabba the Hutt telling their patients to lose weight?" said AMA President John C. Nelson, MD, MPH, who has lost 45 lbs. within the past year. "It doesn't work. We've got to walk the walk."

Experts also agreed that pharmacologics and surgery, while valuable tools, were not going to solve the problem and that what is needed are fundamental changes at every level of society.

"We can't abandon the people who are already in trouble," said Mike Magee, MD, senior fellow in the humanities for the World Medical Assn. "But we will never get ahead of this thing unless we change the way we're making our investments and focus on prevention."

The summit's recommendations will be presented at the AMA's Interim Meeting in December. A full summit report is expected next June.