New Hampshire doctor's words trigger obesity focus

A New Hampshire physician's battle with the state medical board over what he said to an obese patient has other doctors questioning what is OK to say to patients carrying unhealthy extra weight.

Rochester, N.H., family physician Terry Bennett, MD, attracted national attention in August when he said publicly that the New Hampshire Board of Medicine was investigating him because of an obese patient's complaint. Dr. Bennett said he gave the woman his standard obesity lecture that she likely would outlive her obese husband and have a tough time finding someone else because of her weight.

But state officials said Dr. Bennett made a racial remark when he told the patient to lose weight. According to documents, the woman alleged the doctor told her she may only be desirable to a "black guy." New Hampshire Senior Assistant Attorney General Richard Head said Dr. Bennett's remarks to the patient were in the context of obesity, but the probe is "related to the racial undertones."

Although the complaint has issues beyond how the doctor addressed the patient's obesity, it has nonetheless prompted some physicians to call the New Hampshire Medical Society and ask what they can say to obese patients without triggering a complaint.

"I've suggested to the board of medicine that they clarify the obesity issue," said Palmer Jones, the society's executive director.

The board's probe comes at a time when obesity has reached a crisis level and physicians are being urged to place more emphasis on the problem with patients. The Centers for Disease Control and Prevention said 65% of U.S. adults are overweight or obese. A new report in August by the advocacy group Trust for America's Health said obesity rates increased in every state last year except Oregon.

Last year, the American Medical Association held the National Summit on Obesity, which brought health experts together to identify ways to fight obesity. In June after the summit, the AMA issued new directives to fight childhood obesity, including encouraging doctors to collaborate with communities to help develop health programs in schools. AMA policy urges physicians to assess their patients for overweight and obesity during routine medical exams and discuss with at-risk patients the health consequences of further weight gain.

Addressing weight can be difficult

Groups might be encouraging doctors to discuss the issue, but some physicians struggle to get the obesity message across to patients.

A study of 355 North Carolina pediatricians found that pediatricians who identified themselves as thin or overweight had more difficulty counseling about weight than colleagues who considered themselves average weight. Researchers said overweight doctors might worry their counseling would seem hypocritical, while thin physicians might worry their patients would view them as unsympathetic, according to the study in the February 2005 Obesity Research.

"It's very frustrating for physicians and for society to treat obesity. It's hard for people to assume they're responsible for their own weight [problem]," said Reginald Washington, MD, a pediatric cardiologist in Denver and co-chair of the American Academy of Pediatrics' obesity task force. "It's not uncommon for parents and patients to be upset when someone approaches the topic of obesity. That's more normal than not."

Dr. Bennett, the New Hampshire doctor, said he learned about his obese patient's complaint last year and wrote an apology to the upset patient. He said he did nothing wrong.

"My job is to get your attention, and have you read my obituary rather than the other way around," he said. "If we shoot the messenger every time they deliver a bad message, then there won't be any messengers left."

This isn't the first time Dr. Bennett has been brought before the board. It fined him $1,000 in 1995 for providing false information on medical license applications about being denied hospital privileges.

The board also is re-examining a 2001 complaint from another patient who said Dr. Bennett told her to commit suicide to end her physical suffering. The doctor denies any wrongdoing. A hearing has been set for Dec. 7 on that complaint and the one involving the obese patient.

Physician leaders said they hoped the current investigation against Dr. Bennett would not stop doctors from talking about obesity for fear of being the focus of a patient complaint.

"I hope there are none who back off," said American Academy of Family Physicians Board Chair Michael Fleming, MD. "What I hope is doctors look at their sensitivity and be respectful and sensitive when they talk about [obesity]."

Dr. Fleming said physicians need to be sensitive when addressing obesity with patients, just as they would discussing sexually transmitted diseases and substance abuse problems.

Arkansas internist William Golden, MD, said physicians might encounter frustration from patients when they address obesity. He said physicians need to approach the matter with a certain amount of delicacy but they must be honest with their patients about the health problems that come with obesity.

"You cannot assume that you can give every patient the same message in the same format," said Dr. Golden, chair-elect of the American College of Physicians' Board of Regents. "There are patients who you break news to who will not be happy, and that's part of being a doctor."