In the health reform debate, U.S. Health and Human Services Secretary Kathleen Sebelius has been talking a lot lately about personal responsibility. During a recent appearance on the Daily Show, she jokingly admonished host Jon Stewart to "have a lettuce sandwich" instead of a Snickers bar.
"There's personal responsibility in all of this," she said.
So why are so many health providers not in sync with her message? Far too many practitioners who are supposed to model good health habits and counsel their patients about getting to a healthy weight don't think their messages need apply to themselves.
That's the concern from a growing number of providers who worry that excess weight on the trusted healer may be one reason seriously overweight patients don't take seriously any advice to slim down. If the doctor or the nurse or the physician's assistant thinks it's okay to be that way, then it must be okay for the patient too.
One such physician who worries a great deal about the expanding girth of those in the health professions is Nick Yphantides, M.D., now consulting medical director for San Diego County Health and Human Services Agency.
In his new role, he speaks to and attends a lot of medical conferences. "And all around I see a disproportionate number of obese and overweight physicians. And to me, the rate of obesity among health professionals, subjectively, is at least a bad if not worse than in the general population," he says.
"You go to a hospital or an outpatient setting, and the first people you see are the nurses stuffed into scrubs, like 10 pounds of groceries in a 5-pound bag."
"We have to walk the walk and talk the talk," Yphantides said. "Unfortunately, in this area of fitness and weight, the majority of the time, we are saying one thing and doing another. And it really is unacceptable."
Yphantides is an evangelist on the subject because he too used to be morbidly obese, a self-proclaimed "board certified medical hypocrite" One day in 2001, he was trying to counsel an obese patient when he realized the absurdity.
He decided to prove that he could change, and send a message for his patients as well.
He took a leave from his then job directing a community clinic and launched a year-long campaign to tour the country to see baseball games in 50 stadiums, one in each state. Along the way, he absorbed a high protein liquid diet, exercised and lost enough weight to become a shadow of his former self. He shed 270 pounds.
In his role with San Diego County, he hopes to persuade health providers as well as patients that weight is at the heart of health reform. But it must start with the the role models in healthcare. The doctors and nurses.
"I really think that there needs to be a meaningful investment into the health and well-being of those at the bedside," he says.
Kevin Pho, who blogs as KevinMd agrees.
"An overweight doctor is like a skinny Santa - nobody really trusts either one," he once wrote in his blog.
While there is little research on the rate of obese and overweight physicians, some studies are starting to appear on the tendency among nurses.
Last year, a study in the Journal of the American Academy of Nurse Practitioners reported on the results of a questionnaire mailed to a sample of nurses in six states. Nearly one in five of those who responded disclosed a BMI corresponding with obesity, and one in 20 revealed their BMI qualified them as morbidly obese.
Overall, 54% were overweight or obese, lower than the general population of adults which is 65%, but this figure was derived from personal disclosure by the participants in their mailed responses, not clinical examination of the participants, and may in truth have been much higher.
What's worse, in this sample, 71% said their professional roles included health education, but of these nurses, 18% were obese and 31% were overweight.
And 76% said that even though they acknowledged that overweight and obesity are diagnoses requiring health intervention, they do not pursue the topic with overweight and obese patients, perhaps because they did not feel prepared to discuss the problem, the survey study said.
Yes, there is an awkwardness to discuss the subject, wrote pediatrician Perri Klass, MD, in last week's New York Times. She described her own difficulty trying to counsel an 8-year-old whose rapidly increasing weight did not align with the child's age.
"How on earth, I was thinking, am I supposed to give sound nutritional advice when all they have to do is look at me to see that I don't follow it very well myself… How am I supposed to help stem the so-called epidemic of childhood obesity when not a week goes by that I don't break my own resolutions? What price the not-skinny doctor?" Klass wrote.
Another report in the Journal of the American Medical Association several years ago described the reaction from patients who were shown videotapes of a physician giving advice about diet and exercise. The patients reported that the physicians were more believable and motivating if they discussed their own personal healthy practices than if they did not.
"Physicians who have healthy personal habits are more likely to discuss related preventive behaviors with their patients," the report said.
Dr. Michael Dansinger, Obesity Researcher at Tufts-New England Medical Center, sent a video message to his fellow practitioners asking the question: "Is that white-coat feeling a little tight?"
"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," Dansinger said. "Second, we should eat at least five servings of vegetables and fruits daily, and third, those of us with excess body fat should literally count our daily caloric intake and aim for about 12 calories per pound of ideal body weight.
"If we can commit to these goals, both as individuals and as a medical community, imagine the example we would set! As individuals we will feel better and stronger, and as a medical community we'll serve as better role models for our patients.
"To succeed in healing others, we must also heal ourselves."