If Physicians Talk the Talk, It's Time to Walk the Walk
Public Health Feature -- February 2005
By Erin Prather
Centuries ago, the physician Galen wrote, "That physician will hardly be thought very careful of the health of his patients if he neglects his own."
Galen's quote illustrates how a physician's health choices can affect his or her patients' impressions. It also supports the idea that physicians must evaluate their own habits and the messages they are sending patients if they wish to combat the current obesity crisis.
Former Texas Medical Association President Jim Rohack, MD, compares the message conveyed by an overweight physician with that of a disorganized office.
An orderly office "is a nonverbal cue that the office has its act together," he said. "However, if a patient walks into an office with papers strewn everywhere and chaos answering the phone or organizing charts, the impression is negative. Patients become worried that their charts or lab reports may be lost and that they will not receive the best possible care. Likewise, the physical appearance that physicians present to patients is invaluable and can be a strong factor in how receptive a patient is to a physician's counsel."
An Emory University School of Medicine study investigated whether physicians disclosing their own healthy behaviors would enhance their credibility and motivate patients to adopt healthier habits. Study participants watched two videos on improving diet and exercise.
The first showed a physician who talked about her own fitness regime with an apple and a bike helmet on her desk. The second showed a physician who said nothing about personal health practices and did not include props. Viewers considered the first physician healthier, more believable, and motivating about exercise and diet. Researchers concluded that physicians can enhance their counsel to patients to adopt a healthier lifestyle if they share their personal health habits.
Madisonville family practitioner Andrew C. Eisenberg, MD, understands the impression a "healthy" prop can make. He wears a pedometer in the office.
"When my patients ask what the pedometer is, I explain that I am trying to walk 10,000 steps every day, and this is a way to moderate small amounts of activity. It's a method I use to show that all activity is important. It also prompts a discussion about things patients can do to increase activity, such as parking their car at the end of the parking lot or taking the stairs instead of the elevator. These lifestyle changes are small, but they add up."
Kenneth H. Cooper, MD, founder of the Dallas-based Cooper Aerobics Center, believes in setting a healthy example. He exercises regularly.
"I practice what I preach. I keep my weight under control and work out five days a week. I try to set an example for my staff and patients. I have always felt that if you want to get the troops involved, you have to get the general involved."
In 2003, Michael Fleming, MD, of Shreveport, La., board chair of the American Academy of Family Physicians (AAFP), challenged the AAFP's Congress of Delegates to improve their own health and become involved in AAFP's Americans in Motion (AIM) initiative. AIM encourages family physicians to be fitness role models, improve their ability to positively affect their patients' fitness, and enhance family physicians' awareness of their ability to promote fitness in their communities.
Dr. Fleming also committed to wear a pedometer, walk 10,000 steps each day, lower his body mass index, and enroll in the Active Lifestyle Program, created by the President's Council on Physical Fitness and Sports. The program urges citizens to participate in at least 30 minutes of activity five days a week for six weeks.
"In my early 20s, my grandfather was in the hospital with what turned out to be his final heart attack," Dr. Fleming said. "I remember the doctor telling him he had to stop smoking. The doctor then walked over and crushed out his own cigarette in the ashtray."
That made Dr. Fleming realize that he was "acting exactly like that doctor. I was telling my patients they needed to be active, get their weight down, and watch their diet, but I wasn't doing that myself. For many years I wasn't being a good role model, which is essential to being an effective counselor for fitness."
Last October, AIM launched the "Healthiest Family Medicine Office in America" contest to encourage family practices to recruit physicians and office staff members interested in making healthy lifestyle changes that can be woven into daily life.
Dr. Fleming's staff started a "Dump that Frump" weight-loss contest. "At last year's Christmas parties, gift certificates for a health club were given out to the winning team. Everyone on my staff participated and we now have patients involved."
Research in the American Journal of Health Promotion suggests three reasons why worksite health programs are beneficial.
- Discussing physical health at work can reach many people, including those who would not seek professional help on their own. Newsletters, Web sites, and bulletin boards can be used to recruit workers to participate.
- Support from the employer and coworkers can positively influence eating and exercise behaviors.
- Obesity-related health problems can result in direct health care expenses to employers by negatively affecting productivity through illness-related absenteeism, disability, and low employee morale.
Robert McLellan, MD, assistant professor of medicine at Dartmouth Medical School and chair of the American College of Occupational and Environmental Medicine's Committee on Emerging Preparedness and Response, says simple things can be done at work to increase incentives to boost activity and improve diet. Suggestions include encouraging physical activity breaks during the day, giving employees time to walk or use the gym, and posting a list of calories expended by common activities such as walking, bicycling, and running.
In 2001, obesity was estimated to cost Texas businesses $6.3 billion dollars in lost productivity from sick days and health insurance costs.
"Physical fitness is good business for the individual, as well as the corporation," said Dr. Cooper. "The cost of employee health care is reduced, having such programs makes it easier to recruit employees from the marketplace, and productivity increases."
It makes sense for physicians to take care of themselves and their employees. By being an example to their staff and patients, physicians can make a difference and strengthen their role as health advisers.
Erin Prather can be reached at (800) 880-1300, ext. 1385, or (512) 370-1385; by fax at (512) 370-1629.
Obesity Summit at TexMed 2005
The increase in the number of obese people is causing a significant growth in health care costs in Texas and across the United States. It is estimated that approximately $10 billion is spent annually in Texas on obesity-related conditions.
An Obesity Summit at TexMed 2005, May 12-14 in Grapevine, will inform physicians on the magnitude and economic impact of the obesity epidemic in Texas. The program also will provide practical approaches and tools for physicians to address overweight and obesity in both their communities and individual practices.
The situation is particularly evident along the border. Border residents are becoming more overweight and obese.
A study by the U.S. Centers for Disease Control and Prevention, the Mexico Secretariat of Health, and the Pan American Health Organization found that residents along the U.S.-Mexico border are more overweight than national averages in both Mexico and the United States. The survey, which consisted of 4,000 participants from the area, also found that almost 16 percent of border residents suffer from type 2 diabetes.
According to the United States-Mexico Border Health Commission, nearly 4,000 border residents die each year due to diabetes, with about 1,500 fatalities in the United States and about 2,500 in Mexico.
Additionally, a study published in the Dec. 15, 2004, issue of the Journal of the American Medical Association reports that among immigrant subgroups, those who have lived in the United States for 10 or more years approached the same prevalence of obesity as that of U.S.-born adults. The report suggests this escalation may reflect acculturation and adoption of U.S. lifestyle patterns, namely, poor dietary habits and lack of activity.