You sit sheepishly in the exam room after tipping the scales more than you had hoped, your blood pressure clocking in well above a healthy 120/80. You know you’ll get an earful about exercise and eating right. And then, in walks your doctor. He must weigh even more than you do! Indeed, he pants and wheezes as he wends his way over.
Folks, it shouldn’t be like this. Doctors — the very caregivers paid big bucks for doling out health guidance — should have to walk their talk, without wheezing. If you’re obese or smoke or have a little prescription drug problem, well, you shouldn’t be certified to practice.
This isn’t fat-phobia talking. Research shows that obese physicians are less likely to encourage patients to adopt a healthier lifestyle — perhaps because they know their patients won’t take them seriously. Indeed, study after study shows that healthy doctors make for healthy patients. Physicians who don’t smoke are more likely to advise patients to quit smoking, according to a 2010 Canadian Journal of Public Health study. Physically active doctors are more likely to recommend exercise, according to a 2013 American Journal of Lifestyle Medicine literature review. “It makes the message more credible,” says Felipe Lobelo, an associate professor of global health at Emory University’s Rollins School of Public Health, who led the research.
Physician fitness should start at med school, a notoriously high-stress environment that offers students little time to sleep, let alone exercise.
None of this is to say we should impose fitness rules without helping doctors follow them. After all, they “suffer from what many suffer from,” says Sara Bleich, an associate professor at Johns Hopkins Bloomberg School of Public Health: “They have no time.” Some 34 percent are overweight, according to a 2013 Obesity study Bleich led, while 8 percent struggle with obesity.
Which is why physician fitness should start at med school, a notoriously high-stress environment that offers students little time to sleep, let alone exercise: Please, for our sake, abolish the grueling residency all-nighters. Put decent gyms in hospitals. Get rid of the Cheetos in the vending machines and let them eat kale and quinoa instead. Hospitals that care about their employees’ health create “a culture of health” that makes it easier for them to practice what they preach, Lobelo says.
There is a counterargument, of course, and it’s supported by Bleich’s research. It turns out that overweight patients actually preferred to get diet advice from overweight doctors familiar with their own struggle. And weight requirements might further fuel society’s stigma against obesity, which is a complex disease that stems not just from poor diet, but also from genetic and environmental factors. In other words, obesity shouldn’t be blamed on any individual.
Which is all the more reason to create a culture of health around the practice of medicine. The stigma against the obese isn’t going away anytime soon, and it colors how patients view doctors. A 2013 International Journal of Obesity study found that people were less likely to trust overweight or obese physicians, and were more likely to switch providers. “It’s important to talk about preventive messages,” says Lobelo. “But it’s not sufficient sometimes. You also need to walk the talk.”