My brother-in-law, David, recently underwent a complete physical; it had been several years. His regular doctor was booked out for several months, so my sister scheduled David’s appointment with another provider… someone he hadn’t seen before.
This provider entered the exam room and told David his blood pressure and labs looked good. And then she hit him with this: “I’m not going to beat around the bush; you’re fat.” David was stunned. He knew he could stand to exercise more and lose some weight, but this remark was terribly blunt and unkind. She proceeded to ask him what he weighed on graduating from high school (~30 years ago). “I want you to go to the gym, do cardio, and don’t do strength training,” she went on. “Come back in 3 months; by then you should be 30 pounds lighter.”
As David told me his story, his irritation and defensiveness were easy to see. Half-kidding, he said, “Go to a gym? Lose 30 pounds in 3 months? Forget that; I’ll show her — I’ll gain 6 pounds instead.” Later, he stated he would never go back to that provider.
A Missed Opportunity
Health behaviors are personal. Changing them is anything but easy, as discussed in Small Steps or Giant Leaps — What Works Best for Health Behavior Change?
Nobody wants to be treated like a misbehaving child or bulldozed into attempting a change they’re not ready for. The provider may have had good intentions, but her message left him feeling patronized, resentful, and unlikely to make a change anytime soon.
To say I’m disappointed by David’s experience is putting it lightly. As clinicians, employee wellness leaders, registered dietitians, fitness professionals, coaches, and others, we all have a genuine desire to help people. Whatever our specific role, there’s an understanding — and an expectation — that we all work together and do our best for the good of the patient. When somebody drops the ball, and the patient suffers, our collective effectiveness takes a hit.
Many excellent professionals are out there, doing the right things to promote behavior change. But because David’s experience isn’t all that unusual, our industry as well as employers and HR managers have cause for concern. Our carefully constructed wellness programs, integrated services, and communications direct clients to seek regular preventive care. But what if, when they show up for office visits, they’re told, “You’re fat; do this, do that.” Think about the ramifications; they may:
What to Do — HR and Wellness Pros
As large purchasers of healthcare services, employers are gaining ground in influencing quality of care. A few ideas:
What to Do — Health Care Providers
It’s no secret that unhealthy lifestyles form the basis for many noncommunicable diseases. As evidenced by research on tobacco and physical activity interventions, providers can have a profound influence on a patient’s decision to change. Here are a few tips and resources to share for incorporating behavior change counseling into clinical practice:
The Institute of Lifestyle Medicine
American College of Lifestyle Medicine
Wellcoaches® Coaching Psychology Manual — Lippincott Williams & Wilkins, 2010
ACSM’s Exercise is Medicine™— A Clinician’s Guide to Exercise Prescription — Lippincott Williams & Wilkins, 2009.