by ADAM COLE (NPR)
Back when smoking topped the list of America’s health woes, researchers found that smokers who had a brief conversation with a doctor — just a three minute chat that addressed their habit — were significantly more likely to quit.
Now the nation is smoking less, but a whopping two-thirds of Americans are overweight. Can doctors help patients shed weight, the way they have helped them kick cigarettes? A couple of recent papers suggest the answer is yes.
In one study, obese patients whose doctors talked to them about their weight did a better job at preventing further weight gain. In the other, patients who were told they were overweight by their physicians were more likely to want to do something about it.
However, fewer than half of overweight people and fewer than two-thirds of obese people in the second study had been told by their physicians that they wereoverweight.
“Physicians need to tell more overweight and obese patients that they are overweight,” the authors of the second study say. “This may help encourage them to change their behavior to lose weight and lower their risk for many diseases.”
So why aren’t more physicians talking to their patients about weight?
We asked Dr. David Katz, the founding director of Yale University Prevention Research Center, who told Shots some doctors feel it just isn’t their place. They aren’t confident in obesity treatments, aren’t trained to counsel patients about weight loss, and aren’t paid do so. And they’re afraid of offending patients.
“Doctors saying, ‘don’t you realize your fat and its bad for your health,’ is about as constructive as putting pins in a voodoo doll,” Katz said. “Sometimes I joke that if you make your patient feel one foot tall, and they are already overweight, their body mass index goes through the roof.”
To be constructive, doctors have to choose their words carefully. “Patients really feel that words like ‘fat’ and ‘obesity’ can be negative,” Dr. Rebecca Puhl of the Rudd Center for Food Policy and Obesity told us. “Neutral terms like ‘body mass index’ or even ‘body weight’ are better.”
There’s one way to bring up the problem without fear of offense. “Blame it on the government,” Dr. Robert Baron, who directs the UCSF Weight Management Program, told us only half jokingly. “Say, ‘Your body mass index puts you in a range the federal government would call overweight.'”
Comparing patients to standardized definitions brings obesity into the realm of less stigmatized risk factors, such as high blood pressure.
Still, Baron stressed that weight loss may not be the answer for everyone. “We live in a society with all the wrong food choices, and all the wrong messages telling us to do all the wrong things,” agreed Katz. “This problem is not a clinical one, but I think clinicians need to be a small part of the solution.”
CAN COFFEE REDUCE STROKE RISK FOR WOMEN?
DALLAS – Women who enjoy a daily dose of coffee may like this perk: It might lower their risk of stroke.
Women in a Swedish study who drank at least a cup of coffee every day had a 22 to 25 percent lower risk of stroke, compared to those who drank less coffee or none at all.
“Coffee drinkers should rejoice,” said Dr. Sharonne N. Hayes, a cardiologist at Mayo Clinic in Rochester, Minn. “Coffee is often made out to be potentially bad for your heart. There really hasn’t been any study that convincingly said coffee is bad.”
“If you are drinking coffee now, you may be doing some good and you are likely not doing harm,” she added.
But Hayes and other doctors say the study shouldn’t send non-coffee drinkers running to their local coffee shop. The study doesn’t prove that coffee lowers stroke risk, only that coffee drinkers tend to have a lower stroke risk.
“These sorts of epidemiological studies are compelling but they don’t prove cause,” said Dr. David S. Seres, director of medical nutrition at Columbia University’s College of Physicians and Surgeons in New York.
The findings were published online Thursday in the American Heart Association journal Stroke.
Scientists have been studying coffee for years, trying to determine its risks and benefits. The Swedish researchers led by Susanna Larsson at the Karolinska Institute in Stockholm said previous studies on coffee consumption and strokes have had conflicting findings.
“There hasn’t been a consistent message come out,” of coffee studies, said Dr. Cathy Sila, a stroke neurologist at University Hospitals Case Medical Center in Cleveland.
For the observational study, researchers followed 34,670 Swedish women, ages 49 to 83, for about 10 years. The women were asked how much coffee they drank at the start of the study. The researchers checked hospital records to find out how many of the women later had strokes.
There were a total of 1,680 strokes, including 205 in those who drank less than a cup or none. Researchers adjusted for differences between the groups that affect stroke risk, such as smoking, weight, high blood pressure and diabetes, and still saw a lower stroke risk among coffee drinkers. Larsson said the benefit was seen whether the women drank a cup or several daily.
“You don’t need to drink so much. One or two cups a day is enough,” she said.
Larsson, who in another study found a link between coffee drinking in Finnish men who smoked and decreased stroke risk, said more research needs to be done to figure out why coffee may be cutting stroke risk. It could be reducing inflammation and improving insulin sensitivity, she said, or it could be the antioxidants in coffee.
Larsson and others point out that those who want to reduce their chances of a stroke should focus on the proven ways to lower risk: Don’t smoke. Keep blood pressure in check. Maintain a healthy weight.