Aside from health system reform, obesity is perhaps the most-discussed topic in health care in the United States, and certainly in the American media. Healthy People 2010, a nationwide health-promotion plan developed by the U.S. Department of Health and Human Services in January 2000, named overweight and obesity as leading indicators of health and set the goal of bringing the obesity rate under 15 percent by the year 2010. (Unfortunately, we are far from reaching this anticipated goal. Colorado is the only state that has been able to maintain an obesity rate of less than 20 percent.) Recently, First Lady Michelle Obama, in conjunction with U.S. Secretary of Health and Human Services Kathleen Sebelius and Surgeon General Dr. Regina Benjamin, instituted the Let’s Move program to reduce pediatric obesity. It has been widely acknowledged that improvements in American health made by the success of tobacco cessation efforts are under threat from the climbing rate of obesity and obesity-related conditions such as type 2 diabetes mellitus and hypertension. As the topic of obesity takes center stage, ethical treatment, diagnosis, and legislation have become more necessary than ever.
This month’s issue of Virtual Mentor examines many of the ethical questions that arise when physicians confront the need to talk to and treat patients who are obese. Some authors explore physician bias toward patients who are overweight and its sometimes dire effects on the health of those patients; they examine how physicians can best cultivate self-awareness and bring professionalism to the sensitive and effective treatment of the whole patient, not merely the number on the scale or the tape measure. They also point out that respect for the patient does not necessarily mean avoiding the topic of weight; studies have documented patients’ desires for assistance from their doctors and the salutary effect a diagnosis of obesity can have on patient motivation to improve health. Other authors discuss how to overcome impediments to broaching weight loss with patients—impediments that spring from lack of appropriate training on the topic or the assumption that primary care visits are too short to allow for effective counseling. The majority of this month’s contributors stress that only a nuanced understanding of the complex relationship between environmental, genetic, behavioral, and other contributors to obesity will allow clinicians to become more compassionate and more useful to their patients.
The authors in the law, policy and society sections discuss the legislative and policy efforts made in the U.S. to combat obesity, increase physical activity, and encourage the consumption of health-promoting foods. A number of contributors mention that policy efforts to date have been strongly influenced by the American view of obesity as almost entirely caused by lack of willpower, pointing to American individualism and staunch resistance to perceived paternalism as primary obstacles to health-related legislation. Again and again, these articles emphasize the need for collaborative, sustained action to improve America’s health—particularly the health of its children.
Our esteemed authors represent a breadth of expertise in the field and offer unique perspectives on the topic of obesity and our role in either alleviating or perpetuating it in our country. We truly hope that you gain insight from this, the first Virtual Mentor issue dedicated to the topic of obesity.