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核心提示:If there's one place where it's a good idea to come clean, it's the doctor's office. Patients with an ache, a symptom or a bad habit like smoking do no one any good if they keep it to themselves. Yet there's one time doctors are often less than fort

If there's one place where it's a good idea to come clean, it's the doctor's office. Patients with an ache, a symptom or a bad habit like smoking do no one any good if they keep it to themselves. Yet there's one time doctors are often less than forthcoming: when they have to tell patients they need to lose weight.

Researchers at the Mayo Clinic in Rochester, Minn., recently released the results of a survey of more than 2,500 obese patients who went to their doctor for a regular checkup over the course of a year. The investigators found that the charts of only 1 in 5 of those people listed them as obese. What isn't on the charts is probably not communicated between doctor and patient either, and that means trouble. Those in the study who got the diagnosis were more than twice as likely to have developed a weight-management plan with their doctor than were the other obese patients.

"If you don't have a plan, you're not going to lose weight," says the study's author, preventive-medicine specialist Dr. Warren Thompson, whose research was published in August's Mayo Clinic Proceedings.

Obesity, of course, means a higher risk of heart disease, diabetes, hospitalization and early death, so how come doctors are so lax about putting the scarlet O on the chart? Sometimes, Thompson says, doctors perceive that a patient isn't motivated to change, so they just don't bother. Other times, the patient's likely embarrassment silences the physician, or time constraints get in the way as more immediately pressing health concerns get dealt with.

Discussing weight becomes even more complicated with children. According to a 2005 study in the journal Pediatrics, doctors diagnosed obesity less than 1% of the time among 2-to-18-year-olds—a figure far below the one-third of young Americans struggling with weight.

Dr. Mark Jacobson, an adolescent-medicine specialist with the American Academy of Pediatrics, explains that parents may feel guilty about having an overweight kid because they know it's partly hereditary and because they feel it's their responsibility to control their youngster's exercise levels and diet. Parents also worry about a child's developing eating disorders if weight becomes an issue, so they say nothing at all.

"I've had a patient whose mother whispered the letters w-e-i-g-h-t to me, with her hand over her mouth so the child couldn't see. I could tell it was something they had thought about and didn't want to bring up with the child," says Jacobson. Still, he insists that doctors must discuss the topic. One way to do so gently, he says, is to avoid the word obese and instead say the child has a weight problem. Doctors may also tell kids that their weight is a couple of years ahead of their age. Then, Jacobson says, he focuses the discussion more on the behaviors that could help improve the situation—like watching less TV and playing outside more—instead of concentrating principally on shape.

"You don't want to make people feel embarrassed and not want to come back to you. You want them to get treated," he says. Jacobson stresses that every pediatrician should determine a child's body-mass index (BMI)—a figure arrived at by factoring weight and height to produce a two-digit number that roughly diagnoses obesity. BMI is an imperfect metric, in part because it does a poor job of taking body type and muscle mass into consideration, meaning that a stocky person with low body fat can be labeled obese. But as a starting point, BMI helps.

None of this absolves patients or parents from stepping forward and bringing up weight on their own. But whoever raises the topic, it's important for patients and doctors alike to remember that modest amounts of weight loss can disproportionately benefit overall health, even if the loss doesn't feel or look like much. That fact may be the best reason for everyone to show a little courage and say what needs to be said — even if it hurts a bit.







“有个患者的母亲低声做出‘肥胖’两字的口型,还用手挡着她的嘴,怕她孩子看到。我可以看出父母们也在思考这个问题,但是他们不想带给孩子这种困扰,” 雅各布森说。但是他仍然坚持讨论这个话题。有一个婉转一点的办法,他说,就是避免“肥胖”这个字眼,可以说孩子有体重问题。医生还可以对孩子们说他们的体重比他们的年龄长得快了两年。然后,雅各布森将讨论的重点更多地放到了什么样的习惯能改变这种局面—像少看电视,多进行户外活动—而不是就体型问题抓着不放。“你也不想让患者感到尴尬从此再也不来你这里了。你希望的是他们得到治疗,”他说。雅各布森强调每一个儿科医生都应该确定孩子的身体重量指数(BMI)--一组通过身高除以体重得出的数据,能大致诊断是否患有肥胖症。BMI是个不完美的公式,部分是因为它没有将体重与肌肉很好地结合考虑,也就是说,一个矮小结实没有肥肉的人可能测出来是肥胖。但是作为初诊,BMI是有帮助的。



关键词: 肥胖
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