Lead by Example

            It probably comes as no surprise to any MD readers that there's an obesity epidemic in our country. Happily, I'm sure the vast majority of you don't think you fall into this category. However, the enters for Disease Control and Prevention have issued guidelines based on body mass index, a measurement of weight adjusted by height that applies to both men and women. By those standards, at 5-foot-8 you are overweight at 165 and obese at 195. At 6-foot-0 you are overweight at 185 and obese at 220. Following this concept, I have to confess I would be considered obese with my 54-inch chest and 34-inch waist.

            I know this sounds ridiculous, but how many doctors out there that are truly obese themselves? How many of them are included in the data showing

two-thirds of U.S. adults, or 131 million people, are overweight or obese? High blood pressure, diabetes and heart disease are among the complications of obesity. The medical societies want doctors to begin advising their patients in proper diet and exercise. In an article in Archive of Internal Medicine written by Dr. JoAnn Manson, chief of preventive medicine at Harvard's Brigham and Women's Hospital, the following recommendations to physicans are given:

• Assess body mass index and waist measurement and discuss activity levels at every visit.
• Counsel overweight patients to reduce their daily food intake and get more exercise.
• Write prescriptions for exercise.
• Advise strength training or weightlifting.

How much attention will the patient pay to this advice if it looks like the doctor is in no way following the same guidelines? I have the advantage of having been a competitive bodybuilder for many years. You are all welcome to come to my office to see the trophies. It gave me a knowledge and appreciation of diet and exercise far more than any course in medical school. When a patient comes to see me for a surgical consultation, the discussion usually includes diet and exercise recommendations. Very often the surgery is postponed until certain body fat levels are attained or a course of exercise is undertaken.

            I don't believe in high-volume liposuction. If someone comes to me extremely overweight, I will recommend a diet and even help find him/her find a personal trainer. The surgery is there to take care of those areas not correctable by diet and exercise, or to put the finishing touches on genetically stubborn areas. The surgery is also there for those who have to be congratulated for losing the weight and finding themselves with more skin than they need. After all that hard work, they still can't enjoy the look they have strived for. After a skin-tightening surgery, they can have those results.

There are even times when the patient is advised not to have the surgery. Recently, a patient came to me for the treatment of gynecomastia. On examination, he really had an over-development of his pectoral muscles. He did no incline exercises at all.  Once I altered his routine and told him to stop over-developing his ego with his extremely impressive flat bench presses, it was obvious this, and not surgery, was the real answer.

            Fortunately, I am not the only M.D. I see in the gym. Several of my colleagues struggle to get that last rep out. I wish I saw more of them. I try to convince other doctors to get in shape. Those of you who know about diet and exercise should educate your own physicians. Pass on the knowledge to them, so they can know the proper advice to give their other patients.

            Let's all start a "trim the fat movement" with members of our families and co-workers. Let's proclaim a national "Take a Fatty to the Gym Day."