Dear Gynecology Patient,


I was recently given a report card on my physician performance in regards to informing you of your BMI and counseling you on efforts that can improve your health by helping you to lose weight. I squeaked out a grade of C and was told that I need to improve. In order to improve, I will be giving you a written report each year of your BMI and also coaching you in diet and exercise. Unfortunately, the words overweight, obese and extreme obesity are associated with these BMI numbers. Don’t kill the messenger, as I didn’t create those terms.

Over the past few weeks I have done a fair amount of research around weight loss counseling. What I have discovered is a bit overwhelming – there are as many different ways to approach this topic as there are personalities. I have learned that approaching the topic in the wrong fashion can alienate women and make them less likely to adhere to advice. Thus, I have decided that I will have each overweight patient take a personality inventory that I can then use to apply personal weight loss advice.

Unfortunately, the advice all breaks down to a simple concept: burn more calories than you consume.  And make sure that the calories you consume are from real foods, not protein shakes or bars. Activity needs to be counted in order to keep you honest. The following are only a few of the “excuses” that I have heard over the past few months:

  1. My diet says that I can only eat organic fruits and vegetables because it takes more energy to process the pesticides in non-organic fruits/vegetables.
  2. I walk up and down the stairs to do the laundry for exercise.
  3. I am too busy driving my kids to their sports practices to exercise.
  4. I only eat one meal a day.
  5. My knees hurt when I walk.
  6. I don’t have enough money for a gym membership.
  7. Healthy food is too expensive.
  8. I am big boned and everyone in my family looks like me.

And these are my responses:

  1. Organic fruits/vegetables have the same calories as non-organic.
  2. Although stairs are a good form of exercise, most of us only do laundry once or twice a week. This does not amount to the recommended 10,000 steps a day.
  3. When your kids are at sports practice, go for a walk around the rink, soccer field, gym or school. Your kids don’t want you to watch them practice. When they need to be at a game early, use the time before the game starts in a similar fashion.
  4. Eating one meal a day puts your body into starvation mode and you burn fewer calories in addition to consuming more calories in a single meal.
  5. Knees and joints ache because they are carrying too much weight and/or are seldom used. Walking for 10 minutes 3-4 times a day is a good way to start.
  6. If everyone who bought a gym membership on January 1 ever showed up to exercise, the facility would be bulging at the seams. It is much simpler to go for a walk out your front door or find a nearby indoor facility. Ride a bike in the summer and use an indoor exercise machine in the winter. All of these are cheaper than a gym membership and easier to fit into a schedule.
  7. Unhealthy food may be cheaper in the short term, but you will pay much more in the future in medical costs related to being overweight.
  8. An unhealthy lifestyle is often something we learn at a young age when we eat a high fat diet and aren’t encouraged to exercise.

Realize that as a parent of 5 children, I am used to being the bad cop and don’t need everyone to like me. But I am sensitive when you complain about “my nagging”. Obesity is the #1 health concern in this country and is one of the primary drivers of health care costs. Postmenopausal obesity  increases the incidence of endometrial cancer four fold, accounts for 90% of hypertension and adult onset diabetes and increases the incidence of breast and colon cancer. A 10-15 lb weight loss thru lifestyle modification (eating less/moving more) can dramatically decrease these numbers. Your concept of nagging is my notion of gentle reminders to improve your health.

I have now spent over an hour writing 700 words that need to be condensed into a  20 minute visit that also includes discussion about health maintenance testing and a physical exam. If you think I am too direct with my questioning and advice, it is because the patient next door is being roomed and if she waits more than 15 minutes she will complain about the doctor “always being late”. And then I have to tell her that her BMI is ____. You fill in the blank, knowing that 65% of American women are overweight.


One thought on “Dear Gynecology Patient,

  1. vsaam says:

    Excellent as many are. Thanks.

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