Health Horizons : NUTRITION : Physician, Feed Thyself : Many physicians who advise patients on good nutrition are overweight themselves. More than one-fourth of doctors in a survey never exercise.
“Now remember what I told you about losing weight,” Jim, the family doctor, told an obese middle-age women standing at his reception counter. She moaned about how difficult it was. The fat on the back of her hand bunched up as she grasped a pen to sign an insurance form.
“One more thing . . . “ added the man in the white coat.
He took a step into a staff room behind him and emerged a moment later with a thick wedge of peanut butter fudge cake with frosting so chocolate it was black, not brown.
“Here, take this.” The patient’s eyes lit up. Her chubby hands gingerly cradled the cake as she walked out of the office.
This exchange is not fiction, but one that played out before my eyes a couple of years ago. I turned to stare at Jim, incredulous that a doctor advocating weight loss would hand out gooey platefuls of butter, fat and sugar--not exactly fare that promotes fat loss, let alone good health.
“Oh, she won’t eat the cake,” he said, catching my accusatory stare, “at least not all at once.”
Then he offered me a slice of croissant bread pudding from a room always stocked with the likes of cheese Danishes, brownies with fudge frosting, chocolate kisses, coffee cake and other assorted artery-clogging treats. He was just trying to be nice, he said later. “I enjoy food. Anyway, she wasn’t going to start her diet until tomorrow.”
Jim, who is a sports team physician, exercises sporadically and carries 30 pounds too many around his teddy bear-like middle. “I was a food-as-a-reward child,” he explained.
Not all doctors hand out fudge to overweight patients. Or skip exercise. Or carry too much weight and eat the wrong foods. Some are much healthier than the general public. Many are at least a little more attentive to their health than are their patients. Most don’t smoke and almost all wear seat belts.
Still, “a little more attentive” doesn’t a healthy doctor make. Or a reliable health counselor. According to physician surveys, research articles and leading doctors, Dr. Jim is not atypical. Most doctors don’t practice what they preach. Many don’t even begin to preach to patients the role of a good diet and regular exercise in disease prevention. Or, if they do, the advice is so general (“eat less fat”) that it does no good.
Dr. Jim says his patients get “the standard pep talk,” but he doesn’t harangue them about their unhealthful habits. When they say they’re too busy to exercise, he drops the subject.
Then we have Dr. Jeff, a San Diego-area endocrinologist who spends all day counseling people with metabolism and weight problems. Too embarrassed to give his last name, Jeff sums up his health simply: “I’m fat. Oh God, I’m in terrible shape.”
He’s right. At 5-foot-8, he weighs about 200 pounds, about 30 too many. He doesn’t know exactly, because he hasn’t been on a scale, had a physical, taken his blood pressure or measured his blood cholesterol since he-can’t-remember-when. At least Dr. Jim keeps tabs on such health indicators (all fine).
“Physicians should act as role models for their patients and they don’t,” said Dr. Ron Lawrence, a semi-retired neurologist in the San Fernando Valley. “How many big, fat doctors are out there telling their patients to lose weight? C’mon Charlie!
“It’s ‘Do what I say, not what I do,’ ” said Lawrence, 66, who in 1969 helped found the American Medical Athletic Assn., a nonprofit social group of doctors that meets around the world to run races and marathons together.
With a membership of about 3,000, the athletic association represents a minority of doctors. Most of their colleagues do more running between appointments than around the track.
According to results from the Physicians’ Health Study being conducted by Harvard Medical School, slightly more than a quarter of the 21,271 male doctors in the ongoing survey never exercise. That’s a more depressing number than among the general public, of whom 24% never exercise, according to a 1985 survey by the Center for Disease Control.
On the other hand, more doctors do exercise regularly: 38% of the Harvard study participants--who started in the study between the ages of 40 and 84--exercise vigorously two to four times a week. That’s about three times the number of Joe and Jane Q. Publics who exercise regularly and vigorously.
Does that satisfy the healthy doctors of the world?
“We aren’t nearly good enough,” said Dr. Walter Bortz, clinical associate professor at the Stanford University Medical School and an avid runner who completed the Boston Marathon last year.
Bortz did his own study of doctors’ health habits, published in January, 1992, in the Western Journal of Medicine. Using 126 male and female doctors at the Palo Alto Medical Clinic as subjects, he came up with far more encouraging results: 93% exercise regularly. Six ran marathons the previous year.
Remember, though, this study was in California, the birthplace of aerobics, jogging, alfalfa sprouts, water bars, fruits and nuts.
“I wouldn’t for a minute suggest this is representative of Cleveland and Boston and other areas,” said Bortz, author of the best-selling “We Live Too Short and We Die Too Long.” “Can the Mayo Clinic match our figures?”
Not likely. Neither can the far eastern edges of Canada. Out of Dalhousie University in Halifax, Nova Scotia, came a letter to the New England Journal of Medicine in 1991 poking fun at pudgy doctors:
“Some faculty members have been observed to set off their own pagers when assuming a sitting position. This occurs when the ‘love handle’ makes contact with the button on the pager’s top surface. We hope that physicians, who are notoriously poor at monitoring their own health and fitness, will be able to use these observation to good purpose.
“We suggest to members of the medical establishment who are unable to hear their pagers clearly when in a sitting position without resorting to ‘love-handle lift’ or who have signs of the ‘pudge-page phenomenon’ that it may be time to assess both their dietary intake and their exercise programs.”
As Drs. Sarah Shea and Timothy Benstead pointed out in their letter that an improper diet--the kind doctors are supposed to know nd counsel us about--also brings on the spare tire among doctors.
Physicians put the blame partly on long hours that force them to wolf down quick lunches--if at all--and grab a fast-food or cafeteria delight between meetings or appointments. The American Medical Assn. says that in 1991 the average doctor put in 59.1 work hours per week. Nevertheless, you’d think a medical summit would offer role-model fare. Not true.
At a conference on preventive cardiology in France this summer, dinner included a Who’s-Who list of some of the highest-fat, highest-cholesterol foods around: goose liver pate, beef Burgundy and ice cream. One attendee was Dr. Dean Ornish, author of the best-selling “Dr. Dean Ornish’s Program for Reversing Heart Disease” and director of the Preventive Medicine Research Institute of UC San Francisco.
“I didn’t eat it,” he said firmly. Not eating at medical meetings happens often to Ornish, who advocates a strict, high-carbohydrate, vegetarian diet with no more than 10% fat and almost no cholesterol. At a medical conference in Greece earlier this year, he did without lunch.
“At the noon break, they were serving ham sandwiches,” he said. “And people were eating them. That’s what was amazing to me.”
Menus from recent Board of Trustees meetings of the American Heart Assn.’s greater Los Angeles affiliate start with the appearance of heart healthy (California green salad, chicken Santa Fe, pasta du jour), but end with an artery-stopping thud (chocolate mousse cake, tiramisu).
“I don’t eat a lot of the stuff (at medical association meetings). I have to eat a salad without dressing,” said Lawrence, who is 5-foot-9, 164 pounds, and shuns red meat, most fats, and survives primarily on pasta and vegetables. “They think it’s healthy. Chicken. That’s OK. But how do they serve it? With a butter sauce, and butter is bad for you. . . . They bring in buttered vegetables and fried potatoes, then they bring in this big custardy thing or ice cream or something covered with whipped cream so thick you can’t imagine. And the doctors wolf that down.”
What do the surveys say about your doctor’s eating habits? In a 1986 study published in the Western Journal of Medicine, 27% of doctors surveyed ate regular meals only once a week or less. Only half ate three daily meals everyday. Skipping meals can cause weight gain and snacking on the wrong foods, nutrition experts say. Even that exercising bunch in Palo Alto has a bit of a pudge problem, with nearly half saying they were overweight, although most by not more than 15 pounds.
“Physicians don’t really have the fervor to motivate patients to follow a really healthful diet because they don’t follow a really healthful diet,” said James Kenney, a nutrition research specialist at the Pritikin Longevity Center in Santa Monica. “It’s easy for them to write a prescription. It’s harder to teach patients how to lower their cholesterol through diet.”
So here we are, trusting doctors for advice on a healthy diet when many don’t eat right themselves and know little about what eating right means. Most either studied mere snippets of nutrition in medical school as part of other courses, were taught only about deficiency diseases such as beriberi, or learned simply the biochemical basics, rather than details about preventive diets.
Less than a quarter of medical colleges (29 of 126) have a separate required course in nutrition, according to an annual survey by the Assn. of American Medical Colleges. Nearly 70% offer only a nutrition elective. Sounds good, except in the last five years the number of schools with nutrition electives has dropped--from 82% to today’s 70%.
“They’d rather learn how to cut,” Lawrence said. “The surgical specialties are No. 1.”
Snobbery is part of the problem. Doctors don’t know much about good nutrition, yet they shun information from anyone who’s not a doctor who does know, such as a dietitian. “For credibility, you need the magic letters MD ,” said Dr. Elaine Feldman, professor emeritus of medicine and chief of the nutrition section at the Medical College of Georgia.
A doctor’s own bad habits influence what and how much he or she tells patients. At least a third of all doctors only counseled patients about the importance of a healthy diet, regular exercise, not smoking and not drinking alcohol after the patient had been diagnosed with an associated disease, such as liver or heart disease, according to a 1984 RAND Corp. study in the Journal of the American Medical Assn. Doctors who thought they were overweight, for example, only counseled patients about diet after the patient had a disease.
The study concluded: “There may be a far larger group of subclinicly impaired physicians whose health habits may not only affect their own longevity but their practice of medicine as well.”
Dr. Jeff, 46, offers no apologies for his health deficit, not even the excuse of being too busy. It wasn’t more than five years ago he weighed 165 and walked four times weekly for exercise.
“It’s definitely the old story, ‘Do what I say, not what I do,’ ” he says.
He also echoes--and perhaps empathizes with--the sentiments of many overweight, sedentary people: “I’m not happy with me like this at all. I wish I could get motivated. I’ve just gotten lazy.
“Just because you know what’s right and what you should do, doesn’t mean you can do it,” says Dr. Jeff. “I know the consequences. . . . It’s denial. It’s the ostrich syndrome.”
The word doctor stems from the Latin docere, or to teach. “Teaching is what we’re supposed to do,” Lawrence said. “It’s a little better than 30 years ago, thank God, but most doctors still don’t follow their own recommendations.”
Beware of doctors bearing fudge cake.
