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Pediatricians' weight could be obstacle to treating obesity

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RALEIGH, N.C. (AP) _ For many doctors, it's tough enough to talk to an adult about a weight problem, let alone a child.

Apparently, that's an even bigger challenge if the doctor is fat, or thin. Some skinny pediatricians worry they'll seem unsympathetic. Their overweight colleagues, meanwhile, risk seeming hypocritical when they give advice to chubby children.

That's what a pair of studies surveying pediatricians in North Carolina suggests. In fact, many children's doctors ``would rather treat strep throat than obesity,'' said Dr. Reginald Washington, a Denver pediatrician who co-chairs an obesity task force for the American Academy of Pediatrics.

Only 12 percent of the doctors surveyed by researchers at the University of North Carolina at Chapel Hill said they felt very effective in treating overweight children. The pediatricians also said they felt better able to treat asthma or prevent sexually transmitted diseases than treat or prevent obesity.

``I think that virtually all pediatricians feel frustrated with it because it's such a difficult problem to treat,'' said Dr. Terrill Bravender, an assistant professor of pediatrics at Duke University and the medical director for Duke's Eating Disorders Program.

Most doctors simply evaluate the patient, diagnose and treat the illness. ``And obesity is much more complicated than that,'' Bravender said.

The studies also found that a physician's own weight could affect his comfort level in counseling an overweight child. Even more surprising _ nearly half of the doctors surveyed who are overweight didn't know they were.

``It may mean that pediatricians are seeing so many overweight people around them that their standards have become skewed,'' said Dr. Eliana Perrin, one of the authors of the study and an assistant professor of general pediatrics and adolescent medicine at UNC-Chapel Hill.

``If so, they may be less able to diagnose overweight patients as (overweight),'' Perrin said. ``However it is also possible that pediatricians can competently diagnose others as overweight but fail in this regard when looking at themselves.''

The North Carolina results suggest the challenges faced by pediatricians nationwide. About 15 percent of U.S. schoolchildren are estimated to be obese, and 30 percent are believed to be overweight.

The first study, which outlined the role of pediatricians' weight in managing obesity, was published earlier this year in the journal Obesity Research. The second study outlining pediatricians' confidence in managing obesity appeared in the May-June issue of Ambulatory Pediatrics.

Both were based on a mail survey of 738 pediatricians in North Carolina who belonged to both the American Academy of Pediatrics and the N.C. Pediatrics Society. The adjusted response rate was 71 percent.

The survey asked respondents to report their height, weight and whether they classified themselves as overweight, average or thin.

Physicians who viewed themselves as ``thin'' had more than five times the odds of finding obesity counseling ``more difficult'' compared with those of ``average'' weight. Pediatricians who perceived themselves as ``overweight'' were twice as likely to report problems, according to the study.

``I wonder if the patient's going to perceive me as someone who can help with this problem,'' said Perrin, who is not overweight. ``I imagine them saying to themselves, 'OK, she's clearly very trim. What does she know about my struggles?'''

But Dr. Neil H. White, who has battled weight problems for the past 10 years, said his struggles have offered a way to connect with overweight patients. The pediatric endocrinologist with St. Louis Children's Hospital and Washington University in St. Louis has weighed as much as 240 pounds, but is down to 218 and hopes to reach 200.

``I think that doctors and health-care professionals who are overweight ... may be able to be more empathetic and less judgmental than health-care professionals who have never experienced obesity as a problem,'' White said.

``I use myself as an example as to why they need to do better. ... I can say, 'I understand what you're going through.'''
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