A Call to 'Heal Thyself'
Date: October 5, 2012
The instructions for the classroom exercise were simple enough: Plug your body weight and height into a formula to calculate your body mass index (BMI). But the results came as a surprise for first-year Johns Hopkins medical students Veronica Hocker and Taylor DesRosiers, who learned that the tool classified each of them as obese.
The moment was an epiphany for the two young physicians-in-training, spurring both to modify their lifestyle habits to incorporate regular exercise and healthful eating, among other changes. Now Hocker and DesRosiers are among an active cohort of Hopkins medical and nursing students challenging peers and health care practitioners across the country to publicly pledge to do the same.
Through their efforts, more than 500 students and clinicians at 40 universities and academic medical centers have committed to The Patient Promise, a professional oath stating that signers will follow basic tenets of healthy living, such as routine physical activity, eating nutritionally balanced meals and getting ample sleep. Supporters of The Patient Promise, which has been featured in The Atlantic and The Baltimore Sun, say the initiative is more than an exercise in ethics or idealism—it’s their response to a growing body of evidence that suggests that the personal health habits of clinicians may play a powerful role in the health of their patients.
When it comes to prescribing healthy lifestyles, there’s a strong link between what doctors do themselves and what they tell their patients to do, says Erica Frank, adviser for The Patient Promise, who researches physicians’ personal and clinical health habits. “If we pay more attention to physicians’ health, we’ll have a patient population that is healthier,” the University of British Columbia professor told The Wall Street Journal.
Using the slogan “Hippocrates, not hypocrisy,” students describe The Patient Promise as an extension of the Hippocratic Oath, the credo outlining professional physician conduct. In that spirit and tradition, pledgers commit to practice behaviors similar to those that they request of patients, ranging from getting at least a half-hour of physical activity daily to moderating their intake of alcohol and other potentially harmful substances. The oath also encourages health care professionals to be conscious of potential weight bias—delivering care differently on the basis of body shape and size—which founders of The Patient Promise say has been linked to fewer cancer screenings because of reluctance of providers to perform essential services, such as Pap smears, on obese women.
Hocker, who describes herself as a former ballet dancer who’d always been thin, says she put on weight as she grew older and became busy with schoolwork and motherhood. “I felt as if I’d closed my eyes and became larger,” says Hocker. “I ignored scales and mirrors and was embarrassed to be in pictures with my beautiful son.”
Motivated to set an example for him and to build confidence in her ability to prescribe a healthy lifestyle for future patients, Hocker began watching her diet, adhering to a strict nightly bedtime and incorporating weekly spin classes, yoga and jogging into her packed schedule. As a result, the single mom and full-time student shed nearly 30 pounds in less than five months. “With an increased supply of energy and self-esteem,” she says, “I’m trying to motivate others to make similar changes in their lives.”
DesRosiers, who, like Hocker, lost 30 pounds and now has a BMI within the normal range, says she feels more confident discussing weight and weight loss with her patients. “When I tell my patients about my struggle to lose weight, they’re much more open to discussing weight loss,” she says.
Medical students and roommates Shiv Gaglani and David Gatz developed the concept that is now The Patient Promise after taking a week-long course on nutrition and obesity last December—the same class that prompted Hocker and DesRosiers to action. Gaglani says the nationwide prevalence and burden of obesity inspired them to develop the student-led approach. According to the Institute of Medicine, an estimated 170 million Americans are overweight or obese, resulting in $190.2 billion in annual costs for the treatment of obesity-related diseases.
The student founders say the rationale of addressing the habits of physicians and nurses stems from recent research, including a study published in the May issue of Obesity. Lead author Sara Bleich, an assistant professor in the school of public health and an adviser for The Patient Promise, says her team found that overweight or obese physicians were less likely to diagnose and discuss the health risks of obesity with their patients than were their normal-weight peers. “Our findings mirrored behavioral trends of earlier studies, which found that physician smokers were less likely to encourage their patients to quit,” Bleich says.
Gaglani and Gatz say these findings are particularly troublesome, given how closely health care providers reflect the national pattern of overweight Americans. They say 63 percent of male physicians and 55 percent of female nurses suffer from “tight white-coat syndrome,” compared with 72 percent of U.S. adults who are overweight or obese. Gaglani and Gatz hope their clinician-directed campaign will help counter the costs of the country’s rising levels of obesity.
Student supporters aim to persuade at least 1,000 students and clinicians to commit to The Patient Promise by this fall. To broaden their efforts, they’re encouraging academic medical institutions to set up chapters responsible for encouraging people to sign on and stay engaged. To date, the University of California at San Francisco, University of Pennsylvania, University of Pittsburgh, Nova Southeastern University and the Arizona College of Osteopathic Medicine have established official chapters, in addition to partnerships with the American College of Preventive Medicine and The Obesity Society. On the East Baltimore campus, the Denton A. Cooley Center is offering discounted gym memberships and other perks for faculty, students and staff who commit to The Patient Promise.
‘‘Tight White-Coat Syndrome’’ by the Numbers
Although research shows that health care professionals who exercise and maintain a healthy diet are more likely to discuss weight loss with their patients, many clinicians face the same challenge themselves.
- Researchers report a nearly one-third increase in the prevalence of overweight male students in their fourth year of school when compared with their responses during first-year orientation.
- Only one-quarter of fourth-year medical students reported regularly counseling their general medicine patients on weight-related topics.
- In a Johns Hopkins study on the effect of a physician’s body mass index (BMI) on obesity care, only 11 percent of doctors who believed their weight exceeded that of their patients initiated a weight-loss conversation, and only 7 percent diagnosed obesity.
- Although 93 percent of nurses acknowledge that overweight and obesity are diagnoses requiring intervention, 76 percent do not pursue the topic with overweight and obese patients.
- A national survey of medical students’ health behaviors and attitudes found that 51 percent of medical students were overweight or obese.