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Hopkins Medicine Magazine - Eschewing the Fat

Hopkins Medicine Winter 2013

Eschewing the Fat

Date: February 1, 2013

Medical students Shiv Gaglani and David Gatz developed the concept for what is now The Patient Promise.
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Medical students Shiv Gaglani and David Gatz developed the concept for what is now The Patient Promise.

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. 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. Founders of The Patient Promise say such bias 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 become 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.

Hopkins medical students and roommates Shiv Gaglani and David Gatz developed the concept that is now The Patient Promise after taking a weeklong course on nutrition and obesity in December 2011—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.

The student founders say the rationale of addressing the habits of physicians and nurses stems from recent research, including a study published last spring in Obesity. Lead author Sara Bleich, an assistant professor at the Bloomberg 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. Shannon Swiger

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