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During the American Medical Association (AMA) National Summit on Obesityheld in October 2004, a noted expert borrowed a term to describe how Americanphysicians approach treatment of their overweight and obese patients: clinicalinertia.
Inertia has set in for several reasons, says Robert Kushner, MD, professorof medicine at the Northwestern University Feinberg School of Medicine, inChicago.
Although most physicians will tell overweight patients they need to loseweight, recommendations usually don't go beyond advice to cut calories andincrease physical activity. Intensive counseling, referrals to a dietitian, orother focused efforts fall by the wayside because of inadequate training,reimbursement problems, time constraints, and lack of effectiveinterventions.
And when patients don't lose weight, or they don't think they're losingenough weight, physicians themselves begin to feel ineffective. "Sophysicians start shifting their time to things that are more rewarding, wherethey see more benefit," says Kushner.
CALL TO ACTION
The AMA Summit was an attempt to move physicians out of inertia and intoclinical action.
During the 2-day meeting, a national audience of physicians, dietitians,nutritionists, school nurses, and other public health professionals hammeredout recommendations that were sent to AMA's House of Delegates (HOD) forfurther discussion during its Interim Meeting in December. The recommendationscould evolve into policy resolutions for the AMA annual meeting this June.
Recommendations cover broad territory, including ways for physicians towork with employers, schools, and community organizations to help theestimated two-thirds of Americans who are overweight or obese to shed pounds.In terms of medical practice, the summit participants focused on trainingissues and ways that physicians can promote greater recognition of obesity andimprove communications about it with their patients.
J. Michael Gonzalez-Campoy, MD, PhD, medical director of the Eagan-basedMinnesota Center for Obesity, Metabolism and Endocrinology, says that many ofhis patients remark that when he explains various aspects of diabetes to them,"it sounds like whaa-whaa-whaa, like in the Peanuts cartoon."
Important clinical information for patients about diabetes and otherobesity-related conditions often is muddied, says Linda Meurer, MD, associateprofessor of family and community medicine at the Medical College ofWisconsin, in Milwaukee, because the message is too complex.
"Our messages are mixed," says Meurer. "We say don'twatch too much television, and exercise, and change your diet, and don't eatso many potato chips, and don't drink pop. We should focus on changing onething at a time."
Overall, a discussion group charged with prioritizing medical practiceissues offered the following recommendations for AMA's HOD:
The AMA produced a primer on adult obesity to help guide physicians, butmore research is needed to determine effective ways to help overweight adultsfrom becoming obese. 
Footnotes
"Assessment and Management of Adult Obesity: A Primer forPhysicians" is available by calling 800-262-3211 (AMA members) or800-621-8335 (nonmembers).
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| DOC News | Diabetes | Diabetes Care | Clinical Diabetes | Diabetes Spectrum |
