By Judith Graham

Research already demonstrates that physicians are sometimes uncomfortable talking about weight with their obese patients. Now, a new study shows that the doctors’ weight makes a difference too.

Physicians who pack on the pounds discuss weight loss less frequently with obese patients than doctors who have normal body-mass indexes (18 percent versus 30 percent), according to the report published this week in the medical journal Obesity.

And they’re significantly less confident of their ability to provide effective counseling about diet (37 percent vs. 53 percent) or exercise (38 percent vs. 56 percent).

The findings come from an Internet survey of 498 family doctors, internists and general practitioners conducted early last year by researchers at Johns Hopkins Bloomberg School of Public Health.

Two-thirds of the physicians were male, almost three-quarters were at least 40 years old and 53 percent were overweight or obese.

The results matter. More than 66 percent of American adults are overweight or obese and their medical costs total $147 billion. If heavy doctors won’t acknowledge that patients have a problem and offer help, that can be a barrier to effective care, says Sara Bleich, lead author of the new study and an assistant professor of health policy at Johns Hopkins Bloomberg School of Public Health.

A notable finding in the study speaks to the problem: 93 percent of physicians of normal weight said they would be more likely to identify an obese patient when that person was as large or larger than they were. By contrast, this was true of only 7 percent of obese or overweight physicians.

“It seems to be the case that doctors are less likely to diagnose the patient until the patient’s weight meets or exceeds their own,” Bleich says. This could be because physicians’ sense of what’s “normal” changes as they put on pounds and see more excessively heavy patients in their practices, she speculates.

Asked what might explain heavier doctors’ reluctance to discuss weight loss, Bleich says, “It could be that they feel that their advice will not hold a lot of weight with their patients, because they themselves are heavy.”

Overweight and obese physicians expressed greater confidence in prescribing weight loss medications than other doctors, perhaps because they’ve had personal experience with the medications or with the difficulty of behavior change, she observes.

This isn’t the first time that research has shown a link between physicians’ personal characteristics and their willingness to advise patients on lifestyle issues.

“We know that physicians who follow healthy dietary practices themselves are more likely to spend time counseling patients about diet,” says Dr. Robert Kushner, a professor of medicine at Northwestern University Feinberg School of Medicine and clinical director of Northwestern’s Comprehensive Center on Obesity.

Other research has shown that physicians who smoke are less likely to help patients quit tobacco use.

Bleich and her co-authors close their study by suggesting that doctors, who also report high levels of stress, substance abuse and depression, need to be encouraged to take better care of their health, both for their own sake and patients.

Northwestern is one of the few medical schools to incorporate this in its curriculum: Since 2008, it has offered a mandatory six-week course on healthy living.

“Our philosophy is that if doctors understand how to take care of themselves, then they can be a better teacher and guide to their patients,” Kushner says.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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For type 2 diabetics who are not on insulin, monitoring their blood sugar does little to control blood sugar levels over time and may not be worth the effort or expense, according to a new evidence review.

Self-monitoring blood sugar levels for type 1 diabetics and type 2 diabetics who require insulin is recognized as a critical part of self-care.

For these insulin taking diabetics, keeping track of blood sugar levels helps them attempt to keep glucose levels within an acceptable range.

However, it has been unclear if self-monitoring of blood sugar has the same value for type 2 diabetics who are not on insulin.

To answer this question, Uriëll L. Malanda of the VU University Medical Center in Amsterdam and his colleagues reviewed 12 studies, of more than 3,000 non-insulin-using diabetics.

The review showed that self-monitoring of blood sugar by these patients had only a modest effect on a measure called HbA1c, a standard for assessing blood glucose control.

Over a six-month period, patients who tested their own blood glucose levels reduced HbA1c by about 0.3 percent. This effect nearly completely dissipated after 12 months.

Key Points:

• In patients with diabetes who don’t require insulin, self-monitoring of blood glucose had a modest effect on HbA1c levels at six-months, which subsided after 12 months.

• Self-monitoring of blood glucose in non-insulin treated diabetics had no effect on satisfaction, general well-being or general health-related quality of life.

• Supplies required for self-monitoring of blood glucose are more expensive than for urine testing, a common alternative for non-insulin treated diabetics.

Additionally, the review showed that blood sugar self-monitoring had no effect on patients’ satisfaction, general well being, or general health-related quality of life.

One study, which compared the cost of the first year of monitoring blood for glucose versus urine testing, found that monitoring blood glucose was 12 times more expensive.

Mayer Davidson, M.D., a professor of medicine at Charles Drew University in Los Angeles who authored one of the studies included in the review, notes that many endocrinologists recommend blood glucose self-monitoring as part of efforts to educate patients on the effect of lifestyle habits—for example, how eating an apple affects their blood glucose compared to drinking a glass of apple juice. However, knowing their blood sugar numbers doesn’t appear to change patients’ behavior.

“Patients aren’t using these numbers to do anything clinically significant,” he says.

With the cost of blood glucose test strips for home monitoring equipment hovering around 1 dollar apiece, he adds, there doesn’t appear to be enough “bang for the buck” to recommend that form of self-monitoring for most patients.

Authors of the review agree. “Regular self-monitoring of blood glucose in non-insulin treated patients has minimal impact on glycemic control, has no impact on general well-being or quality of life, and is rather expensive. Consequently, it does not add to a clinically relevant long-term benefit,” Malanda says.

Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.

Signs that read, “Burn Calories, Not Electricity” posted in lobbies of New York City buildings, motivated more people to take the stairs and continue to use them even months later.

A new study, which appears online in the February issue of the American Journal of Preventive Medicine, observed and analyzed people making 18,462 trips up and down stairs at three sites. The signs immediately increased stair use between 9.2 and 34.7 percent at all locations.

“The gains in physical activity continued to be observed nine months after the signs were first placed,” noted Karen K Lee, M.D., author of the study at New York City Department of Health and Mental Hygiene. “We found that placing stair prompts at the point of decision is effective.”

The study is among the first to assess the effects of stair prompts on stair climbing as well as descent in different types of buildings over many months. Prompts were posted in a three-story health clinic, a 10-story affordable housing building, and an 8-story academic site and studied over several months.

“Human-made environments in everyday life offer numerous opportunities for maintaining health, controlling weight and preventing disease,” Lee said. “One of those health opportunities is stair climbing, a vigorous activity which can burn more calories than jogging.”

Instead of removing the signage after the study was completed, the prompts were purposely left in place. New York City continues to promote the health benefits of stair climbing by distributing free stair signs to owners and managers of public and private buildings who request them.

“So far, we’ve distributed over 26,000 signs to owners and managers of about 1,000 buildings including residential, worksites, hospitals and academic centers,” said Lee.

Remington sees opportunities for widespread use of prompts. “For example, a zoning law could be enacted that requires buildings to have stair prompts …like they require signs for exits.”

Remington added, “Overall, this is a great study, showing how for almost no investment we can improve health.”

Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.