Henry had a problem: The medicine that calmed his mind was hurting his body. A middle-aged man with bipolar disorder, Henry had tried several medications before he became my patient. The only one that stabilized his mood made him crave fattening foods so intensely that after three years on the drug, he’d gained 50 pounds.
With this excess weight came diabetes, hypertension and high cholesterol — and with them, more drugs to take. I urged Henry to keep his weight under control, but he kept gaining. Frustrated, I decided to let his primary care physician decide how to help him. After all, his mental health was in good shape. Ultimately, his weight wasn’t really my concern.
Today, no doctor can afford to think that way. Between 1980-2000, the percentage of obese Americans more than doubled; in children and adolescents, it tripled. The rate of increase has slowed since 2000, but the numbers are still rising. At this pace, 42 percent of American adults will be obese by 2030, costing our country an estimated $25 billion annually.
Doctors often don’t know what to do with obese patients. Just like them, we become impatient, frustrated and, at times, disgusted. Surgeons curse higher complication rates and sometimes refuse to operate, while medical specialists bemoan rising rates of weight-related chronic conditions.
In psychiatry, many have accepted obesity as collateral damage; some of our best medications can cause substantial weight gain. Often removed from day-to-day general medicine, we’re tempted to punt responsibility to the primary care physician, as I did. Even those of us concerned with our patient’s expanding waistlines must acknowledge that compared with the psychotic delusions of schizophrenia or bipolar mania, it’s better to be fat. Establishing mental stability while maintaining a healthy weight often seems incompatible.
Or at least that’s what I thought until Henry showed me otherwise. Just when I’d decided to stop nagging him about his weight, he showed up 10 pounds lighter. At first, I worried that he might have cancer or some other medical problem. Instead, his simple explanation was, “I finally started listening to you. I’m changing my eating pattern and walking each day.”
Three years later, he’d dropped 55 pounds, all while taking his bipolar medication. He no longer needed diabetes or blood pressure pills.
Henry had reminded me how important simple doctor-patient interaction can be. While the tide of obesity exceeds the power of any individual physician to defeat, all of us on the medical front lines need to engage in this fierce battle. Sadly, that is not happening. According to a 2011 study, nearly one-third of obese patients had never been told by a doctor that they were overweight. Some doctors think it’s a waste of their time. Others complain their efforts won’t pay enough.
But these excuses are unacceptable. We have a responsibility never to quit. Talking and persistence are sometimes the most powerful medicines for both doctor and patient.
Damon Tweedy, an assistant professor of psychiatry at Duke University Medical Center, is a staff psychiatrist at the Durham VA Medical Center.
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