Why your doctor will not talk to you about obesity

Majority of doctors are neither warning their patients on the risks of obesity nor prescribing a lifestyle change.

“I was never told that my weight was a problem despite religiously attending antenatal clinics. I almost died during labour,” says Beth Mwachea, a businesswoman in Nairobi.

“I liked my curvy body so it was a surprise to be told weight may have led to difficult labour and stillbirth. I was devastated.”

But despite the diagnosis, Mwachea says the doctors never advised her on what to do about the weight problem. Mwachea, who is hard-wired to a well fried and salted chicken, says she now knows better after her near-death experience. She walks more, occasionally visits the gym and is now contemplating cutting down on fatty foods for more of sukuma wiki, unrefined ugali and fruits.

She is taking the cue from Dr Rashid Aman, the Cabinet Administrative Secretary for Health, who has advised that diet may beat diseases assisting Covid-19 put people down.

“I urge all of us to adopt healthy lifestyles by reducing consumption of highly refined processed foods, sweets, sugar-sweetened and flavoured drinks or beverages which have high amounts of unhealthy fats, sugar and salt,” advised Rashid.

“We wish more of such advice is coming from doctors and health providers to their patients. Evidence shows patients are highly likely to take advice from their healthcare providers seriously and act on it,” says Dr Rahma Mkuu of Texas A&M University, US.

Dr Mkuu recently led an international team to assess how much Kenyan doctors and health providers advise their obese and overweight patients to lose weight in the face of increasing chronic diseases.

With nearly 45 per cent of women and 20 per cent of men in parts of Nairobi, for example being obese, the team suggests that hospitals must be seeing a lot of overweight patients.

The team, in its report published in the African Health Sciences journal in June, said only a few of such patients are being advised on weight.

“Only 19 per cent of overweight or obese individuals in Kenya reported receiving weight loss advice from a health professional,” the report said.

Kenyan physicians and health care providers, the scientists say, are in a unique position to ameliorate the escalation of their overweight and obese patients. 

“This can be achieved by educating overweight patients and guiding them toward a healthier lifestyle,” says Dr Mkuu.

The study involved 1,355 overweight individuals from a larger national survey by the health ministry covering 6,000 households. Of the few patients receiving advice on weight loss, more women than men are likely to get the advice.

The team suggests that women may be getting more advise because they visit hospital more than men, especially for preventive antenatal care. More educated patients and those in urban areas than poor and rural residents are also likely to get advice on weight loss from doctors.

Educated patients, the report says, are more likely to engage doctors on their treatment compared to the less educated. Female and younger doctors were more likely to advice on obesity than their older colleagues, a relatively new phenomenon in medicine.

But more importantly, the report said, healthcare providers in Kenya might be hesitant to provide weight loss advise to patients because of cultural reasons.

“Body weight and thickness is culturally associated with power, wealth, health and prosperity in many African societies,” says the study.

This is further puffed by a new media culture that glorifies a bigger backside as the epitome of female beauty. An earlier study by the Nairobi based African Population and Health Research Centre found that many people in Nairobi are likely to prefer a big body despite the known health risks.

When study participants, who included 2,669 men and 2,265 women, were shown and asked to choose their preferred figure from a set of drawings, many chose the heavy figures. About 15 per cent of women and 20.6 per cent of men chose an obese image as ideal.

“But you can’t just blame doctors, many Kenyans are just too stubborn and unlikely to adhere to good loss weight advise,” says consultant nutritionist Abby Olenda.

She gives the example of a survey among diabetic patients at Jaramogi Oginga Odinga Teaching and Referral Hospital in Nyanza.

Even though 89 per cent of the study respondents had received diet advice, and 66.8 per cent acknowledged that they could afford the recommended diet, only 22.3 per cent said they always adhere to prescribed diet.

The implication, she says, is that patients who receive diet or physical activity advice and even those who can afford it, will not necessarily adhere to them.