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Doctors fighting the battle of the bulge

The day of his important meeting at the Capitol, Dr. Raye Bellinger, a cardiologist, found that his 46-inch waist had outgrown even his last pair of pants. He ended up using his wife's bobby pin to hold the waistband together.

And Dr. Tom Ferguson, medical director at the University of California-Davis Student Health Center, had been diagnosed with two classic - and scary - consequences of obesity: high blood pressure and elevated cholesterol. His heart doctor prescribed a handful of pills to treat them.

These physicians, among others, hit what might be called their "bottom" because, they admit, they had not practiced what they preached, failing themselves to heed the advice they frequently gave patients.

Despite a general perception that doctors have superior health consciousness, overweight physicians are about as common as, well, the common cold. In every field - from pediatrics and family practice to cardiology or sports medicine - the battle of the bulge persists.

A national study of male physicians in 2004 found that 44 percent were overweight and six percent were obese. Though there's no similar study on female physicians, experts generally agree that all doctors are just as or even more likely to be overweight and out of shape as the rest of adult Americans.

Dr. Jo Marie Reilly, a Los Angeles family physician and obesity expert, likens the problem of overweight doctors to the high rates of smoking among physicians decades ago.

"Once there was more awareness of the risks, doctors quit smoking," she said. "My hope is that as obesity is the newest thing, maybe doctors will also jump on that bandwagon."

Reilly, who trains young doctors, is doing her part to make that happen. She instructs her medical students to write themselves prescriptions for nutrition and exercise, a concept unheard of in medical schools of yore.

"Just like children," she said. "You try to build habits early in life. Hopefully those will sustain them and carry them through 40 or 50 years of practice life - and help them be good examples to their patients and colleagues.

But there is more at stake when doctors are overweight than physician credibility. Increasing numbers of Americans are overweight and coming to their doctors with obesity-related risk factors and deadly diseases than ever before.

"A physician's behavior is the strongest predictor of how they will counsel patients around preventive health behaviors," said Harvard Medical School professor Dr. David Eisenberg, who recently put on a healthy cooking workshop in Napa, Calif., designed to help health care practitioners better guide their patients.

Research backs Eisenberg's claim. A study published in the journal Preventive Medicine in 2003 found that when doctors watch their own weight, they are more apt to counsel and encourage their patients to lose weight and improve their diets.

By the same token, heavy doctors who attempt to counsel their patients to lose weight may find their advice falling on deaf ears.

"Some of us are the worst role models," acknowledged Bellinger, who at one point carried 285 pounds on his 6'4" frame. "We work long hours, and do a lot of intermittent eating of terrible things."

Hernandez, who worked as a family doctor while she was at her heaviest, said it was awkward advising patients to watch their diet and exercise regularly.

"There was a feeling of being a hypocrite, sitting across from patients and being overweight myself," she said. "Regardless of what my story was, there was a physical barrier from what I was saying."

Ferguson said he was behaving like some of the students he saw in the University of California, Davis clinic, piling on weight as a result of long hours, stress and poor diet.

"I could see the writing on the wall," said Ferguson, who, at 5'6" topped out at 230 pounds. "It came down to: `Look in the mirror. Physician heal thyself.' I needed help."

Over in Sutter County, Calif., workers had for too long ribbed County Health Officer Dr. Mike Kinnison for touting his employee wellness program when he was about 100 pounds overweight himself.

Ferguson, Bellinger and Kinnison all found help at the Obesity Treatment Center, a for-profit operation run by internist John Hernried. The program, which in its most intensive phase costs as much as $700 per month, combines a very low-calorie diet and medical monitoring with intensive education around nutrition, exercise and awareness of behaviors that lead to weight gain.

The son of a doctor who died of obesity-related heart disease, Hernried hid his own expanding belly under his white coat until just a few years ago, when his cholesterol level soared to 260 and his weight to 195.

Doctors and weight gain tend to go together, he said, because of the intense and erratic physician lifestyle, which gets entrenched during medical school and tends to worsen with time.

"You don't think about yourself," he said. "You need to focus on taking care of others. It's ingrained and hard to break those habits."

Ron Sockolov, a family doctor with a master's degree in exercise physiology who also practices sports medicine, is a creature of disciplined habit. Up every morning by 5:30, he operates a successful private medical practice, maintains a tight ship financially and hits the gym for heart-pumping workouts every weekday from noon to precisely 1:12 p.m.

But the 55-year-old has a less desirable habit: overeating. At 5'10" and 240 pounds, he is, according to the body mass index, obese.

Sockolov joined the Obesity Treatment Center program a year ago. He lost 32 pounds, but said he has since gained all but 10 pounds back, despite his intensive fitness regimen.

"At night, I'm a vacuum cleaner," he said. "You think you are invincible, and you can have the extra piece of bread, you can have the rice and potatoes and a few chips."

Hernried said his most successful patients are enrolled in the program for about two years (including 18 months of weight maintenance classes), and that long-term success often requires a second or third attempt.

With a self-proclaimed sweet-tooth and a dislike of exercise, Hernried admits his own weight has yo-yoed a bit since losing 30 pounds in 2001. When he gains a few, he quickly reverts to his program, which starts with meal replacement drinks, then adds low-calorie foods. He regularly weighs himself, watches his calories, gets personal fitness training and keeps careful records of it all.

Eisenberg, from Harvard Medical School, said all doctors have an obligation to "walk the walk."

"They have a higher responsibility to learn the skills on advising patients to make improvements in their own lifestyle, and they must do this themselves, serve as agents for change," he said.

Many of Hernried's physician-patients have done that _ and more. Ferguson's 50-pound loss, for example, inspired his assistant to lose 55 pounds with plans to lose another 40.

Bellinger, who jokes that he used to walk into French patisseries and eat his way from one end to the other, now prohibits pharmaceutical company sales reps from dropping off sweets in his medical office. He does allow fresh fruit, however, and whole wheat bagels.

Kinnison, down 80 pounds with about 20 to go, has urged Sutter County employee groups to trade their donuts, cupcakes and cookies for healthier snacks in the workplace. And he's now known for coaxing co-workers outside for "walking meetings."

Hernandez, who has kept her weight off for several years, can now advise her own patients with impunity. "I can say, `Look, I struggle with this as well,' " she said. "I am able to use my experience as an inspiration for my patients." --- RESEARCH A sampling of research findings on overweight/obese doctors: _An estimated 44 percent of male physicians in the United States are overweight and 6 percent are obese. Source: "Body Mass Index and Mortality among US Male Physicians," Annals of Epidemiology, 2004 _It is more difficult for physicians to give credible medical advice when they do not follow that advice. Source: "Does physician weight affect perception of health advice?" Preventive Medicine, 2003 _Patients have less confidence in advice from obese doctors. Source: "Personal exercise habits and counseling practices of physicians: a national survey." Clinical Journal of Sport Medicine, 2000. _Obese physicians are less likely to diagnose obesity in patients and are less comfortable providing obesity counseling. Source: "Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002," Journal of the American Medical Association, 2004. _Physicians who perform aerobic exercise regularly are more likely to counsel their patients about aerobic exercise. Source: "Personal exercise habits and counseling practices of physicians: a national survey," Clinical Journal of Sport Medicine, 2000. _Physicians who are not overweight are more likely than overweight physicians to address obesity with patients before obesity-related ailments develop, and do so more aggressively. Source: "Do physicians preach what they practice? A study of physicians' health habits and counseling practices," JAMA, 1984.

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