On May 6, Mark Stephen DeFrancesco, MD, became the 66th president of the American College of Obstetricians and Gynecologists (ACOG), based in Washington, DC. During his opening remarks, Dr. DeFrancesco urged ob-gyns to provide more comprehensive care with specific focus on obesity and smoking. The American Board of Obesity Medicine asked Dr. DeFrancesco to expound on his remarks related to obesity. His thoughts are below:
When I began my year-long term as President of the American College of Obstetricians and Gynecologists (ACOG), I challenged my fellow ob-gyns to join me in stepping up to fight obesity in American women.
This seems straightforward. After all, obesity results in 300,000 deaths annually in our country alone, and is a worldwide problem. As health care professionals, we would be remiss in not addressing it.
But why do I believe that this is also a particularly essential issue for ob-gyns specifically to confront?
For one thing, we know that for many women, the ob-gyn is the only physician seen on a regular basis. And let’s not forget that due to the sensitive nature of the ob-gyn’s connection with patients, we tend to have a highly trusted relationship. We don’t solely focus on reproductive health. We regularly counsel about mental health issues and avoiding or reporting intimate partner violence. That same holistic approach to a woman’s comprehensive care certainly should include the role that obesity may be playing in her wellness, and her family’s welfare also.
As ob-gyns, we often meet our patients when they are young, perhaps when they approach us for their first cervical cancer screening or birth control counseling. This gives us the opportunity to provide them with tools that will help to prevent obesity, long before they gain the weight that we all know is very difficult to lose.
But we also can play a role in encouraging our patients who are obese to regain their health, as well. It must be a rallying cry for us that it is never too late for a woman to begin to take care of herself, and to make her health a priority.
After all, let us look at what we are up against. Obesity is a risk factor for diabetes, hypertension, high cholesterol, stroke, heart disease, certain types of cancer, and arthritis. Imagine the good we could do for women if we do a better job helping them avoiding these conditions.
Let’s not forget that women often set the tone for the well-being of their families, as well. Keeping mothers healthy pays dividends for their children, and even their significant others.
Recently, we are learning that investing in health early is important for pregnancy, also. It is well established that obesity increases the cesarean delivery rate and other pregnancy-related complications. But we are now also seeing that a mother’s obesity during pregnancy can lead to a medically complicated life for her child – not just as a newborn, but throughout life.
We can give women tools to get healthier, and those tools can help them build a foundation of wellness for their children. What is a better use of the health care system than that?
Now, how we approach these changes is critical. It’s not just about what we say to our patients, it is also about how we say it. That will determine the success of our efforts, and it will significantly define our relationships with our patients.
For one thing, we must approach these conversations empathetically, constructively, and without judgment. This is appropriate, it is professional, and it is likely to be the most effective approach. We are not here to scold, we are here to counsel. We should not feel embarrassed to bring up the discussion of weight, nor worry that we will embarrass the patient. I’ve found many patients are in fact grateful that I did broach the subject with them directly.
For another, we must approach obesity for what it is – a medical condition, just as are other conditions that we regularly screen for and treat. And the approaches that we take to address our patient’s weight should be just as grounded in best practices and appropriate care as approaches that we would take to any other medical condition.
When I raised this issue in my inaugural address at the ACOG Annual Meeting, I made a call to action for all ob-gyns that I will continue to raise with my counterparts in other specialties: “First do no harm? Let’s go way beyond that: let’s do even more good than we do right now.”