Should the doctor say anything?

There were a couple of interesting questions posed on a weight loss support email list I belong to, 3 Fat Chicks. The first question: should the doctor say something about the effect of excess weight on your health? I'm assuming the question to mean after that first time it's brought up. I didn't say on the list how I felt about it because I wasn't sure.

On the one hand, a doctor is supposed to be concerned about your health. If there's something that's affecting it doesn't he or she have the responsibility to speak up about it? On the other hand ... how helpful is it? Does it make the patient feel nagged, shamed, pressured and maybe unwilling to return?

This has been my experience: I go into the doctor's office half dreading what I'm going to hear. I know what my weight is doing to me without the doctor even saying so. But having my face pushed into it will make me have to look at the issues ... at least for a few minutes.

Has it helped? Not really. I feel motivated to lose the weight and I try but it's not easy to stay true to a diet over a period of time.

I remember I lost about 30 lbs in 2002 and happily shared that with my doctor. She was so pleased and said she was proud of me. And then ... I gained it all back plus another 20 lbs. I felt so ashamed. The doctor hasn't addressed that issue and I thought, hm, is it because she's disgusted with me now and figures I'm just going to stay a fat person with deteriorating health now?

The subject came up when my daughter and I were at the doctor's office to have working papers signed. My daughter's been losing weight too and the doctor once again said that she was happy and proud.

I asked her about the question that came up on the list and her answer was that she didn't want to create a situation where overweight patients would be reluctant to come and see her because they were nervous about being lectured. Her view was that she would discuss the weight issues with a patient and then not bring it up again unless asked.

I didn't quite get the courage to ask my next question, which is: when we lose weight and then gain it back, does the doctor figure we're sort of a lost cause?