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Health Horizons : NUTRITION : Physician, Feed Thyself : Many physicians who advise patients on good nutrition are overweight themselves. More than one-fourth of doctors in a survey never exercise.

March 21, 1993|THERESE IKNOIAN | Therese Iknoian is a free-lance health and medical writer based in San Jose

"Now remember what I told you about losing weight," Jim, the family doctor, told an obese middle-age women standing at his reception counter. She moaned about how difficult it was. The fat on the back of her hand bunched up as she grasped a pen to sign an insurance form.

"One more thing . . . " added the man in the white coat.

He took a step into a staff room behind him and emerged a moment later with a thick wedge of peanut butter fudge cake with frosting so chocolate it was black, not brown.

"Here, take this." The patient's eyes lit up. Her chubby hands gingerly cradled the cake as she walked out of the office.

This exchange is not fiction, but one that played out before my eyes a couple of years ago. I turned to stare at Jim, incredulous that a doctor advocating weight loss would hand out gooey platefuls of butter, fat and sugar--not exactly fare that promotes fat loss, let alone good health.

"Oh, she won't eat the cake," he said, catching my accusatory stare, "at least not all at once."

Then he offered me a slice of croissant bread pudding from a room always stocked with the likes of cheese Danishes, brownies with fudge frosting, chocolate kisses, coffee cake and other assorted artery-clogging treats. He was just trying to be nice, he said later. "I enjoy food. Anyway, she wasn't going to start her diet until tomorrow."

Jim, who is a sports team physician, exercises sporadically and carries 30 pounds too many around his teddy bear-like middle. "I was a food-as-a-reward child," he explained.

Not all doctors hand out fudge to overweight patients. Or skip exercise. Or carry too much weight and eat the wrong foods. Some are much healthier than the general public. Many are at least a little more attentive to their health than are their patients. Most don't smoke and almost all wear seat belts.

Still, "a little more attentive" doesn't a healthy doctor make. Or a reliable health counselor. According to physician surveys, research articles and leading doctors, Dr. Jim is not atypical. Most doctors don't practice what they preach. Many don't even begin to preach to patients the role of a good diet and regular exercise in disease prevention. Or, if they do, the advice is so general ("eat less fat") that it does no good.

Dr. Jim says his patients get "the standard pep talk," but he doesn't harangue them about their unhealthful habits. When they say they're too busy to exercise, he drops the subject.

Then we have Dr. Jeff, a San Diego-area endocrinologist who spends all day counseling people with metabolism and weight problems. Too embarrassed to give his last name, Jeff sums up his health simply: "I'm fat. Oh God, I'm in terrible shape."

He's right. At 5-foot-8, he weighs about 200 pounds, about 30 too many. He doesn't know exactly, because he hasn't been on a scale, had a physical, taken his blood pressure or measured his blood cholesterol since he-can't-remember-when. At least Dr. Jim keeps tabs on such health indicators (all fine).

"Physicians should act as role models for their patients and they don't," said Dr. Ron Lawrence, a semi-retired neurologist in the San Fernando Valley. "How many big, fat doctors are out there telling their patients to lose weight? C'mon Charlie!

"It's 'Do what I say, not what I do,' " said Lawrence, 66, who in 1969 helped found the American Medical Athletic Assn., a nonprofit social group of doctors that meets around the world to run races and marathons together.

With a membership of about 3,000, the athletic association represents a minority of doctors. Most of their colleagues do more running between appointments than around the track.

According to results from the Physicians' Health Study being conducted by Harvard Medical School, slightly more than a quarter of the 21,271 male doctors in the ongoing survey never exercise. That's a more depressing number than among the general public, of whom 24% never exercise, according to a 1985 survey by the Center for Disease Control.

On the other hand, more doctors do exercise regularly: 38% of the Harvard study participants--who started in the study between the ages of 40 and 84--exercise vigorously two to four times a week. That's about three times the number of Joe and Jane Q. Publics who exercise regularly and vigorously.

Does that satisfy the healthy doctors of the world?

"We aren't nearly good enough," said Dr. Walter Bortz, clinical associate professor at the Stanford University Medical School and an avid runner who completed the Boston Marathon last year.

Bortz did his own study of doctors' health habits, published in January, 1992, in the Western Journal of Medicine. Using 126 male and female doctors at the Palo Alto Medical Clinic as subjects, he came up with far more encouraging results: 93% exercise regularly. Six ran marathons the previous year.

Remember, though, this study was in California, the birthplace of aerobics, jogging, alfalfa sprouts, water bars, fruits and nuts.

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