Surgeon general’s figure a question of health

As a registered dietitian, Sharon Salomon of Phoenix teaches clients how to eat right and lose weight.

But despite her expertise, Salomon says there’s just one word to describe her own physique: “fat.”

To some, Salomon’s 5-foot-2-inch, 170-pound body would be a professional deal-breaker. After all, are chubby dietitians or portly physicians in any position to advise others how to get healthy?

That question is at the heart of a debate set off when Dr. Regina Benjamin was nominated for surgeon general last month by President Barack Obama.

Supporters say Benjamin, a MacArthur Foundation “genius grant” recipient who set up a medical clinic in hurricane-ravaged Alabama, is being treated unfairly.

After all, they point out, many previous surgeon generals – most of them men – weren’t so skinny themselves.

But with the nation’s obesity crisis worsening, some advocates say it’s increasingly critical for health care workers and those with visible, influential roles to “walk the walk” and serve as role models.

“A doctor doesn’t need to be perfect, but it’d be hard for me to take financial advice from a CPA who had just filed for bankruptcy,” says Dr. Timothy Harlan, medical director of the Tulane University School of Medicine.

On the other hand, Harlan says, he once had an obese partner who was well-loved by his overweight patients.

Many doctors and psychiatrists listed on a “fat friendly health professionals” Web site are overweight themselves, which some argue makes it easier for them to understand what their patients are going through.

“The weight of a health professional is irrelevant,” says Roki Abakoui, assistant director for clinical services at Northwestern University’s Counseling and Psychological Services and an activist for size acceptance. “People come in all shapes and sizes.

“Weight and health are not the same thing,” Abakoui adds. “There are thin people who are unhealthy and there are fat people who are healthy.”

Obesity, which disproportionately affects African-Americans and other minority groups, is a risk factor for a number of chronic diseases, including diabetes, cardiovascular disease and some cancers.

The costs to the U.S. health system caused by obesity could be as high as $147 billion each year, according to a study released at the U.S. Centers for Disease Control and Prevention’s recent Weight of the Nation conference.

Patients have more confidence in their doctors if they aren’t obese, according to a 2003 study in the journal Preventive Medicine.

“If (health officials) don’t hold themselves accountable to healthy standards, what are they going to be able to do for me?” asks Leesa Drake, a 42-year-old endurance athlete from Chicago.

“These are presumably people to whom I would pay money for their services and expert opinions. I want to know that they know what they’re talking about by walking the talk themselves.”

But people struggling with weight issues might be intimidated by a doctor who runs marathons, says Dr. Ronald Epstein, a professor of family medicine at the University of Rochester Medical Center who studies how to improve patient-physician communication and relationships.

Ultimately more important, says Epstein, is the ability to communicate: “The better the communication, the less those superficial differences seem to matter.”

Those bonds influence how willing patients are to work closely with physicians, says Dr. Michael Dansinger, a nutrition and obesity researcher at Tufts Medical Center.

“What makes a physician credible is whether they practice what they preach and heed the lifestyle recommendations they propose,” says Dansinger.

“Whoever the surgeon general is can set the best example by actually practicing the lifestyle recommendations that are necessary in order to turn around an obesity epidemic,” he says. “That’s slightly different than judging someone on weight.”