If there's one place where it's a good idea to come clean, it's the doctor's office. Patients with an ache, a symptom or a bad habit like smoking do no one any good if they keep it to themselves. Yet there's one time doctors are often less than forthcoming: when they have to tell patients they need to lose weight.

Researchers at the Mayo Clinic in Rochester, Minn., recently released the results of a survey of more than 2,500 obese patients who went to their doctor for a regular checkup over the course of a year. The investigators found that the charts of only 1 in 5 of those people listed them as obese. What isn't on the charts is probably not communicated between doctor and patient either, and that means trouble. Those in the study who got the diagnosis were more than twice as likely to have developed a weight-management plan with their doctor than were the other obese patients.

"If you don't have a plan, you're not going to lose weight," says the study's author, preventive-medicine specialist Dr. Warren Thompson, whose research was published in August's Mayo Clinic Proceedings.

Obesity, of course, means a higher risk of heart disease, diabetes, hospitalization and early death, so how come doctors are so lax about putting the scarlet O on the chart? Sometimes, Thompson says, doctors perceive that a patient isn't motivated to change, so they just don't bother. Other times, the patient's likely embarrassment silences the physician, or time constraints get in the way as more immediately pressing health concerns get dealt with.

Discussing weight becomes even more complicated with children. According to a 2005 study in the journal Pediatrics, doctors diagnosed obesity less than 1% of the time among 2-to-18-year-olds—a figure far below the one-third of young Americans struggling with weight.

Dr. Mark Jacobson, an adolescent-medicine specialist with the American Academy of Pediatrics, explains that parents may feel guilty about having an overweight kid because they know it's partly hereditary and because they feel it's their responsibility to control their youngster's exercise levels and diet. Parents also worry about a child's developing eating disorders if weight becomes an issue, so they say nothing at all.

"I've had a patient whose mother whispered the letters w-e-i-g-h-t to me, with her hand over her mouth so the child couldn't see. I could tell it was something they had thought about and didn't want to bring up with the child," says Jacobson. Still, he insists that doctors must discuss the topic. One way to do so gently, he says, is to avoid the word obese and instead say the child has a weight problem. Doctors may also tell kids that their weight is a couple of years ahead of their age. Then, Jacobson says, he focuses the discussion more on the behaviors that could help improve the situation—like watching less TV and playing outside more—instead of concentrating principally on shape.

"You don't want to make people feel embarrassed and not want to come back to you. You want them to get treated," he says. Jacobson stresses that every pediatrician should determine a child's body-mass index (BMI)—a figure arrived at by factoring weight and height to produce a two-digit number that roughly diagnoses obesity. BMI is an imperfect metric, in part because it does a poor job of taking body type and muscle mass into consideration, meaning that a stocky person with low body fat can be labeled obese. But as a starting point, BMI helps.

None of this absolves patients or parents from stepping forward and bringing up weight on their own. But whoever raises the topic, it's important for patients and doctors alike to remember that modest amounts of weight loss can disproportionately benefit overall health, even if the loss doesn't feel or look like much. That fact may be the best reason for everyone to show a little courage and say what needs to be said — even if it hurts a bit.

如果有一個(gè)地方在那兒全盤托出是一個(gè)好的主意，它就是醫(yī)生的辦公室。一個(gè)有疼痛，一個(gè)像吸煙這樣的癥狀或者壞習(xí)慣的病人如果他把秘密留給自己是對(duì)誰(shuí)都沒什么好處的。然而有一段時(shí)間當(dāng)醫(yī)生們經(jīng)常地而不是熱心的必須告訴病人們需要減肥。

在明尼蘇達(dá)州羅切斯特·馬尤診所的研究人員. 透漏了在一年多的時(shí)間里到他們的醫(yī)生那兒進(jìn)行常規(guī)檢查的兩千五百多個(gè)肥胖病人的調(diào)查。研究者發(fā)現(xiàn)圖表中只有五分之一的人被列為肥胖之列。 沒列在表格上的很可能是既沒有和醫(yī)生交流也沒有和病人交流。那意味著麻煩。那些在調(diào)查中被確診的可能已經(jīng)和醫(yī)生發(fā)展了體重管理計(jì)劃的人比其他的肥胖病人要多出兩倍還多。

這個(gè)研究的作者預(yù)防醫(yī)學(xué)專家，也是在八月份出版的《梅奧臨床進(jìn)展》的作者Dr. Warren Thompson說：“如果你沒有計(jì)劃，你的體重就不會(huì)減少”。。

解決肥胖當(dāng)然是意味著高風(fēng)險(xiǎn)的疾病，糖尿病，住院和早早的死亡。因此醫(yī)生們?cè)趺磿?huì)如此輕率地在表格上按上朱紅的O呢？Thompson說，有時(shí)醫(yī)生病人沒有改變的動(dòng)機(jī)因此就不想打擾。有的的時(shí)候病人好像對(duì)醫(yī)生或者是需要立即著手解決的強(qiáng)制性的保健事宜的制約時(shí)間保持沉默。

在英國(guó)兒童科學(xué)院的青春期醫(yī)學(xué)專家馬克Jacobson醫(yī)生解釋道，父母?jìng)儗?duì)超重的孩子有負(fù)罪感因?yàn)樗麄冎�道超重大部分有遺傳的因素，同時(shí)也因?yàn)樗麄兏杏X對(duì)控制年輕人的運(yùn)動(dòng)水平和飲食他們有義務(wù)。父母?jìng)円舱�在不斷發(fā)展的孩子的飲食紊亂而擔(dān)心體重是否變成一個(gè)重要問題，因此他們什么也不說。

Jacobson 說：“我有一個(gè)病人他的媽媽用手捂著嘴巴（從而使他的孩子看不見）小聲對(duì)我耳語(yǔ).體重這個(gè)詞。我能夠分辨出他們已經(jīng)思考了并且不想對(duì)孩子提及這個(gè)問題。”但是他仍然堅(jiān)持醫(yī)生們必須討論這個(gè)問題。想溫柔的做這一點(diǎn)的方法就是避免說肥胖這個(gè)詞兒說孩子有體重問題。醫(yī)生也可以告訴孩子們他們的體重是十幾年前就存在了。然后，Jacobson說，他更多的集中討論能夠幫助提高改善環(huán)境的的活動(dòng)像少看電視和到戶外玩耍而不主要集中在體型上。

“你不想讓人們感到窘迫也不想讓他們?cè)賮?lái)，你想讓他們得到治療。”Jacobson說。他還強(qiáng)調(diào)每一個(gè)兒科醫(yī)生應(yīng)該確定孩子的人體重量指數(shù)(BMI)通過選配體重和身高產(chǎn)生一個(gè)大致能確診為肥胖的兩位數(shù)，BMI是一個(gè)非完美的公用制。部分是因?yàn)樗�不能考慮體型和肌肉的因素，一個(gè)有很少脂肪的敦實(shí)的人也可能被定義為肥胖。但是作為一個(gè)開始點(diǎn)，BMI是有用的。

沒有這樣的人赦免病人或者父母?jìng)兪顾麄兏�進(jìn)一步或者對(duì)自己提及體重這個(gè)問題，但是無(wú)論誰(shuí)提起這個(gè)問題，記住謙虛的減肥可能對(duì)整體有很大的利益這一點(diǎn)對(duì)于病人和醫(yī)生都是重要的，即使這個(gè)減少感覺或者看起來(lái)很不像。彰顯勇氣并且說他需要有人說這樣問題，對(duì)于每一個(gè)人來(lái)說事實(shí)總是最好的理由——即使受了點(diǎn)傷害。