As a primary-care provider, youll likely need to address obesity with overweight, diabetic patients. Unfortunately, while theres a wealth of educational information about diabetes and treatment options (see The New Fundamentals of Diabetes), advice on how to appropriately broach the subject of weight is scarce.

As you know, you walk a fine line when you discuss weight with a patient. Its an emotionally charged topic, and I dont know of any manuals that describe how to effectively convince a patient to lose weight. A New Hampshire physician recently tried, only to find himself at the center of an investigation by the states attorney general.

Dr. Terry Bennett, who practices in Rochester, N.Y., says he was trying to get the patients attention, but she was offended and reported him to the New Hampshire Board of Medicine. The board later referred the matter to the attorney general for investigation.

An Internet search on the case will unearth a virtual love-fest for Dr. Bennett, with such headlines as NH Doctor in Trouble with State Because He Told Patient She Need-ed to Lose Weight, and Woman Offended by Docs Obesity Ad-vice. The Associated Press (AP) reports that Dr Bennett gave his overweight patient advice that backfired. The AP further reports on a former patient who is speaking out on Dr. Bennetts behalf, telling of his dedication to convincing patients to lose weight. In short, the reports are, by and large, very favorable to Dr. Bennett.

And why shouldnt they be? On the surface, Dr. Bennett was doing his job. He was informing his diabetic patient of the risks associated with obesity. His quote to the AP: I told a fat woman she was obese. I tried to get her attention. I told her, You need to get on a program, join a group of like-minded people and peel off the weight that is going to kill you.

What the AP did not report, as of our press date, was that Dr. Bennett delivered a lecture specifically designed for his female patients. In a live interview on NBCs Today show and in interviews with the New Hampshire Union Leader, Dr. Bennett admits that he tells obese women that they most likely will outlive an obese spouse. He then tells them that they will have a difficult time establishing new relationships because studies show that most males are completely negative to obese women. Rather than focus on the physical health consequences of obesity, Dr. Bennett tries to appeal to female patients vanity and fear of rejection.

To see him or hear him speak, Dr. Bennett doesnt come across as a bad guy. Im sure he doesnt wake up in the morning and look forward to obliterating any remaining sense of self-confidence that an obese woman might have. But thats what hes doing. If I cant get your attention gently and progressively, then you get a confrontation, he said in the Today show interview.

Dr. Bennett might argue that the end justifies the means. That certainly seems to be the opinion of the media. But the consequences of obesity extend far beyond diabetes, heart disease and stroke. For many patients, the social and emotional consequences of obesity are far more devastating, even if theyre less scientifically measurable.

Walking around in a world that tries to ignore you, surrounded by people who find you repulsive, takes its toll on many obese individuals. Imagine how much worse it must feel when even your doctor reinforces your greatest fears and suspicions: that no one loves or fully accepts a fat person. Id say that crosses the line and does more harm than good, regardless of what Dr. Bennetts intentions may have been.

The board of medicine offered to resolve this case if Dr. Bennett would agree to take a communications course. He refused on the basis that he would be required to sign a paper stating that he is disruptive. Despite the ongoing investigation, Dr. Bennett says he still delivers the same lecture to his female patients.

As an increasing number of overweight diabetic patients turn to you for treatment, I hope youll take time to consider not only the physical ramifications of obesity but the emotional ones as well.

Vol. No: 142:9Issue: 9/15/2005