Despite the record number of overweight people today -- one in three Americans is obese, according to the U.S. Centers for Disease Control and Prevention -- many doctors become frustrated at patients' failure to see the common connection between their weight and their medical problems.
"I sometimes feel like patients are telling me they want me to make them stop bleeding, but without pulling out the arrows stuck in their chests," said Dr. Lee Green, professor of family medicine at the University of Michigan in Ann Arbor.
Obesity can lead to diabetes, high blood pressure, heart disease and arthritis -- especially in the knees, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Yet losing just 10 percent of a person's body weight can delay or prevent some of these diseases.
"The most frustrating thing for me is patients whose lifestyle is making them miserable but they won't change it," Green said.
Green said many problems, such as sleep apnea and chronic tiredness, can be attributed to eating too much and moving too little. In that case, the treatment isn't disease, but "lack of health."
"[It's] people whose knees are killing them, because they're 80 pounds overweight, and they're dead set on the idea that the fix is a drug, or an injection, or surgery," he said.
"I'm in good shape, pretty fit, and my knees hurt after a day of hiking with a 50-pound pack. These folks are carrying more weight than that, lugging it 24/7, and they weren't fit to start with," he said. "Why do they hurt? Hmm, not a major medical mystery ..."
The United States is one of the few countries in the world that allows direct-to-consumer drug advertising. Since the FDA's 1997 decision to let drug companies market pharmaceuticals to the masses (previous drug marketing was aimed largely at physicians), doctors have reported more patients asking about drugs than ever before.
In some cases, it might have been helpful. But doctors say patients who are simply sold on a drug can interfere with their own care.
"For me, what is most frustrating is when patients view doctors as simply a source of a signature for something they want, without really wanting the physician's guidance or opinion," said Dr. Thomas Schwenk, chairman of family medicine at the University of Michigan.
Schwenk is not alone. In the February issue of Archives of Internal Medicine survey of doctors' difficult patients, the most frequently cited complaint was patients who insisted on getting an unnecessary drug.
However, that doesn't mean Schwenk is against any research or questions in the office.
"I don't mind when patients do their own research on the Internet; I actually value it, as long as their purpose is to be informed so they can engage in complex discussions and decision-making," Schwenk said.
Although not quite as common as patients who demand medicine the doctor would not otherwise prescribe, doctors say plenty of patients also demand extra tests and procedures.
"This is the bias some patients have to just doing more, without any understanding of how more care is not only expensive, but actually often leads to complications, poor outcomes and lower quality," Schwenk said.