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.

如果有一个地方在那儿全盘托出是一个好的主意，它就是医生的办公室。一个有疼痛，一个像吸烟这样的症状或者坏习惯的病人如果他把秘密留给自己是对谁都没什么好处的。然而有一段时间当医生们经常地而不是热心的必须告诉病人们需要减肥。

在明尼苏达州罗切斯特·马尤诊所的研究人员. 透漏了在一年多的时间里到他们的医生那儿进行常规检查的两千五百多个肥胖病人的调查。研究者发现图表中只有五分之一的人被列为肥胖之列。 没列在表格上的很可能是既没有和医生交流也没有和病人交流。那意味着麻烦。那些在调查中被确诊的可能已经和医生发展了体重管理计划的人比其他的肥胖病人要多出两倍还多。

这个研究的作者预防医学专家，也是在八月份出版的《梅奥临床进展》的作者Dr. Warren Thompson说：“如果你没有计划，你的体重就不会减少”。。

解决肥胖当然是意味着高风险的疾病，糖尿病，住院和早早的死亡。因此医生们怎么会如此轻率地在表格上按上朱红的O呢？Thompson说，有时医生病人没有改变的动机因此就不想打扰。有的的时候病人好像对医生或者是需要立即着手解决的强制性的保健事宜的制约时间保持沉默。

在英国儿童科学院的青春期医学专家马克Jacobson医生解释道，父母们对超重的孩子有负罪感因为他们知道超重大部分有遗传的因素，同时也因为他们感觉对控制年轻人的运动水平和饮食他们有义务。父母们也正在不断发展的孩子的饮食紊乱而担心体重是否变成一个重要问题，因此他们什么也不说。

Jacobson 说：“我有一个病人他的妈妈用手捂着嘴巴（从而使他的孩子看不见）小声对我耳语.体重这个词。我能够分辨出他们已经思考了并且不想对孩子提及这个问题。”但是他仍然坚持医生们必须讨论这个问题。想温柔的做这一点的方法就是避免说肥胖这个词儿说孩子有体重问题。医生也可以告诉孩子们他们的体重是十几年前就存在了。然后，Jacobson说，他更多的集中讨论能够帮助提高改善环境的的活动像少看电视和到户外玩耍而不主要集中在体型上。

“你不想让人们感到窘迫也不想让他们再来，你想让他们得到治疗。”Jacobson说。他还强调每一个儿科医生应该确定孩子的人体重量指数(BMI)通过选配体重和身高产生一个大致能确诊为肥胖的两位数，BMI是一个非完美的公用制。部分是因为他不能考虑体型和肌肉的因素，一个有很少脂肪的敦实的人也可能被定义为肥胖。但是作为一个开始点，BMI是有用的。

没有这样的人赦免病人或者父母们使他们更进一步或者对自己提及体重这个问题，但是无论谁提起这个问题，记住谦虚的减肥可能对整体有很大的利益这一点对于病人和医生都是重要的，即使这个减少感觉或者看起来很不像。彰显勇气并且说他需要有人说这样问题，对于每一个人来说事实总是最好的理由——即使受了点伤害。