"It's a little disingenuous to say, 'I want you to do something I don't do myself,"' said Fleming, a family physician in Shreveport, La.
According to the Centers for Disease Control and Prevention, two-thirds of Americans are overweight or obese, including doctors, the very people they turn to for guidance on healthy living.
Fleming, who has been overweight since childhood, leads a busy professional life that makes weight control a struggle. He grabbed burgers on the run, slid up to banquet tables at medical organization meetings where high-calorie meals were on the menu, and missed chances to exercise.
But being overweight is not only unhealthy for him, it makes the profession look bad, Fleming said.
As president of the 94,000-member American Academy of Family Physicians, he's doing something about it.
Since October, when Fleming began his one-year term, he has lost about 25 pounds by managing his diet and staying more active. He's challenging academy members to get in shape themselves, and attending regional meetings to enlist them.
To gauge what shape the membership is in, the academy is taking a survey of members' exercise patterns as well as their heights and weights.
Obesity is measured with a height-to-weight ratio called the body mass index. A BMI of 30 is obese - for someone 6 feet tall like Fleming, a healthy weight would be below 184 pounds, which would reduce his risk of heart disease, stroke, diabetes and some cancers.
The academy is not recommending a specific diet and exercise program, figuring the members know enough to be able to choose their own. But Fleming does want his colleagues to enroll in the active lifestyle program of the President's Council on Physical Fitness and Sports, which asks participants to commit to some type of physical activity at least 30 minutes a day, five days a week, for six straight weeks.
To start on the right path, participants get pedometers. Fleming uses one to make sure he takes at least 10,000 steps a day, typically by going for walks or using an elliptical machine at a gym. He cut back on carbohydrates like potatoes and bread, although he doesn't follow a specific diet, such as the low-carb Atkins or South Beach plans.
He intends to keep up the diet and exercise regimen for at least another year, until he loses the 80 pounds that would put him in a healthy weight range.
The academy's "physician-heal-thyself" drive kicks off what the AAFP hopes will be a 10-year campaign it calls Americans in Motion, to spread the message of healthy eating and exercise to patients, who make more than 210 million office visits each year.
"As we developed this, we felt that, unless we look at ourselves and how we deal with our own fitness, it's not going to be easy to get it across to patients," said Dr. Tim Tobolic, of Byron Center, Mich., a member of the advisory committee that is planning the campaign.
What doctors learn by trying exercise themselves should help them understand patients' problems, Tobolic said.
Not having enough time, for instance, is among the most common reasons people give for not working out. Tobolic does not accept that as an excuse.
"You have to find the time," he said. "I have to do it at 5 o'clock in the morning. Even if it's only a half hour a day, people can find the half hour."
Other doctors are watching the family physicians and considering their own initiatives.
"We have not picked up the mantle the way they have, but it is something that has been discussed internally and makes a lot of sense," said Dr. Ed Langston, of Lafayette, Ind., a member of the American Medical Association's board of trustees and past president of the AAFP.
Langston, who exercises at 5 a.m., applauded Fleming's lead-by-example approach. Doctors give themselves more motivation if they go public with their lifestyle changes, as Fleming has, he said.
"If you decide to run a marathon, you tell all your friends and it's kind of hard to back out," he said.
By Ira Dreyfuss
By Ira Dreyfuss