Taped to the file cabinet in my office is a cartoon by Randy Glasbergen. It shows a doctor, clipboard in hand, saying to his overweight patient, “What fits your busy schedule better, exercising one hour a day or being dead 24 hours a day?”

I don't think real doctors would ever say this to their overweight patients, but they should say something. The United States Preventive Services Task Force found that less than 20 percent of doctor's visits involve counseling on weight loss. Considering more than 60 percent of our population is overweight or obese, I'd say that 20 percent should be higher.

Unfortunately, doctors either don't have the time or are uncomfortable discussing weight issues with their patients. And that's a shame, considering that another recent survey in The Journal of Internal General Medicine shows that patients want advice from their doctors about their weight. Many of the patients in the study said that they thought their doctor had the knowledge to help them but the doctors didn't give enough concrete advice on how to lose weight. The patients wanted specific information on weight loss, short-term and long-term goals, plus referrals to resources that could help them with those goals.

And to what resources would doctors refer their patients? More than likely, those resources should include health clubs and personal trainers. However, I still don't think that the medical community has enough faith in the fitness industry in general to be comfortable recommending specific health clubs or personal trainers — even though I know some personal trainers and clubs have developed great relationships with the medical community in their area.

Could that all change if personal trainers were licensed, as has been proposed in many state legislatures in the past and is currently being proposed in several states this year? Would the medical community be more comfortable recommending that their patients go to a trainer if the physicians believed licenses conferred upon personal trainers a level of competency higher than that of the multitude of certifications out there?

Yes, the industry has tried to regulate itself — at least on the for-profit side — through the International Health, Racquet and Sportsclub Association's (IHRSA) recommendation that its member clubs hire only personal trainers with certifications accredited by the National Commission of Certifying Agencies. I remember that when IHRSA first made the recommendation, I asked several club operators if they planned to comply with it. Most of them had not heard of the recommendation, and when informed about what it was, many of them said the recommendation wouldn't deter them from requiring the certifications they thought were best.

Perhaps the industry just hasn't had enough time to see if IHRSA's recommendation will improve the certifications out there and, therefore, improve the quality of personal trainers. Perhaps four-year degrees are necessary before the medical community will be more agreeable to recommending personal trainers. Or perhaps licensing is necessary.

If you want to weigh in on this subject, feel free to comment on this story online or to attend the Town Hall Meeting on personal trainer licensing, which will be held May 28 in Boston at the Club Industry East conference. More details are available at http://east.clubindustryshow.com/east2009/custom/CIE09_Town_Hall_Flyer.pdf.