So they say it’s unhealthy to be fat, but have you considered the role of weight stigma?

distinctlybeautiful

“There are several mechanisms by which provider attitudes may affect the quality of, or potential for, patient-centred care. First, primary care providers engage in less patient-centred communication with patients they believe are not likely to be adherent (54). A common explicitly endorsed provider stereotype about patients with obesity is that they are less likely to be adherent to treatment or self-care recommendations (23,24,55,56), are lazy, undisciplined and weak-willed (12,55,57–59). Second, primary care providers have reported less respect for patients with obesity compared with those without (59,60), and low respect has been shown to predict less positive affective communication and information giving (61). Third, primary healthcare providers may allocate time differently, spending less time educating patients with obesity about their health (62). For example, in one study of primary care providers randomly assigned to evaluate the records of patients who were either obese or normal weight, providers who evaluated patients who were obese were more likely to rate the encounter as a waste of time and indicated that they would spend 28% less time with the patient compared with those who evaluated normal-weight patients (59). Finally, physicians may over-attribute symptoms and problems to obesity, and fail to refer the patient for diagnostic testing or to consider treatment options beyond advising the patient to lose weight. In one study involving medical students, virtual patients with shortness of breath were more likely to receive lifestyle change recommendations if they were obese (54% vs. 13%), and more likely to receive medication to manage symptoms if they were normal weight (23% vs. 5%) (23).”

“The effects of stigma are both immediate and long-term. The direct effects of provider attitudes on patient-centred care may reduce the quality of the patient encounter, harming patient outcomes and reducing patient satisfaction. Patients with obesity who experience identity/stereotype threat or felt/enacted stigma may experience a high level of stress which can contribute to impaired cognitive function and ability to effectively communicate (66). Accumulated exposure to high levels of stress hormones (allostatic load) has several long-term physiological health effects, including heart disease, stroke, depression and anxiety disorder, diseases that disproportionately affect obese individuals and have been empirically linked to perceived discrimination (67–69). Indeed, stress pathways may present an alternate explanation for some proportion of the association between obesity and chronic disease (70).”

“Clinic equipment may also promote identity threat for patients with obesity (87,88). Waiting room chairs with armrests can be uncomfortable or too small. Equipment such as scales, blood pressure cuffs, examination gowns and pelvic examination instruments are often designed for use with smaller patients. When larger alternatives are not available, or are stored in a place that suggests infrequent use, it can signal to patients that their size is unusual and that they do not belong. These experiences, which are not delivered with malicious intent, can be humiliating.”

Full article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381543/#!po=29.2208

Aaron_K123

Well to be honest obesity is sort of a visual cue that a person has no prioritized their health. Can we really fault a doctor for assuming that someone who is morbidly obese may be less likely to adhere to health related advice/needs relative to someone who is in good physical condition? Let's not protect feelings at the expense of reality.

crackpotbaby

It would be unethical to medicate people for a symptom that is caused by excess weight.

whosshe

Why would a doctor waste their time with someone who really doesn't want their professional opinion? There is one simple thing you have to do to not be obese anymore- eat less. Humiliation should be felt.

rheddmobile

It only makes sense to suggest that an obese person who is having shortness of breath, which can be caused by lack of fitness, attempt lifestyle changes before trying medication. A person who doesn't need to lose weight is not going to be told to lose weight. I don't want a doctor who slaps me on medication before trying other options.

When I was obese I received nothing but consideration as far as the correct gown size, blood pressure cuff, etc. was concerned. One nurse even went to the trouble of showing me how to drape a second gown over my back so I was properly covered. Of course, where I live, most of my nurses were as big or bigger than I was. When larger sizes are not available it does indeed suggest that your size is unusual - because it is. Sometimes the truth can be uncomfortable.

I have experienced one dietician - who happened to be the person in charge of nutrition at one of the largest hospitals in the MidSouth - who assumed that because I was obese I would not follow appropriate diabetic diet recommendations, so she didn't offer them. Although her assumptions were faulty in my case, it's my belief they were not based on prejudice - again, she was a large woman herself - but on years of observing patients and what they were willing to do.

WillingtoLose1001984

Weight has nothing to do with someone prioritizing their health. Both of my sisters are very thin and have been all their lives while I struggled with my weight. One of them just eats whatever she wants and the other is a vegan and a bit of a health nut even though she has never really been out of the healthy weight range. I care about health as well. I don't drink coke. I try to eat whole foods or foods relatively healthy and eat fruits but sometimes can be slack on vegetables which I am trying to work on. I am still 100 lbs overweight. Medications I was on made me super hungry and feel totally out of control and out of touch with my hunger full signals which made it super hard to diet. I am off of them now and able to stick to a diet ( of course you may not believe medications can make a difference). There are overweight people who have other struggles that have contributed to their being overweight that a normal weight person has not had and sometimes overeating, eating unhealthy, or not being as active are going to be lifelong struggles for them. Everyone has some sort of struggle in their life. Obese people just wear it on the outside where it is easy to see and judge.

WillingtoLose1001984

Oh, and I did get a good 90 lbs over my healthy weight range when I just ate what I wanted, usually pretty healthy just in huge portions, before I really felt like I could make a change. I do NOT eat everything I want now and haven't for years but still obese. I am down 30 hope to get the rest off over the next year and a half.

SueSueDio

I never got the feeling that my doctor treated me any differently to thinner patients - she always had time for me when I was obese, and although she's delighted that I've finally lost weight her overall attitude hasn't changed.

rheddmobile wrote: »

When larger sizes are not available it does indeed suggest that your size is unusual - because it is. Sometimes the truth can be uncomfortable.

Yep, that!

And before someone says, "But the average person is bigger now than they used to be!" so the sizing of things should be adjusted to reflect this - I would argue that just because many people (not a majority in ALL countries) are bigger than the average used to be, that's not a reason to encourage that trend to continue by making everything else bigger to compensate.

If people feel uncomfortable about their size and the way they fit into the world around them, they have the option to do something about that.

crackpotbaby

I once was unable to administer a intramuscular injection to an obese lady in her early twenties.

She was big, but not *that* big but her adipose tissue was carried in a way that it covered all the muscles suitable for the drug to be injected into to the point that the needle wouldn’t reach the tissue.

Any injected drug would be subcutaneous not intramuscular.

One doctor wanted me to give the injection anyway knowing it would be in the wrong spot.

I refused.

A second (more senior) doctor went out of her way to hunt down a longer, bariatric length intramuscular needle. We were then able to administer the drug into the woman’s deltoid muscle.

This was unuasual. This was out of the ordinary.
We did have to seek out special equiptment.

The patient probably felt her body was not typical. It wasn’t. We (aside from the dopey resident who said just use the standard needle even if it won’t reach her muscle) treated her with dignity and respect though and ensured she got the medical treatment she required.

canadianlbs

i can't speak to the bad attitude about obesity, but this statement about preconceptions of futility mirrors my experience as a person with rheumatoid arthritis. it's like a rug that a lot of things can get shuffled under. so pushing to get the same care and diagnostic attention as a 'normal' person has definitely been a factor since i got diagnosed.

i've been seeing it lately too, as i try to advocate for my father who is in his nineties. 'la la la mr x, you're just old, too bad. next!' it comes down to not being taken seriously.

"physicians may over-attribute symptoms and problems to obesity, and fail to refer the patient for diagnostic testing or to consider treatment options beyond advising the patient to lose weight"

whosshe

canadianlbs wrote: »

i can't speak to the bad attitude about obesity, but this statement about preconceptions of futility mirrors my experience as a person with rheumatoid arthritis. it's like a rug that a lot of things can get shuffled under. so pushing to get the same care and diagnostic attention as a 'normal' person has definitely been a factor since i got diagnosed.

i've been seeing it lately too, as i try to advocate for my father who is in his nineties. 'la la la mr x, you're just old, too bad. next!' it comes down to not being taken seriously.

"physicians may over-attribute symptoms and problems to obesity, and fail to refer the patient for diagnostic testing or to consider treatment options beyond advising the patient to lose weight"

Obesity can cause a variety of health issues. I don't think we can blame a doctor who would chalk up "shortness of breath" to being overweight. Even as an asthmatic the only thing the doctors can do for me is prescribe me a puffer that will probably reduce inflammation in my airways.

I don't know about the diagnostic process of rheumatoid arthritis but I can't blame a doctor if he/she says "lose some weight and then we'll see". That seems like the first step in the diagnostic process. I'm sure some doctors are absolutely terrible, but how many doctors get obese patients complaining about all the symptoms of being obese. Must be frustrating.

sarahthes

The problem with discriminating against patients with obesity and assuming all their health problems are obesity-related is that the doctor may miss a real health condition.

I'm sure glad that when my rate of gain increased to 20 lbs in a single month my doctor decided to do thyroid testing even though a) I'd already lost that bit of regain and b) even I was convinced it was just due to holiday bingeing. Turns out I am slightly hypothyroid. Not enough to impair weight loss when I really knuckled under, but enough that I could have suffered pregnancy losses had I been unaware (my synthroid dose tripled from my baseline by the time I was 9 weeks pregnant, about 10 months after I was diagnosed.

Not to mention that getting dismissed by doctors is hardly likely to make patients with obesity more receptive to weight loss counseling...

tomteboda

eliciaobrien1 wrote: »

Obesity can cause a variety of health issues. I don't think we can blame a doctor who would chalk up "shortness of breath" to being overweight. Even as an asthmatic the only thing the doctors can do for me is prescribe me a puffer that will probably reduce inflammation in my airways.

That treatment may literally be the difference between life and death LONG before significant weight could be lost. Asthma is no joke.

eliciaobrien1 wrote: »

I don't know about the diagnostic process of rheumatoid arthritis but I can't blame a doctor if he/she says "lose some weight and then we'll see". That seems like the first step in the diagnostic process. I'm sure some doctors are absolutely terrible, but how many doctors get obese patients complaining about all the symptoms of being obese. Must be frustrating.

Rheumatoid arthritis is an autoimmune disease. It is not a disease of excess weight. Wait-and-see is a TERRIBLE approach to take with autoimmune disease that has obvious progression and is already affecting quality of life.

crackpotbaby

‘Shortness of breath’ is a non specific subjective symptom.

Asthma or COPD can cause shortness of breath, but does the patient have an expiratory wheeze?

Aortic stenosis can cause shortness of breath, but does the patient have abnormal heart sounds?

Coronary artery disease can cause shortness of breath, but does the patient have ECG/EKG changes of elevation in cardiac specific enzymes?

Heart failure can cause shortness of breath, but does the patient show clinical signs of heart failure such as peripheral odema?

Obesity can cause shortness of breath, but is the patient obese?

.........

The reasoning for suggesting a patient lose weight as primary treatment does not happen in isolation. Scenarios such as those few I mentioned are taken into account and considered/excluded.

I doubt many patients appreciate the process of elimination/examination a good doctor will go through before giving a clinical opinion.

.........

Of course - general disclaimer - there are good doctors and bad. Always seek a second, or third etc opinion if you feel you’re getting inappropriate advice. Blah blah blah.

tomteboda

lizery wrote: »

The patient probably felt her body was not typical. It wasn’t. We (aside from the dopey resident who said just use the standard needle even if it won’t reach her muscle) treated her with dignity and respect though and ensured she got the medical treatment she required.

Thank you. Every human being deserves to be treated with dignity and respect. And it is the moral obligation of health care professionals to provide the necessary medical treatment to all their patients.

I am astounded by the utter disregard for other people based on perceived moral superiority some people display. Yes, this person is fat.. and that one is addicted to drugs. Yet another is promiscuous, and another engages in high-risk sports. Yet well we are busy judging, we are not meeting their very real needs. And the judgments are, as many studies suggest, blinding.

Somehow we are all familiar and comfortable now with the idea that people hold prejudices against minorities, and that the health care and therefore health outcomes of minorities suffer as a result. We are aware that the mentally ill suffer because of judgment and dismissal. Yet so many are willing and eager to dismiss that similar effects occur against the obese; not because they don't happen, but because the obese somehow deserve them? That we are being most compassionate by shaming them, making sure that they aren't able to get adequate care or dignified treatment because it will "make them lose weight"? How cruel! How utterly unconscionable, to justify poor treatment in this way.

maryannprt

lizery wrote: »

It would be unethical to medicate people for a symptom that is caused by excess weight.

Do you know what else is unethical? Assuming someone's hip pain is because they're fat, when in actual fact they have pain from bladder cancer. Not medicating someone for their asthma or Copd because they're fat, of course they're short of breath. Dismissing their joint pain because he's fat when he actually has rheumatoid arthritis.

crackpotbaby

maryannprt wrote: »

lizery wrote: »

It would be unethical to medicate people for a symptom that is caused by excess weight.

Do you know what else is unethical? Assuming someone's hip pain is because they're fat, when in actual fact they have pain from bladder cancer. Not medicating someone for their asthma or Copd because they're fat, of course they're short of breath. Dismissing their joint pain because he's fat when he actually has rheumatoid arthritis.

That is true. As is what I wrote. The comments are not mutually exclusive.

maryannprt

eliciaobrien1 wrote: »

canadianlbs wrote: »

i can't speak to the bad attitude about obesity, but this statement about preconceptions of futility mirrors my experience as a person with rheumatoid arthritis. it's like a rug that a lot of things can get shuffled under. so pushing to get the same care and diagnostic attention as a 'normal' person has definitely been a factor since i got diagnosed.

i've been seeing it lately too, as i try to advocate for my father who is in his nineties. 'la la la mr x, you're just old, too bad. next!' it comes down to not being taken seriously.

"physicians may over-attribute symptoms and problems to obesity, and fail to refer the patient for diagnostic testing or to consider treatment options beyond advising the patient to lose weight"

Obesity can cause a variety of health issues. I don't think we can blame a doctor who would chalk up "shortness of breath" to being overweight. Even as an asthmatic the only thing the doctors can do for me is prescribe me a puffer that will probably reduce inflammation in my airways.

I don't know about the diagnostic process of rheumatoid arthritis but I can't blame a doctor if he/she says "lose some weight and then we'll see". That seems like the first step in the diagnostic process. I'm sure some doctors are absolutely terrible, but how many doctors get obese patients complaining about all the symptoms of being obese. Must be frustrating.

We absolutely can blame a doctor who attributes shortness of breath to being fat without investigating why they are experiencing SOB,( or multiple joint pain or whatever) because guess what. They've been fat for a long time and they've been having this symptom for a week. It's a piss poor doctor who doesn't listen to his or her patient.

distinctlybeautiful

@Aaron_K123 Assuming your premise that fat people have not prioritized their health is true, yes, we can still absolutely fault doctors for working under the assumption that these patients are less likely to adhere to health-related advice, if this assumption is decreasing the quality of care they provide. Do you think it’s fair for people who smoke to receive a reduced quality of care because doctors work under the assumption that patients who smoke are less likely to adhere to health-related advice? I don’t see a difference.

distinctlybeautiful

@eliciaobrien1 Why would someone go to the doctor if s/he doesn’t want a professional opinion? What about people who do other things society has deemed unhealthy? Should they also be humiliated?

distinctlybeautiful

@lizery It sounds like you treat everyone with respect and that when it’s your call, you take into account multiple factors. The problem is that, as this article states, this isn’t always the case, that doctors see a fat person and immediately attribute health issues to being fat and prescribe weight loss as the primary treatment. Fat people shouldn’t have to ask doctors to take into account the same things they would were a non-fat person presenting with the same symptoms.