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

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  • canadianlbs
    canadianlbs Posts: 5,199 Member
    edited November 2017
    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.

    i would. idk anything much about asthma, but i'm going to assume that it can be identified by more t han just its observable symptoms. how long does it take to test someone for it? how much weight can they lose in that length of time? refusing to eliminate some of the causes while waiting for someone to fulfill the slowest pathway - merely because that pathway is one of the possible reasons why someone can't catch their breath - seems negligent to me.
    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".

    my point wasn't about that, actually. r.a. is an inherent and systemic thing that you eitehr have or you don't regardless of how much you weigh. my point was a sort of parallel, i.e. that once people find out you have it, then just like with obesity, they tend to default to the easy answer of 'your r.a. causes' whatever i'm trying to get some help for. and since they have such an easy answer right before them, i can't always get people to take seriously the idea that maybe what's bothering me has a different cause. or has treatment pathways that are NOT about whatever i'm doing to manage the r.a.

    if i were obese i think it would be the same thing. by the way, rheumatoid arthritis is a completely separate thing from obesity, medically. it is a systemic aberration of the immune system, and it is inherent to someone whether it's active or not, and whatever they weigh. that inherent atypicality is not a side-effect of being too fat. it can be found by a simple blood draw in a lot of cases. when a person is sero-negative it gets diagnosed by a rheumatologist with a checklist.

    the damage it does is permanent, debilitating and not directly related to mechanical stress (although having it does make you more vulnerable to mechanical stress). an aggressive case of r.a. can do permanent, irreversible damage in the course of a couple of months. you don't fix the problem by losing weight. so again, how is it acceptable to ignore a diagnostic procedure that could get the thing controlled almost immediately, on the grounds that 'just maybe your joints are hurting because you're too fat'? it just isn't.

  • whosshe
    whosshe Posts: 597 Member
    edited November 2017
    "The major criticism of the epidemiological studies has been the basis of diagnosis of asthma. Obesity impairs ventilatory functions i.e. forced expiratory volume in one second (FEV 1), forced vital capacity (FVC), total lung capacity and expiratory reserve volume.5 Besides, it may reduce respiratory muscle strength, decrease thoracic cage compliance and impede diaphragmatic excursion, especially when it is massive and central. The resultant increase in work of breathing may lead to the perception of increased respiratory effort i.e. dyspnoea. The latter may be confused as asthma. Thus, there is a risk of over diagnosing asthma in the obese. Further, it is apprehended that the correlation between obesity and asthma may not be causally related but may be due to existence of common risk factors."

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2853040/
  • maryannprt
    maryannprt Posts: 152 Member
    edited November 2017
    I've given you several antecdotal examples, which I realize are just that. When a doctor assumes a person of color coming in for back pain is drug seeking (this happens, they've done studies, people of color are prescribed pain meds less often than their white counterparts... which is maybe a good thing, but that's a different discussion) When a fat (or formerly fat) person has symptoms that don't resolve using standard treatments, and the doctor continues to treat as if their initial diagnosis doesn't need to be reinvestigated. When women are literally sent home with a Tums when in reality they are having a heart attack, but a man with indigestion is given a full cardiac work up. I personally had a coworker who made different recommendations to a patient because she was trans and the therapist was uncomfortable and wanted her out of the office ASAP. The whole point of this article (and I realize they weren't "real" patients) is that doctors dismiss health concerns of the obese. Just like they dismiss the concerns of the elderly, of women, of people of color, etc. Of course, obesity raises your risk of certain illnesses or conditions. SO WHAT? Because someone is fat, does that mean they can't develop rheumatoid arthritis? Or MS? Or ankylosing spondylitis? Or COPD? or the literally hundreds of illnesses people develop every day that may be exacerbated by obesity, or may even share symptoms in common with other illnesses? I'm not saying a doctor needs to do an MRI the 1st time a fat person comes in with knee pain. It's probably arthritis, it's probably related to their obesity, and losing weight, along with meds, reduced weight bearing (i.e., using a cane or other assistive device) some exercises specific to their knee is probably appropriate. Is that what the doctor suggested? Or did he/she just tell them to lose some weight and send them off without any other interventions, which is what this study suggests. What this study really says to me, is we need another study. And I don't know how you would design such a study. You're in public health. How would you do it? How do we get doctors to take health concerns of their patients seriously? I've worked in healthcare most of my adult life, and it can be very frustrating for providers when their patients don't do what they are instructed. But I'll tell you, in my experience, someone's weight has very little to do with their compliance.

    Also, I'm going to apologize if any of my comments sounded overly personal to you, and remind you (and myself!) tone and intent don't always come across clearly in this type of a format . I certainly intended no offense.
  • Aaron_K123
    Aaron_K123 Posts: 7,122 Member
    Also, I'm going to apologize if any of my comments sounded overly personal to you, and remind you (and myself!) tone and intent don't always come across clearly in this type of a format . I certainly intended no offense.

    Apology accepted and understood, intent and tone are difficult to interpret in an online text-based discussion no doubt.
  • maryannprt
    maryannprt Posts: 152 Member
    Aaron_K123 wrote: »
    If a doctor looks at a patient, sees that they are obese and without any effort or attempt to dig deeper declares them to be diabetic and sends them away with insulin even though that diagnosis was in fact wrong then yeah that doctor is being a bad doctor. Conversely if a doctor looks at a patient, sees that they are obese and decides it is inappropriate to take that into account and decides without any effort or attempt to dig deeper declares them artharitic and sends them away with methotrexate even though that diagnosis was in fact wrong then that doctor is equally a bad doctor. Whether or not one takes into account the appearance of the patient isn't the thing that makes a doctor good or bad, it is the level of effort and appropriate actions taken. If anything the first doctor at least applied some sort of criteria.

    Are you claiming that if doctors were blind to race, gender, age, weight and just ordered the exact same lab tests for everyone that that would be ideal? Because if that is the case why even have doctors? Why not just have automated labs that dole out tests based on patient symptoms? The entire point of having a doctor is so they can apply observational biases to a patients symptoms in order to deduce what the most likely cause is. They are detectives and observational assumptions are their main tool. Obesity is part of that, as is race, as is gender, as is age. That isn't automatically prejudice.

    Inappropriate prejudice would be bringing in personal stereotype beliefs that are not epidemiological based at all into it and being dismissive of a patient because you don't like their race/gender/bodytype w/e and assume they are lying or are overly disrespectful. That would be wrong yes, but do we need a study to say that is wrong?

    I specifically said a doctor shouldn't order labs or imaging, just because. If someone comes in complaining of excessive thirst, urination, appetite, etc. I expect a doctor to order a lab for possible diabetes, whether the patient is 100 lbs or 300. If I don't have any complaints, I don't necessarily expect the doctor to do that lab work. (I think my doctor does it routinely every 5 years or so if I had other risk factors, a family history, gestational diabetes, a different race, maybe she would do that test more frequently, which would probably be appropriate) If I go in with knee pain, (which I recently did) I don't expect my doctor to dismiss this new symptom and in fact, she didn't. She wanted to order x-rays (which I agreed to) and she wanted to refer me to an orthopedic guy. I said no, I'm confident it's arthritic changes at 57 and being fat most of my adult life, my knees are wearing out. We discussed meds, exercises etc. X-ray showed arthritis and joint effusion, a couple of months of anti inflammatories, exercises, and losing a little weight, my knee pain is mostly resolved. (At least it's not waking me up at night) This is what I expect from my healthcare provider, and it's been my experience, even as a fat person. If my knee pain didn't resolve with these conservative measures, I would expect her to kick it up a notch. I know as an ex-smoker some doctors absolutely have prejudices they have a really hard time getting around, and I'm perfectly willing to believe the many, many people who say their doctor didn't take them seriously or look deeper because of their obesity. I understand these stories aren't really "evidence" and this study is fundamentally flawed in that they aren't looking at real live patients. It's very possible if the patient was standing in front of the doctor, they would get very different treatment from this hypothetical.

    You keep saying doctors are human, too. And I certainly understand that, and even agree with it up to a point. But frankly, I expect more from my doctor. My life is literally in your hands. You're probably smarter than me, and definitely better educated than me, and I'm paying you lots of money to take me seriously. I'm also able and prepared to advocate for myself, and perfectly willing to pitch a fit, complain to your supervisor or get a different doctor, as appropriate. I check my prejudices every day. Did I make assumptions about Aaron because he's a man and men tend to dismiss women's arguments as hysterical? I did. Is that true about you? Maybe not. And I'm willing to give you the benefit of the doubt. I don't think it's too much to ask that our healthcare providers do the same.
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