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

distinctlybeautiful
distinctlybeautiful Posts: 1,041 Member
edited November 22 in Debate Club
“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
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Replies

  • WillingtoLose1001984
    WillingtoLose1001984 Posts: 240 Member
    edited November 2017
    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.
  • whosshe
    whosshe Posts: 597 Member
    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.
  • crackpotbaby
    crackpotbaby Posts: 1,297 Member
    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.
  • distinctlybeautiful
    distinctlybeautiful Posts: 1,041 Member
    @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
    distinctlybeautiful Posts: 1,041 Member
    @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
    distinctlybeautiful Posts: 1,041 Member
    @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.
  • distinctlybeautiful
    distinctlybeautiful Posts: 1,041 Member
    @rheddmobile Assuming it’s true that it makes sense for doctors to suggest weight loss to address shortness of breath, it doesn’t make sense to suggest only this without investigating the symptom first.

    Regarding the dietician who didn’t believe you would follow through and your sense that her belief was based on experiences with previous patients, it might be worth taking into account the idea of self-fulfilling prophecies, such that perhaps what began as a bias affected the way this dietician approached her delivery of care, resulting in less adherence.
  • distinctlybeautiful
    distinctlybeautiful Posts: 1,041 Member
    @tomteboda Thank you for responding. You expressed it so well.
  • distinctlybeautiful
    distinctlybeautiful Posts: 1,041 Member
    @rheddmobile The study said the virtual fat patients were more likely to receive lifestyle change recommendations than the virtual non-fat patients. It doesn’t say they were given instructions concerning obesity. There was an assumption that fat people were likely doing something that caused their shortness of breath. There was no such similar assumption with the non-fat people, despite that non-fat people could just as easily be neglecting their health.
  • distinctlybeautiful
    distinctlybeautiful Posts: 1,041 Member
    @lizery I take note of your experience and don’t discount it. While the article does present just one side of the story, it’s an important one to share, as it’s not commonly heard. I think it’s pretty typical to assume everyone receives the same quality of care, as the experiences of marginalized groups are just that - marginalized.
  • rheddmobile
    rheddmobile Posts: 6,840 Member
    distinctlybeautiful wrote: »
    @rheddmobile The study said the virtual fat patients were more likely to receive lifestyle change recommendations than the virtual non-fat patients. It doesn’t say they were given instructions concerning obesity. There was an assumption that fat people were likely doing something that caused their shortness of breath. There was no such similar assumption with the non-fat people, despite that non-fat people could just as easily be neglecting their health.

    This makes no sense at all. Of course the instructions concerning lifestyle changes were to exercise and lose weight - what else would they be? And by definition the obese people were neglecting their health - they were eating too much for their expenditure. That's not an assumption but an observation.
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