Obesity has become of paramount concern in the United States over the past several decades. Many prominent political figures have advocated for the introduction of public policy initiatives in an effort to decrease the frequency of both adult and childhood obesity. However, this suggestion only focuses on part of the problem. Obesity presents both multifarious health costs to an individual. In addition to having an increased risk for diseases such as cancer and type II diabetes, obese patients also face a stigma in the healthcare community: doctors view them differently from non-obese patients and assume that many of their health problems are due to their weight. Healthcare practitioners need to fundamentally change their perception of obese patients so that they can receive the highest quality care possible.
There are many logistical problems that obese patients face when they enter a doctor’s office or a hospital. Frequently, there are no scales available that can accommodate the individual’s weight, the patient cannot fit inside the imaging machines (CAT scans and MRI machines) that are necessary for proper diagnosis, and there are inadequate amounts of anesthesia to account for the patient’s large size. While all of these problems (and more) prevent optimal patient care, they also contribute to a much bigger problem: the stigma toward obese people within the healthcare community. Obese patients seek help from physicians only to have their concerns dismissed, as the doctors assume that losing weight will solve all of the patient’s problems. This exact situation happened to Patty Nece, a 58-year-old woman who sought an orthopedist for her aching hip. Nece had lost 70 pounds since her last appointment but was still considered obese. The orthopedist diagnosed Nece without examining her; he dubbed her hip pain “obesity pain” and suggested that Nece lose more weight to cure her ailment. Nece proceeded to ask for a second opinion, and only then was she diagnosed with progressive scoliosis, a disease not caused by obesity[1]. Many individuals across the country face the same situation that Nece did. Melanie Jay conducted a study suggesting that physicians tend to display more negative attitudes towards obese patients than non-obese patients: “Studies have shown that physicians’ attitudes toward obese patients can be negative...and therefore may decrease physicians’ motivation to counsel such patients. Even health professionals specializing in obesity have implicit anti-fat bias and are more likely to associate ‘fat people’ with negative stereotypes than ‘thin people’”[4]. This propensity to treat obese people differently from non-obese patients causes the former to become embarrassed by their weight and consequently embarrassed by themselves. Additionally, obese patients may develop a fear of hospitals or doctors’ offices because of prior experiences similar to those of Ms. Nece. Another obese patient (who opted to remain anonymous due to embarrassment) experienced these same events. She was unable to walk from her bedroom to her kitchen without experiencing severe shortness of breath. She went to an obesity specialist who told her that “weight was pressing down on her lungs”, which was why she experienced shortness of breath. The patient became very distressed upon this diagnosis, saying, “I don’t have a pressing weight on my lungs. I can’t breathe. I am very scared.”[1] It turned out that this woman had blood clots in her lungs, a life-threatening condition. An obesity specialist, someone who is supposedly trained in how to treat obese patients, made these prejudiced assumptions. The type of discrimination obese patients face from unspecialized physicians is likely higher.
The root problem both of these patients encountered is that some healthcare professionals hold negative stereotypes about obese people. Kimberly A. Gudzine, M.D., M.P.H. led a study in which she concluded that physicians are less likely to build an emotional rapport with their patients. This lack of empathy leads to poor physician-patient communication and mainly occurs because “studies show that physicians may have negative attitudes towards these patients”[3].While it is certainly easier said than done, there needs to be a psychological change in the way that the healthcare sector views obese individuals. Dr. Sean Phelan, MD led a study that aimed to identify potential ways to bring about this necessary change and improve obese patients’ care. Among his solutions included the following: reduce the likelihood that a provider’s negative opinions will influence his or her behavior and alter the clinical environment so that patients do not feel threatened or stigmatized[2].
Obesity is a current epidemic that U.S. policy makers grapple with every day when formulating decisions regarding healthcare. The direct physiological effects of obesity are well documented, but what often gets swept under the rug is the indirect sociological effects that obese patients face in a clinical setting. More attention needs to be placed on the latter so that obese patients receive the highest possible quality of care, just like any other person.
References:
1. Kolata, Gina. "Why Do Obese Patients Get Worse Care? Doctors Don't See Past the Fat." The New York Times. September 25, 2016. Accessed October 8, 2016. http://www.nytimes.com/2016/09/26/health/obese-patients-health-care.html?action=click&contentCollection=Health&module=RelatedCoverage®ion=EndOfArticle&pgtype=article&_r=1.
2. Phelan, S. M., D. J. Burgess, M. W. Yeazel, W. L. Hellerstedt, J. M. Griffin, and M. Van Ryn. "Impact of Weight Bias and Stigma on Quality of Care and Outcomes for Patients with Obesity." Obesity Reviews 16, no. 4 (March 05, 2015): 319-26. Accessed October 8, 2016. doi:10.1111/obr.12266.
3. Gudzune, Kimberly A., Mary Catherine Beach, Debra L. Roter, and Lisa A. Cooper. "Physicians Build Less Rapport with Obese Patients." Obesity 21, no. 10 (June 06, 2013): 2146-152. doi:10.1002/oby.20384.
4. Jay, Melanie, Adina Kalet, Tavinder Ark, Michelle Mcmacken, Mary Jo Messito, Regina Richter, Sheira Schlair, Scott Sherman, Sondra Zabar, and Colleen Gillespie. "Physicians' Attitudes about Obesity and Their Associations with Competency and Specialty: A Cross-sectional Study." BMC Health Services Research BMC Health Serv Res 9, no. 1 (June 24, 2009). Accessed October 10, 2016. doi:10.1186/1472-6963-9-106.