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Do Obese Patients Receive Worse Medical Care?

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Do Obese Patients Receive Worse Medical Care?

-Dave McNamara

The answer is “yes,” according to a recent New York Times article. Why? As reported, many medical doctors seem unable to give any diagnosis or treatments beyond telling obese patients they need to lose weight. Certain conditions with no relation to obesity go unchecked, and treatments often remain neglected.

Disturbing Narratives
One patient interviewed in the article was in the process of weight-loss and had already shed an impressive 70 pounds. I’m referring to Patty Nece. Nece is 58. She went to an orthopedist due to a chronic aching hip. Since Nece already lost 70 pounds, she seemed to feel a greater sense of self-worth and accomplishment. Though still on the journey to lose weight, she felt good.

Until her doctor came to give her a cursory check-up, at which point that sense of accomplishment receded.

Nece reports, “He came to the door of the exam room, and I started to tell him my symptoms...he said: ‘Let me cut to the chase. You need to lose weight.’" The doctor never examined her and made a cursory diagnosis of, “obesity pain,” which was then sent to her internist.

Later, Ms. Nece learned she had progressive scoliosis: a condition not caused by obesity.

Supporting Evidence
Research, unfortunately, gives credence to Ms. Nece’s experience. One report states that doctors spend less time with obese patients and often do not send them for diagnostic tests. One particular study within the Texas Medical Center in Houston asked 122 primary care doctors affiliated with the center for their attitudes towards obese patients. The doctors were reported as stating, “seeing [heavier] patients was a greater waste of their time.” Physicians also tended to like their jobs less when given heavier patients. Perhaps the worst indictment against doctors’ views of heavier patients was that they tended to view obese patients as “more annoying,” and felt less patience with them.

How can this be? Aren’t doctors supposed to be the ones who help those suffering?

Evidence of Varying Treatment
Dr. Louis J. Aronne, an obesity specialist at Weill Cornell Medicine, states that he has patients recount stories like Ms. Nece’s all the time. He thus helped found the American Board of Obesity Medicine in order to address these kinds of issues. The goal of the Board is in educating doctors to learn how to treat obesity so they’re a real resource for the patients. It can be hard to seek doctors willing to look past weight when there could potentially be a medical problem unrelated to how much one weighs. Dr. Aronne says, “Our patients say…[their doctors] blow [their issues] off and tell [them] to go to Weight Watchers.”

He continues, “Physicians need better education, and they need a different attitude toward people who have obesity...they need to recognize that this is a disease like diabetes or any other disease they are treating people for.”

Other Discrepancies in the Care of Obese Patients
Equipment size is an issue. Scales and scanners, like M.R.I. machines, for example, are often not built for very heavy people. Scanners that do handle very heavy people are made, but often not in the hospital for utilization. One national survey found at least 90 percent of emergency rooms did not have a scanner for heavier people. Even four out of five community hospitals deemed bariatric surgery centers of a certain level of excellence lacked them. CT or M.R.I. imaging is crucial in evaluating patients with a diversity of ailments. These include trauma, acute abdominal pain, lung blood clots, and strokes.

Drug dose adjustments are also a serious issue. Many physicians treating obese patients with cancer, for instance, do not calibrate dosage based on weight.

Draconian Weight Cut-Offs
And then there is arthritis of the hip or knee, which plagues many obese patients. Many patients come to the doctor’s office in excruciating pain. Dr. Adolph J. Yates Jr., an orthopedics professor at the University of Pittsburgh School of Medicine, provides what is perhaps the harshest criticism of the treatment of obese patients. According to Dr. Yates Jr., many orthopedists will not offer surgery unless patients first lose weight.

A recent survey confirmed Dr. Yates’s impressions. Sixty-two percent of physicians said they use a body mass index (BMI) score as a cutoff for requiring weight loss before offering surgery.
Many, it was stated, were worried about their own performance score or that of their hospital.

Ingrained Stereotypes
Denying patients the medical care they need does strike one as the heart of a general prejudice against the obese population: that their “lazy,” “have no will-power,” and is their problem, not “ours.” These prejudices can be heard among the general population, yet particularly troubling when it seems manifested in the practice of doctors.

Other Subtle Reinforcements of Prejudice
Weight IS a serious issue in America. A number of studies show strong evidence linking obesity to numerous conditions, some of which are life-threatening. I wonder, though, what it does to the person struggling with their obesity when constantly barraged with the term “obesity epidemic.” It’s reinforced constantly by the media, people of prominence, such as politicians and policy-makers, and the general public. What’s most disturbing, however, is to see it manifested in the selective care doctors give obese patients.

As Dr. Yates points out, “It’s a zero-sum game [conducting surgery on obese patients], with everyone trying to have the lowest-risk patient…[those] patients who may be at marginally higher risk may be treated as a class instead of individuals. That is the definition of discrimination.”

How Do Obese People, Then, Seek Out Treatment?
They often don’t. “I have avoided going to a doctor at all,” said Sarai Walker, the author of “Dietland,” a novel. “That is very common with fat people. No matter what the problem is, the doctor will blame it on fat and will tell you to lose weight.”

She adds, “Do you think I don’t know I am fat?”


References

  1. Kolata, Gina. ‘Why Do Obese Patients Get Worse Care? Many Doctors Don’t See Past the Fat’. Health (The New York Times), September 27, 2016. http://www.nytimes.com/2016/09/26/health/obese-patients-health-care.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=second-column-region®ion=top-news&WT.nav=top-news&_r=0.
  2. Kolata, Gina. ‘Why Do Obese Patients Get Worse Care? Many Doctors Don’t See Past the Fat’. Health (The New York Times), September 27, 2016. http://www.nytimes.com/2016/09/26/health/obese-patients-health-care.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=second-column-region®ion=top-news&WT.nav=top-news&_r=0.
  3. M, Hebi and Xu J. ‘Weighing the Care: Physicians’ Reactions to the Size of a Patient’. International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity. 25, no. 8 (July 31, 2001): 1246–52. Accessed September 30, 2016. https://www.ncbi.nlm.nih.gov/pubmed/11477511
  4. 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 5, 2015): 319–26. doi:10.1111/obr.12266.
  5. Ginde, Adit A., Anthony Foianini, Daniel M. Renner, Morgan Valley, and Carlos A. Camargo. ‘The Challenge of CT and MRI Imaging of Obese Individuals Who Present to the Emergency Department: A National Survey’. Obesity: A Research Journal 16, no. 11 (November 2008): 2549–51. doi:10.1038/oby.2008.410.