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Too Overweight for Medical Care?

Posted: 06/10/11 02:44 PM ET

Recently, the South Florida Sun Sentinel reported that several area ob-gyn doctors are refusing to accept overweight women who are otherwise healthy as their patients. In defending their decision, the doctors cite concerns about potential complications in care, risk of malpractice suits and medical equipment that is not designed to deal with excess weight. Wow. More than 60 percent of American women are considered overweight. That's a lot of people to exclude from medical treatment.

Let's take a moment to think about the absurdity of this situation -- and the headlines we might read if other specialty health care providers followed suit:

"Oncologist Declines to Treat Woman's Breast Cancer Due to Excess Weight"

"Cardiologists Determine Obese Men are Beyond Help, Decline to Perform Surgeries or Prescribe High Blood Pressure Medications"

Of course, it's highly unlikely that these scenarios would ever come to pass. And it's not because breast cancer or cardiology patients are not at high risk. They are. But medical professionals don't turn away cancer and cardiac patients because of their high-risk disease; it's precisely why they treat them.

Across the country, we have many specialists who handle complex conditions and high-risk patients but we have few specialists who are trained to manage obesity -- and even fewer general physicians who are trained to help their overweight or obese patients improve their health.

In recent surveys, we found that nearly 90 percent of those with obesity have tried to lose weight and more than 50 percent are currently involved in a weight loss effort. At the same time, almost three-quarters of primary care physicians -- 72 percent -- say that neither they nor anyone else in their office has received training regarding weight issues.

It seems to us that those who are overweight or obese know they have a problem. Many are seeking help and they continue to seek help -- even when they are discouraged by previous efforts. The irony is that what would seem to be a key resource for help -- a primary care doctor -- really has no relevant expertise.

Add to this another study, which found that more than half of primary care physicians view those with obesity as awkward, unattractive, ugly and non-compliant. Apparently those South Florida ob-gyns are in good company.

We cannot think of any other health condition where there are so many affected and trying to improve, while large components of our health care delivery system seem completely unable, or unwilling, to help.

There are many laudable independent efforts underway at both the state and federal level to address issues in our environment that are contributing to this epidemic, but as a nation we have yet to think how we can comprehensively approach this issue. Some have suggested that screening and education efforts are necessary. The more important question, however, is, "What happens next?!"

Our health care system is already facing the impact of the obesity epidemic -- costs are increasing exponentially and lives are being lost. We need to stop and face the reality that we are doing very little in our health care system to help until other serious conditions -- like diabetes, heart disease and cancer -- kick in. It's time to change.

Christine C. Ferguson, J.D. is a professor at The George Washington University School of Public Health and Health Services as well as the Director of STOP Obesity Alliance. Scott Kahan, M.D., M.P.H. is a Clinical Advisor for STOP Obesity Alliance.

 

Follow Christine Ferguson on Twitter: www.twitter.com/stopobesity

 
 
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01:24 AM on 07/04/2011
When I complained to my previous primary care physician about the excessive nature of my menstrual cycles, she said "You have to expect more blood, you're overweight." In August of last year something went terribly wrong and I was losing tremendous amounts of blood. I was hysterical when I showed up at the emergency room and had to sit through a lecture about how I could only have birth control if I agreed to be weighed before receiving the prescription and three months after. I was in an altered state so I agreed. But the pills did nothing and the primary care doctor and ER doc refused to discuss Depo Prevara because of some side effect, losing bone strength I thought. I gave up on them both and finally switched primary care doctors. By this time my menstrual cycle was three months long. No break. She agreed to give me the depo because she said what was going on was destroying me, physically and mentally. It took FIVE months for the cycle to stop. She got me into the best OB who was so concerned after reading my ultra sound report he moved me to another room immediately and did a biopsy. It hurt more than I've ever hurt before and has caused small cycles to come back, but at this point I am actually hoping it's something serious so I can rub it in Dr. You Have to Expect That's face.
01:22 AM on 06/23/2011
The reason why pepole gain weight is due to all of the toxins in the food. Property food and nutrition will help you loose weight along with and active lifestye.

The body is a miracle. When it is given what it needs it will heal itself. The reason why some people fail to understand that herbal medication work is because they are depending on the pharmacutical (which by the way means pharmekia. Phamekia in greek means potions and sorcery). But I digress,
most of us are depending on man made medication to fix our health problems.

I you give the body the right dosages of natural medication - guess what? It will work. For example, you may need to take 4000 mg of goji juice (I currently use 100% pure premium goji juice from www.gojijuicekit.com and it has some awesome benefits) to help reverse heart problems, liver failure, or sleepling issues just to name a few. But if given the right dosage and some time, everything goes back to its natural state. I just wish I had more time to disuccs the phenomenon. But people - please reasearch this for yourself.

There is nothing that heals the body... the body heals itself. It is regenative. If it is given the right things on the cellular level. I guess I may need to right a book to get all this information out of my head :)
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HerrMonk
Son of Apollo
11:25 AM on 06/28/2011
While toxins (anti-nutrients) may contribute to hormonal imbalances, that contribute to fat gain/stifling fat loss... toxins themselves don't make you fat.
11:42 PM on 07/02/2011
Toxins effect your cellular health. When your body cannot release waste, it cannot heal itself in turn holding on to harmful agens and creating free radicals that destroy other cells. Toxins do make us fat...Just look at everything that we eat versus other countries.

It is either pumped with pesticides or hormones. These toxins is also a reason why we never feel satified when we eat. Causing us to overeat. But don't take my word for it. I encourage everyone to do some research on the effects of toxins in food and out products.
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Irene Rubaum-Keller
author of the book Foodaholic, psychotherapist
07:46 PM on 06/15/2011
I've been working on this! Doctors get little to no training in nutrition, obesity control or the psychological aspects involved in eating disorders. I have made headway in that now the first year docs at UCLA have to take a short course in it. I have offered free seminars to the local doctors in Los Angeles and they are not interested. It's rough. Nutritionists, Registered Dieticians and Psychotherapists who specialize in this are the professionals to go to. Not the M.D. Great post!
09:41 PM on 06/15/2011
I actually don't think we need more primary care physicians in this country. We just need about 5 times more dieticians... As a doctor, I almost feel like prescribing metformin is damaging to the patient, since it makes them less likely to correct the root cause: horrible diet, no exercise, excess adipose tissue. Less than 1% of our healthcare costs are spent on prevention in this country, but more than 10% is spent on treating diabetes and its complications (the wrong way). Uggh, a disease that's mostly completely preventable by diet (since most diabetics are type II and overweight).
MommyMD
MD, Professor, Mom
02:37 AM on 06/17/2011
You are really right. As an endocrinologist, I start my new Type 2 diabetics with the phrase: "I can either be your drug pusher for the next 30 years, or you can start to change this right now." Metformin and other drugs are great but often just tacit approval of an unhealthy lifestyle..sometimes the truth hurts, but the cost of long term complications of DM2 will ruin many lives and truly bankrupt our country. We MDs have more than enough business from other diseases...we REALLY really don't want to treat the preventables and leave our kids and grandkids with the tab.
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HerrMonk
Son of Apollo
11:26 AM on 06/28/2011
Ehh... most dietitians are clueless too.

The people who've ended up really having it together on diet and nutrition are the sports nutrition guys (some of whom are dietitians, some are MD' but their authority comes from what they do, not their degree).
MommyMD
MD, Professor, Mom
01:54 AM on 06/25/2011
Kudos for your short class in nutrition for first year med students, but are you publicly berating the doctors who are not interested in or cannot attend your seminars? I assume you are simply suggesting that it is tough for overworked docs to attend seminars about eating disorders and psychotherapy, and not that our hubris makes us "not interested." This faculty member would like to know.
02:53 AM on 06/15/2011
It seems to me that the blame lies in allowing frivolous lawsuits that forces doctors out of business when something goes wrong with a high risk patient. It's natural for doctors to want to protect themselves - the blame should go to the courts that allow doctors to get sued into oblivion when a high risk patient gets unlucky, as some obviously will.
MommyMD
MD, Professor, Mom
03:53 AM on 06/15/2011
Happy to be your first fan.:)
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Sister Bluebird
09:33 AM on 06/15/2011
I have been treated by doctors who are uncaring, and incompetent over the years. I don't feel sorry for them at all. If they would simply turn on their incompetent brethren instead of turning into a wall of white when someone cuts the wrong foot off, perhaps malpractice suits wouldn't be such an issue. Just for starters.
10:47 PM on 06/14/2011
Unfortunately, I think the insurance companies (and doctors) are more concerned about being sued than they are about these patients. If we can put a man on the moon, we can tend to the obese. If the drunks can learn to quit drinking ( and millions have ) if the addicts can learn not to use (and millions have) then the overweight can be treated and taught proper nutrition and wellness. They want to live happy and fullfilling lives, too.
It is the LOVE of money that is stopping these insurance companies and these healthcare professionals from doing their job - healing.
MommyMD
MD, Professor, Mom
01:55 AM on 06/15/2011
Jeepers, I LOVE money! I spent 18 years training to be superspecialist in one of the lowest paying internal medicine fields, have 300K in debt, and worked at least 8 years, 110 hours/week for less than minimum wage. Sorry, forverstudy (although I suspect you are a long-time grad student as well), this is not the case with all of us. Most of us DO LOVE caring for patients. I would be happy to take my degrees and be a banker/lawyer etc., but I have a calling, and really try to do my best. Again, after all their training, I think the OBs just don't want to see their lives and livelihoods taken away from a birth complication.
To Sister Bluebird, it sounds like you may require a team approach: you (a motivated and informed patient), a nutritionist, an OB, and an endocrinologist....not to toot my specialty but your story is sadly far from uncommon.
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Sister Bluebird
10:04 AM on 06/14/2011
To all you men and women out there who are over weight or obese, there is hope.It helps tremendously if you can identify the underlying factors that lead to the initial fatigue and metabolic changes to begin with. Don't be afraid to take your own health in hand. These links have more to do with women's health: Use Wikipedia as a starting point for PCOS, Endometriosis, and Hypothyroidism [for starters]. Look at the symptoms: PCOS Wikipedia "The symptoms and severity of the syndrome vary greatly among women. While the causes are unknown, insulin resistance, diabetes, and obesity are all strongly correlated with PCOS."--one symptom: Metabollic syndrome http://en.wikipedia.org/wiki/Metabolic_syndrome Subclinical Hypothyroid: NYT- http://www.nytimes.com/2005/11/08/health/08hypo.html?pagewanted=all "...women who report weight gain, fatigue, memory problems and depression...Hypothyroidism, characterized by slowing mental and physical performance and other symptoms, is the most common thyroid disorder in the United States, affecting an estimated 13 million people. " Postpartum Thyroiditis: http://endocrine.niddk.nih.gov/pubs/pregnancy/ Meds that cause weight gain: http://www.fitwoman.com/expert-advice/fitbriefings/medications-and-weight-gain ; psychiatric meds that cause weight gain: http://www.inspire.com/groups/stop-sarcoidosis/discussion/drugs-that-cause-weight-gain/ and see what this nurse's guide says about causes of weight gain and corn syrup-http://www.nursingdegreeguide.org/2008/50-surprising-causes-of-weight-gain/
Research estrogen dominance and check the symptom list.
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Angie Tyne 1
I want my disagree button!!
05:29 PM on 06/14/2011
It took 10 yrs and 5 Drs to find out that I had PCOS. The first few just told me to eat less & excercise!!! Arrrrgggghhh! I finally self diagnosed from a woman's magazine article.

I did the 60 mile 3 day cancer walk. Trained for 3 mos, dieted, walked 60 miles in one weekend and after all that I had lost a grand total of 9 lbs. :P

I wish it had been as easy as those first few drs tried to make it.
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Sister Bluebird
09:43 AM on 06/15/2011
If someone had only figured out sooner that 90 percent of my lower back pain was due to PCOS causing muscle spasms and that it was not a serious back injury, then my exercise regimen wouldn't have been constantly disrupted for weeks at a time. I finally got to where I don't need a nap during the day. All my other stats were excellent except the weight, but I had constant fatigue, acne, hair loss, painful cycles, dry skin and weird allergy episodes only during my cycles. I have PCOS, it is caused by Endometriosis. I have the telltale signs of Thyroid issues, but I cannot get treatment though I show physical symptoms {unmistakable ones} because my numbers are in the "normal range". I battled my weight for years, even in the military and never knew why. Well now I know why and now that I have been treating that hormonal imbalance, many of these symptoms have subsided and the others have become less immediately annoying. Battling weight gain all your life is exhausting.. I mountain bike, I hike, I rollerblade, I garden, and except for the bike and the blades I did this stuff while I was pregnant too. I took water aerobics classes after the birth of the kids only to end up bedridden, not knowing why I couldn't move and why even with breast feeding the weight didn't come off. Some of the comments I read on this thread are astoundingly mean and ignorant.
MommyMD
MD, Professor, Mom
03:44 AM on 06/25/2011
Any doc should be able to diagnose PCOS. It has strict criteria...not rocket science. But truthfully, weight loss (along with medication) is actually a stellar treatment for both restoration of menses and symptoms of hyperandrogenism (male pattern balding, facial/body hair, acne etc.) 9 lbs is great! I don't know how much you weigh, but if you are overweight, only a small (10%) weight loss is necessary (in the literature) for the above symptoms.
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09:00 PM on 06/13/2011
and thus we see the Hippocratic, become a travesty.
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Sister Bluebird
07:54 AM on 06/14/2011
It became so a long time ago. Like 20 years or more.
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Angie Tyne 1
I want my disagree button!!
05:29 PM on 06/14/2011
Concurrent w/the HMOs.
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UsedtobeAlongst
Correcting the Left's hypocrisy
07:01 PM on 06/14/2011
Please tell me where in the Hippocratic Oath it says you have to endanger your professional life by accepting high risk/legal risk patients to satisfy some one elses feelings ?
09:26 PM on 06/15/2011
Or endangering all your other patients who will have no doctor when you suddenly disappear. It's not selfish.
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09:44 AM on 06/17/2011
"First, do no harm" takes far more precedence over Lawyer's fees.
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08:58 PM on 06/13/2011
"OB-Gyn Doctors refusing to accept overweight women"....Is it just me or is it lost on most people that this is firstly about WOMEN, and the increasing pressure that they FIT in by being smaller? We already live in a world hostile to women who are not a size zero; and while yes, obesity is an epidemic and carries with it many potential health problems, is the REFUSAL to treat, not going to just compound the problem and the suffering?
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Sister Bluebird
07:55 AM on 06/14/2011
This is about lazy doctors who have 0 diagnostic skills. Women as usual, bear the brunt of their egotistical ignorance.
11:57 AM on 06/14/2011
Actually, no. It is about physicians who are scared to death of one lawsuit ruining their lives. The doctors in question are in Dade/Broward areas, the worst OB litigation area in the United States. One bad OB case will not only end their career it will whipe out their personal net worth as well.

So, they are hardly lazy, they are simply not willing to take on excessive risk. It is that simple.
11:59 AM on 06/14/2011
Do you really think these docs are talking about size 6's and 8's? No, they are talking about women who are 250lbs+, the category known as morbidly obese. So, please, don't spin this like it is all about rail thin models, it is about people who are killing themselves and their unborn baby and the physician who doesn't want to be in the room when it explodes since they will inevitably get blamed.
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UsedtobeAlongst
Correcting the Left's hypocrisy
07:02 PM on 06/14/2011
Fanned and Faved !
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Sister Bluebird
09:46 AM on 06/15/2011
I know, I weigh 230 lbs. Boo Hoo. Don't treat me, I haz fat in bad places.
MommyMD
MD, Professor, Mom
02:31 AM on 06/13/2011
OBs can and do lose their entire careers over a "non-perfect" baby and a subsequent lawsuit. It is a fact that statistically speaking, overweight women (not all) have higher risks of pregnancy complications (gallstones requiring a pre-term birth, increased risk of DM pre-pregnancy- increased congenital malformations, increased risk of gestational DM-- increased risk of birth trauma from large babies, and in case of crash C-section, more time to get a baby out). Our system is broken/consumer-based/and litiginous. OBs are frightened. After spending one's youth learning their profession, often with 300K in debt to show for it, I don't blame them for not taking on high risk patients. Single payer insurance would (hopefully) give everyone the right to proper medical care.
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Sister Bluebird
09:49 AM on 06/15/2011
Many of us women go to midwives now. A good independent direct entry or nurse midwife is perfectly adequate for a regular pregnancy. I gained a lot of weight during pregnancy, the first one I lost it all and was back down to 160 at 5'8. The second pregnancy I couldn't loose the weight. And as per previous, repeated experiences, trips to the doctor tended to be not just disappointing but down right scary. Some of these people in the white coats, I seriously wonder how they were able to get a license to drive, much less persevere through medical school.
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ThinkinPerson
01:46 PM on 06/12/2011
Doctors might have to ask, 'what is going into our food that is causing this epidemic, what about our current structuring of life that leads to this epidemic?'

But I suppose then the doctors would have to research and ask tough questions of some of our food producers to explain the explosion of obesity since corn syrup went into everything.

Besides, isn't it just easier to isolate and make seem worthless another part of the society? Notice the study published today, skinny women make more money!

I guess someone's trying to direct policy thru the media again.

Honestly, some skinny woman are pretty unhealthy, some large women are healthier than others, and this whole notion that one body type is 'more valuable' is such a WASTE of time.

How sad, and how sad doctors are a part of the game. Gross.
03:03 PM on 06/12/2011
What do you want them to do, sit there? You want an OBGYN to sit there and discuss dietary planning? How about some personal responsibility. If you are ballooning in weight, aka: any woman over 180lbs, needs to take a serious look at intake and exercise, if they don't do that, the doctor should just shrug and keep moving.
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Sister Bluebird
09:45 AM on 06/13/2011
I want my OBGYN to be able to recognize the symptoms of Hypothyroidism, Estrogen Dominance, and understand the effect that these are caused by Pregnancy, Endometriosis, and Poly Cystic Ovarian Syndrome. Then I want that worthless white coat to help me know if my pain is something I can ignore and exercise through or if I need to look for other causes. Then I want that person to sit down with me and actually communicate with me, my real options instead of throwing pills at me without consideration to my unique health needs.
MommyMD
MD, Professor, Mom
02:36 AM on 06/13/2011
I think most "thinkin" people, MDs or not, suspect that corn syrup, subsidies to corn/meat farmers, and a country designed to be as sedentary as possible is at least partly to blame for an obesity epidemic that will eventually bankrupt our nation. Maybe speak up to your congressperson...I think they direct the cash.
08:15 AM on 06/13/2011
Is someone out there forcing this stuff into your mouth? They said the same thing about smoking, guess what, I never smoked because I had a brain.
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ThinkinPerson
02:03 PM on 06/13/2011
Understood.

Still, it was a report about Drs 'perception' of overweight people, and the Drs willingness to treat the person. That isn't about congress. That's about Drs. looking at patients in need, knowing the complexity and instead taking the simple path of isolating and not treating the patient. Lovely. What can Congress do about that?
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ThinkinPerson
01:38 PM on 06/12/2011
Dear God, can you help the people who must now deal with doctors who are beyond selfish, but instead an embarrassment to you and your mission?
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UsedtobeAlongst
Correcting the Left's hypocrisy
07:07 PM on 06/14/2011
Med schools are open to all. Feel free to apply and see these land whales.
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11:29 AM on 06/12/2011
not surprising. overweight & obese people are treated badly in every other area of life, so why not by doctors too? a few years of medical school doesn't make them different from anyone else.
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Sister Bluebird
09:53 AM on 06/15/2011
A few years of medical school doesn't even educate some of them. They might as well have not even bothered to attend. It is shocking. I have repeatedly had encounters with different doctors who were stupid. I don't know how else to describe it. I wouldn't let them wash my car they were so stupid. It really causes me to question how they qualified for med school much less how they managed to get a degree in it medicine of any kind.
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09:31 AM on 06/12/2011
"Its time to change." Totally agree. Unfortunately all signs point to changes for the worse.
01:29 AM on 06/12/2011
"But medical professionals don't turn away cancer and cardiac patients because of their high-risk disease; it's precisely why they treat them."

That's not entirely the case. Someone with advanced metastatic cancer would not be offered heart surgery, and someone with severe cardiac disease would not be offered cancer surgery. If your body cannot tolerate an operation or would not benefit from it, you won't be offered that option. If someone were 900 pounds and developed colon cancer, I can all but guarantee that no one would operate on them.
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Sister Bluebird
09:55 AM on 06/15/2011
Not treating someone with terminal cancer, because it would not lengthen their life nor improve their quality of life, isn't the same as turning away someone simply because they are fat. Fat is treatable. Not just with diet and exercise, but also with finding those underlying conditions that lead to the lethargy and the cravings and/or metabolic imbalance to begin with.
12:37 AM on 06/12/2011
Why were there no fat people in my parent's generation? Just watch old newsreels and other real-people footage. If you saw one fat person in a crowd, it was an event. I suppose there must have been some, but very few. Of course then people walked a lot, did a lot more manual work, didn't drink pop all day, nor did they eat garbage.
I believe they came home and with their families ate homemade food that cost quite a big proportion of the family budget, and didn't spend the rest of the evening watching the idiot box or typing comments in to online newspapers.......Well, those were the days of the stay at home mothers and homemakers. Bless their hearts. They cleaned, cooked, sewed for the daughters, did laundry and heaps of ironing, raised the children, enforced church attendance, volunteered in the neighbourhood and guarded the family against bad influences - and were treated like second class citizens. But they prevented so much of the rotten stuff that goes on today, because that was their day's work.
Not a lot of money left over for junk food and empty calories.
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Sister Bluebird
09:56 AM on 06/15/2011
There were fat people.