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Can Overweight Women Trust Their Doctors?

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Being a doctor these days is hard. But so is being a patient, especially if you happen to be female and overweight.

A study last year found that more than 40% of doctors feel "frustrated" by obese patients. But feelings among doctors are not the only problem. Recent studies have found that a woman who is as little as 13 pounds overweight may receive less than optimal medical care. Women who are over 20 pounds on the wrong side of the scale are more prone to inaccurate diagnoses, have more trouble finding a fertility doctor for help with getting pregnant, and are less likely to receive early diagnosis and effective treatment for cancer.

The research matches up quite accurately with my clinical experience. Over the years I have known many overweight women who have been misdiagnosed by their physicians. And though I realize that anyone can be misdiagnosed, the striking numbers of overweight women whose doctors have missed serious illness reinforces the belief that doctors think differently about those carrying extra pounds.

Of course obesity is a serious problem and one that should be addressed. But weight gain is partially related to self-control, as well as genetic and biological factors. Many physicians, whom we often expect should know better, attribute being overweight solely to dietary habits. This is in spite of data on biological factors that are implicit in weight gain. Psychotropic drugs, which are taken by millions, cause people to put on pounds. Ironically, these medications are often prescribed by the very same doctors that are annoyed with their patients for being heavier than they should be. Additionally, though in need of further study, some have speculated on chemical and environmental factors that impact metabolism via hormone production. There is even speculation that environmental toxins are associated with the development of diabetes in some populations.

That being said, some people simply do eat too much. And they can learn to change this behavior. But where are realistic discussions about today's overwhelming guidelines about what is required of all of us to stay healthy? At last count, recommendations for crucial self-care behaviors for reducing heart disease, cancer and dementia include the following: manage weight, get plenty of exercise, avoid high fat and high cholesterol foods, eat several vegetables and fruits a day, floss at least once a day, get regular teeth cleaning, reduce meat consumption, don't smoke, avoid sugar and other simple carbohydrates, and take medications strictly as prescribed. And then there are the more confusing recommendations-- vitamin D intake (which experts don't agree on), drinking alcohol (the amounts vary depending on the kind of disease you are trying to avoid) and eating a lot of fish (but not too much, because of mercury). And regarding mercury, how do we manage this potentially dangerous metal? Should we all rush to get our fillings replaced? And in this economy, who can afford it?

As if that list weren't comprehensive enough, for those of us especially worried about both the environment and our health, we are told that we should avoid foods with preservatives, eat organic, and ingest meat that is responsibly raised and without hormones.

Though I personally agree with many health recommendations, this dizzying list of behaviors is quite frankly out of reach for most people. Work commitments, time and finances limit many from achieving these ideals. Doctors know this. Many physicians have trouble doing all that is needed to take care of themselves. Presumably, like the rest of us, they are too busy or too confused to follow the guidelines.

But still, why do some doctors give up on patients who have trouble controlling their weight, especially if they happen to be women? Since doctors are human, they are subject to the same biases many of us share. And with almost half of medical patients in the U.S. being noncompliant with medical advice, doctors are understandably frustrated.

Why this gets taken out on women, however, remains curious. We can look at our fascination with women in the popular media as a guide. Dramatic weight loss post-pregnancy is a major source of hits on websites that profile the famous. And let's face it, we expect our women role models to be thin, despite how busy they might be trying to raise a family or deal with post-partum hormones and mood. Maybe if things were more balanced on the gender scale for us in society, then doctors would follow. Although medical clinicians are an easy target of our derision, holding them to a higher standard is not working, at least for overweight women who need care.

While doctors certainly need to come to terms with their biases, the rest of us need to come to terms with our own. We should stop holding women to higher standards in terms of weight and beauty. Let's talk about how healthcare guidelines are useful, but more realistic for people who have the time and money to follow them.

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