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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Health-risk wise, maintaining healthy weight is roughly equivalent to quitting smoking- not easy, but so hugely beneficial to overall health that it would be irresponsible of doctors to totally let the issue slide because a patient doesn't want to hear it. Losing weight really IS the first step to better health for many Americans. Doctors aren't stupid, they are well aware of genetically high cholesterol, etc, but whatever you've got, additional pounds probably aren't helping. Also, being overweight results is poorer health overall, and since it is human nature to blame or praise the doctor based on the outcome rather than the actual competence of care, it would not surprise me at all to learn that the overweight as a group are more disgruntled with their care.
Some of these comments also suggest that women are going into their doctors already defensive and distrustful, which doesn't contribute to a positive doctor-patient dynamic. Your doctor wants you to lose weight to maintain your health at the highest possible level, not because they are enforcing society's body judgements.
I agree that loosing weight can be a way to avoid the emergence or exacerbation of health problems. And I also agree that some overweight women feel mistrustful about going to the doctor (as do smokers, people who use drugs and not to mention the massive amounts of research suggesting that GBLT populations, who feel so discriminated against, they avoid medical care because of worry they won't find clinicians who won't pathologize them).
Regarding weight, avoidance of doctors seems related to the research I mention in the article, as well as shame in general regarding being overweight in a culture that values being thin. The messages women receive about eating, dieting and being skinny, in my mind, exacerbate the problem. One feels bad and then helpless. What I feel most worried about in my work, is how some people, because of shame, avoid doctors all together. That does not help anyone. Patients, physicians and the healthcare system all suffer when someone is ill with a disease that could have been treated earlier. You are right that a good-doctor patient dynamic is important, and I do hope that we can all understand biases better so that people can feel free to get needed medical care.
Thanks for reading and for your comment.
That isn't what the article is saying. The point here is that overweight women often receive substandard healthcare because of doctors biased against the overweight and obese. We've not even talking about morbidly obese people, we're talking about people with 13 extra pounds.
Being extremely overweight probably isn't so good for you. But is it horrible enough that not being treated for serious maladies is all right? Have we really reached a point where it's so acceptable to hate fat people that we'd rather mock them, lecture them and scold them instead of treating them?
So in addition to the spiffy eat less exercise more tips that always accompany an article such as this, does anyone have a suggestion for how to handle a thyroid tumor when your doctor doesn't pay attention to you because you weight 187 pounds at 5'7'? Just curious. Because that's what happened to me.
and i don't see 187 at 5'7" to be so awful.
yeah, pathologise the ovrweight, but not the food corporations that sneak high fructose corn syrup into everything.
They take stories where doctors have neglected patients by saying, "Go lose weight first" rather than treating the patient.
Good luck!
Peace,
Shannon
Thank you, Tamara, for breaking down the mistrust and discomfort many fat women have with doctors. The attitudes some doctors have toward their fat patients is driving patients away from health care. Is that really what we want?
Or there's the other disturbing trend of segregating fat patients from "normal" patients, as we are seeing in the budding field of bariatric obstetrics. Just another way to create a new kind of specialist while simultaneously stigmatizing fat women further.
I can already hear the fat haters going apoplectic, but dealing with the weight of our nation does not take shaming and brow-beating. If you're interested in a middle-of-the-road approach to obesity, I highly recommend reading the blog of Dr. Arya Sharma (www.drsharma.ca), a leading bariatric specialist out of Edmonton.
He is urging doctors to stop recommending weight loss for overweight patients since it DOES NOT WORK. He promotes weight maintenance and treating the disease NOT ascribing all diseases a fat person complains about as a symptom of their fatness.
This is the kind of compassionate assessment of the facts (rather than getting mired in the bias) is exactly what this country needs right now.
Peace,
Shannon
But what about when the disease is not a stand alone disease and is a direct result of the person's obesity...or, if it is a normally mild condition which is exacerbated by obesity?
I find it morally unethical for a doctor to prescribe medications or to perform surgery on a patient...both of which can be fraught with complications and risks...when the problem can be solved or at least lessened by weight loss.
Losing weight and focusing on nutrition, when done in a healthy manner (change in lifestyle as opposed to dieting) has no side effects.
Medications, surgery, and other medical procedures ALWAYS have the risk of side effects. Also many of these solutions are temporary at best.
Of course each patient should be listened to. Not every disease is caused by obesity. And no one should be treated with derision, it won't do any good.
But it is a violation of the hypocratic oath for a doctor to promote a risky medical procedure or treatment when weight loss would have the same effect.
So for patients who are currently obese, saying, "Losing weight solve your problem" is not a long-term solution. They may be able to lose some of the weight, but odds are they will gain it back and then some. Then they'll be right back where they started (something Dr. Sharma agrees with).
Personally, I believe lifestyle change is the key. Promoting lifestyle change (rather than weight loss or ideal weights) will be MUCH more effective at preventing further weight gain in patients is where the most impact can be made. Likewise, promoting lifestyle change in currently obese patients will do more for a person's health than promoting weight loss (and the research of Dr. Steven Blair indicates as much).
Peace,
Shannon
I've lost 15 lbs in the last four months.
The only significant change has been.....my doctor switched me from the generic Simvastatin to Lipitor. I started to lose weight a few weeks after that.
I started to gain weight about six years ago. About the time I was diagnosed with high cholesterol and put on Simvastatin. I gained 10 lbs a year. When I complained the doctor said told me I just had "Bad genes". Any complaints I had were dismissed and blamed on my being overweight. Even those that existed prior to the weight gain.
The weight is slowly coming off and I'm slowly going back to "normal" for me. And when I'm finally normal, maybe my doctor won't be so quick to dismiss me.
I'm still going to switch from Synthroid to a natural dessicated Thyroid. I think that will solve my fatigue problems.
i stopped white flour and all forms of sugar cold turkey. end of story. no more sugar, nothing but whole grain. and that's all it took for me to drop 20 lbs in about 4 months. may through august 2009. 20 lbs just disappeared! and it took me by surprise because i wasn't weighing myself. all of a sudden, i couldn't keep my jeans from sliding down, my underduds just hung on me and my face no longer was round but actually rather square, like my great grandmother's! i recommend it!
www.diamondhour.com
www.realherosjourney.com
I just lost 15 lbs after being switched from Simvastatin to Lipitor.
Now I realize the Simvastatin may be why I gained 10 lbs a year for the last 6 years.
Unfortunately high cholesterol runs on both sides of my family and no amount of diet and exercise can keep it low enough. But at least now my body isn't fighting itself and making me sicker.
And here I thought medicine was supposed to make me healthier.
Either way, I'm looking for a new doctor. One that encourages, rather than discourages.
So my point is, why is my doctor telling me NO tea, coffee, alcohol, etc? What's wrong with a glass of wine sometimes? She went too far, I think. Which was the point of my post.
As an anesthesiologist, every time i deal with an obese patient, what hangs in my head is the fact that each and every one of them, has increased their chances of dying in the operating table by several ten folds. So yes, i will dedicate all the available resources to that particular encounter dispropotionately .
People are pleasuring themselves to death.
And taking the rest of us with them.