Lynne Murray says:
Debbie pointed out this New York Times article by Tara Parker Pope, where transcripts of doctor patient appointments showed the doctors’ comparative lack of engagement with fat patients when compared with their interaction with normal weight patients:
In conversations with patients of normal weight, the doctors offered simple comments to show concern — for example, “I’m glad you’re feeling better” to a woman who had experienced hot flashes. When a normal-weight patient had trouble getting an appointment with a specialist, her doctor shared her concerns. “I agree with you,” the doctor said. “That gets extremely frustrating when that happens.” …
While such expressions of concern and empathy are not remarkable on their own, what was surprising was how absent they were in conversations with overweight and obese patients.
And statements like these are no small thing. Studies show that patients are far more likely to follow a doctor’s advice and to have a better health outcome when they believe their doctor empathizes with their plight.
I have always been the patient doctors don’t want to see. Even before I open my mouth, my body size marks me as “noncompliant.” Once I started to resist weight loss advice, I became “the patient doctors avoid if at all possible.”
My first experience in requesting non-diet-oriented medical care came back when I had insurance in the 1990s. I brought The NAAFA Healthcare Bill of Rights (from the National Association to Advance Fat Acceptance) to an appointment. The first mistake I made was not giving it to the doctor before the appointment. When she started her diet spiel, I realized the flyer was in my purse and started to get off of the table, clad only in the flimsy paper covering. The doctor, a petite woman, literally stepped back in fear of being assaulted by a large, mostly naked, noncompliant patient. I gave her the flyer and she abandoned the diet talk. After that she managed not to ever to see me again.
She also took a certain kind of revenge for my having frightened her. When I developed extreme pain in my hands, arms and back at my job, which was all-keyboarding in a word processing center, she recommended only one week of leave. The specialist she referred me to intervened and I managed to get six weeks of disability to recuperate.
Fast forward 15 years, during which time I was self-employed and uninsured. The next doctor I saw at a local free clinic refused to accept that my maintaining a stable weight for 15 years was a good thing. She suggested that losing weight was the only solution to my arthritis, particularly my knee problems, even after I told her that decades of attempting weight loss had inevitably been followed by gaining back more than I had lost. So how did she propose to drastically reduce my already minimal food intake? Her view was that I was either mistaken or lying about what I eat. Essentially she stated that I must be doing something wrong or I wouldn’t be so fat.
She said “If what you say is true about what you are eating, you need to look into portion size and break it into several small meals.” She didn’t address, or maybe didn’t believe what I said about always regaining weight. This doctor wanted to share her eating disorder with me in the guise of treatment. The only reason I continued to see her was that I needed the clinic’s help. For my next appointment with her I both mailed in advance and brought in the Health At Every Size® manifesto, recommended by Linda Bacon, complete with citations to studies supporting the HAES approach.
She avoided seeing me at all during the appointment. Nurses at the clinic conveyed the necessary information to her and prescriptions to me. Mercifully she went on maternity leave and didn’t return. At my next appointment I actually saw another doctor. I could see the HAES materials in my file on the counter, but we didn’t discuss the subject. She simply said, “Aside from mobility problems and blood pressure you seem to be pretty healthy.” And we let it go at that.
I also have personal experience with the doctors described in the New York Times article, doctors who have been proven to provide sympathetic care for lower weight patients behaving very differently toward fatter patients. One friend had a doctor who had treated her with such sensitivity and concern that she felt he had saved her life. She wanted me to be able to have the same experience and even offered to pay the “concierge doctor” fees for his services. As it turned out money was not the problem. He simply refused to see me. Based simply on my friend’s description of me, including my weight, he recommended gastric bypass surgery.
In the New York Times article quoted above, Dr. David L. Katz, director of the Yale-Griffin University Prevention Research Center, notes:
In dealing with patients who are overweight … doctors often show the same biases and prejudices as the culture at large. The problem may be compounded by the fact that doctors are trained to deal with immediate medical problems that have specific solutions, like a pill to lower blood pressure or emergency treatment for a heart attack. But obesity is a far more complex problem that isn’t easy to solve, and that can be frustrating to doctors.
“When we can’t fix what is broken we tend to behave badly,” he said.…
Dr. Katz said his grandmother, who was obese, was so tired of physicians’ negative comments about her weight that she stopped going to the doctor altogether, even when she developed a breast tumor. When she finally sought treatment, she had advanced-stage breast cancer and died in her 50s.
“Every time she went to the doctor for any reason, they wagged a finger at her and talked about her weight,” Dr. Katz said. “We need to understand that the stakes are very high.”
The solution, he said, is better training so that medical students and doctors understand the complex nature of obesity as well as their own (perhaps subconscious) biases. Yale, for one, offers a continuing education program for doctors on compassionate and effective lifestyle counseling for patients.
“I think a lot of them are compassionate and don’t realize this is going on,” Dr. Katz said. “The antipathy for obesity is really rooted in our culture. We should expect better from doctors and train them better.
Even a small weight gain can put a patient “over the line” as far as doctor empathy is concerned.
At Fierce Fatties, bronwenofhindscroft writes about her husband’s first encounter with one doctor. Bronwen’s husband had gained 20 pounds in three years after a knee injury slightly curtailed his still impressive physical activities:
Those 20 pounds were enough to bring his BMI up three points and put him into “OMG YOU’RE GOING TO DIE TOMORROW!” range.
The doctor came in and, right off the bat, told him that he was “obese,” and needed to lose weight, first and foremost. If he didn’t, dire things would happen….
This leads many fat people to to mistrust the medical establishment and dread doctor visits. The physician bias against fat patients has been shown to exist as early as medical school.
The problem goes beyond doctors. The NAAFA newsletter points out:
A study by the Yale Rudd Center now shows that bias can be a two-way street, with patients being biased against physicians who are viewed as carrying excess weight.
Respondents reported more mistrust of physicians who are overweight or obese, were less inclined to follow their medical advice, and were more likely to change providers if the physician was perceived to be overweight or obese, compared to normal-weight physicians who elicited significantly more favorable reactions. These weight biases remained present regardless of participants’ own body weight.
In a post entitled “What to Say at the Doctor’s Office,” Ragen Chastain at Dances with Fat offers some wonderful boiled-down-to the essence Doctor Cards containing an explanation of Health at Every Size and a request for “shame free health care”–I love this phrase! The cards also offer some useful phrases to use at during office visits and citations to research to clearly make the point that science backs up the HAES approach.
I love her credo:
I believe that everybody of every size should be treated with respect.
I believe that it’s impossible to tell somebody’s health based on their weight.
I believe in giving people correct information and affordable options for eating and movement.
Doctors seem to share fatphobia with the rest of the world; this results in an unhealthy habit of discounting whatever fat people have to say, and thus translates into fat people getting treated at least as badly in the medical system as anywhere else.