Fat patients and Fat doctors: impact of weight bias in healthcare

 

The Well Column, the New York Times wellness blog, has posted two articles this week about weight bias and stigma in healthcare. The first, reference a  study that indicated physicians are nicer to non-obese patients. This is significant because  physicians then foster better relationship with their normal weight patients, often leaving obese patients to not engaged in their care and less likely to follow doctor’s orders. Read the full article: Overweight Patients Face Bias

I have experienced weight bias from medical professionals many times, the most frustrating is providers not having a scale to accurately weigh obese patients or blood pressure cuffs to fit my arms. Weight and blood pressure are too very important vital signs and the equipment for both would not be a financial burden to the office. I have a home scale that has a 440lbs capacity, why can’t they afford one? Then of course the scary weeble wooble exam tables. YIKES. Hospital gowns. I’ve twice not been able to have a medical test performed because the equipment could not hold someone over 300lbs.

Then there is the direct from the physician bias, my diagnosis of lymphedema was delayed nearly two years because my doctor blamed the size of my legs on my weight. After that experience I began to advocate for myself, I didn’t accept a doctor blaming my weight, I didn’t allow them to deflect the real issue at hand to my size and appearance. One of my favorite incidents, yes odd that I say favorite as it wasn’t so positive at the time I was in a lot of pain, it was when I had been admitted to the hospital for cellulitis in my legs. This was not the first time I was hospitalized for IV antibiotics to treat my cellulitis. I had reached the point of packing a bag and taking my own pillow to the ER because I knew I would be admitted for several days of treatment. This time I had gone to the ER at night, was admitted but the next morning was still waiting  for the hospital doctor to examine me before any antibiotics were ordered.

So the young doctor comes into my hospital room and starts asking me questions. As he is going over my medication list he asks, “So you’re on depo provera?”

I reply, “yes.”

He then says “You know that’s not a reliable form of birth control at your weight?”

I quickly sniped back, “don’t worry, my weight IS a reliable form of birth control. Can we focus back on the cellulitis, the actual reason I am here?”

I weighed 500lbs at the time, Super Morbidly Obese, I was on 100% birth control at the time, if you know what I mean.

But it’s not just patients who encounter weight bias and stigma, the second article addressed how patients act towards doctors who are overweight. We must remember doctors and other medical professional are human too, and face the same challenges we do. The article mentions Dr. George Fielding, a weight lose surgeon, who was overweight and found his patients questioned his ability because of his appearance. However, he was able to relate to the same struggles his patients were trying to overcome. Read the full article here: When the Doctor Is Overweight

• Have you experienced weight bias and stigma when seeking healthcare treatment?
• Have you ever not been able to have a test performed because the table or equipment could not accommodate  your weight?
• Have you ever questioned  a doctor’s advice because of his/her weight or habits?

Join in the conversation at Born2lbFat

 

I switched doctors because of weight related issues.

in my case, I finally realized that I had been seeing this man for 9 years, at least once a year for some reason or another, and in that time I gained 90 pounds and he never once mentioned my weight and it's impact on my health.

Reflecting back, it may have been because he was overweight (40 or 50 pounds probably) but regardless, I lost faith in his ability to manage my health

i self paid for my WLS and did not consult him until after my surgery.  Then I switched to his female partner.  I see her about every 6 months and she does a 'what's changed' history at the start of every appointment.  We review my weight, labs, family history, etc.

i have a high confidence level of her ability to help me manage my healthcare.

I realized too that as much as doctors blamed my weight fur issues growing up they never offered help, even at my highest weight I had to propose the idea of sending me to physical therapy so I could safely start to exercise, etc.

I am certain that  this type of bias exists and goes both ways and it is very unfortunate that some suffer the effects of behaviors as others form opinions based on first impressions.  Unfortunately first impressions count and while I would not have an issue with an obese GYN or ENT (just random examples)  caring for me I PERSONALLY would have an issue with having an obese/morbid obese doctor engaged in my BARIATRIC care/after care ... My person (and I am only human) would be wondering whether I am about to embark on a case of the blind leading the blind... I would be wondering how I would embrace the thought of weight loss surgery working for me and if it works that well what's up with this doctor that he has not jumped on the opportunity for him/herself that he is offering me?   I would certainly LOVE IT if this doctor were a successful post-op himself no matter what surgery type ..  then I would definitely feel that it would be an awesome experience because he/she would have walked down the road I am about to take.  I had this awesome experience at my psych eval ... the handsome gentleman doing my eval happened to be a post op patient of my bariatric group who had had his surgery 10 years prior and was 100% successful ... a cyclist and a gymnast ... I WAS IN AWE and I wanted what he had achieved for ME...

I am glad I have not experienced any such bias probably because I have pretty much stuck to the same group of internists or have or have had a working relationship with them of some sort or another ... I have been blessed with an exceedingly supportive medical team both in dealing with my issues as well as the team including the transplant and vascular as well as endocrinology and ortho teams dealing with my husband's issues which are many and not weight related at all.

I was and AM truly blessed with an AWESOME PCP who both he and his APRN who is married to a bariatric surgeon were fully supportive of me and always showed much concerned about my weight related health issues ... they always genuinely and kindly addressed my issues until I said WHEN and was ready for surgery ... I WISH I HAD CHOSEN THE DS but at the time that option was not available to me.  

When I made the decision to go ahead with weight loss surgery they were VERY supportive too ... exceedingly so ... my ONLY regret besides not having made this move sooner is not having had the option of a DS readily available with my group of choice ... I went with what I considered to be MY best option at the moment however I would have jumped all over a DS if I had that option.

I am happy though knowing that should I have any malfunction or undesired results down the road with my RNY OUT OF MY CONTROL as I am determined to WORK MY TOOL and MY LIFE as I LOVE IT for ME ....  I would exhaust every effort and advocate for a revision to a DS ... I truly believe that obesity kills because I was almost there as long as I have an option I will pursue it ...  I like good things and strive to get and/or achieve the best of things I would certainly go for the best option available for me.  Today that would be the DS ... who knows with all the progress science brings us daily if there would be a better option yet tomorrow ... I am certainly leaving all windows open and pursuing any better options because I simply REFUSE to go back ... 5 co-morbidities and limited mobility is not the lifestyle that I want as I age younger in health and strength each day.

Of course this doesn't say it was the case for him but I wonder if a leading bariatric surgeon might perhaps have not had the surgery because he/she has yet to find a surgeon they trust to perform it on them? Just something to think about....being able to take the time off for recovery, etc, if they are self-insured does their insurance cover it?  I can think of a lot of reasons they might not make that choice for themselves, and actually I'd rather just engage them in that conversation verses making an assumption about their skills. 

People may look at me and think I know nothing of health, nutrition, and wellness, or wls because I am deemed by many as a "failure" because I am still SMO. Without engaging in a conversation they would not know about my lipedema or lymphedema or how much weight lose I have maintained since surgery in 2003. Not that I am a professional in any of those areas so no don't take my professional advice, but it still leaves me open from unsolicited advice from strangers on how I could/should lose weight as if I'm just not doing something I should be doing.

Here in America we have a nation wide epidemic of obesity.  You see it more and more everywhere we go and has been crossing into the medical community for some time now.  There is only so much you can defend for the obese community when most of us now want a healthier nation.  Not until I went through the classes and researched and finally had the surgery how much I lived in denial.  I knew I was obese, but it got totally out of hand.  I want to see a healthier community and that includes our healthcare doctors and employees.  We have to put a stop somewhere and draw the line as to the fact that obesity kills no matter what.  Funeral directors seldom bury old, obese people.  They generally die way before that from complications from diabetes, heart disease and many other diseases.  I had diabetes and STILL did nothing to eat healthier and exercise.  I don't know if I would have done a thing about my weight if it weren't for the fact I damage my joints so bad I use a walker and will have to have my hips replaced.  So that and my Internist telling me if I don't get the weight off I probably wouldn't live another ten years.  So I can only advocate that in most people's cases their weight can be helped through WLS.  I don't buy for a minute that a WLS surgeon would not have coverage for WLS. This is the medical community and if a lot of regular people can be self-pay I am sure he/she could also.   Jane

 

 

You think I don't want a healthier nation? There are a lot of normal weight people who need to get "healthier". Fat does not equal unhealthy nor does skinny equal healthy. You read it as I'm defending the obese community, it's not ok to be unhealthy but is also not ok to judge someone by appearance. And in order for people who are obese to get the medical treatment needed to be healthy individuals the stigma and bias against them in the healthcare field needs to end. As for old people, my mother is 66, MO still works 12 hour shifts as an RN, no diabetes, no heart disease, 13 year breast cancer survivor. My father normal weight passed away from myelofibrosis at 62. It amazes me that smokers get treated for the medical conditions related to their smoking habit, they wheel their IV stands outside the hospital to SMOKE, doctors don't simply say stop smoking and be on your way. Yet, most doctors would tell a patient "it's because of your weight" then dismiss them, not even offer them options or help to lose weight. Then what about the patients who do try to lose weight, and say lose 5lbs but the doctor wants them to lose 10lb, so they are told they didn't try hard enough. For the record I have maintained 100lbs weight lose for 10 years, yes I am still SMO, but have maintained a loss that many WLS "only" have to lose.

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The birth control issue would be something for me to discusse with my treating GYN, not some doc who was suppose to treat an infection in my leg.

I have had a difficult time with the ER.  Once I was in the ER very ill and the nurses stood just on the other side of the curtain discussing how much fatter I looked without my clothes on.  Needless to say I wrote a letter to the administration regarding my treatment.  Another time I was scheduled for an MRI.  It was not in a hospital...I had been sent to a clinic. They asked me if I weighed 300 lbs and I said no I was just under that.  They said that was fine and proceeded to give me the MRI, only for me to get stuck briefly in the machine.  They had to pull me out manually.  I was told I couldn't go back. You can imagine my embarrassment... It was one of the final straws that led me to decide to get weight loss surgery...one of many things...mostly being my health.  

I have also had some very positive experiences.  The nurse who gave me the larger hospital gown without even mentioning my weight and the gown size, the doctor who had the right scale for me and the right blood pressure cup size and that same doctor who never judged me about my weight.  She remained encouraging all the  time and promoted overall health.

i think we can get both the bad and the good...I try to remember the good experiences.