Emergency Room

Obesity in the Emergency Department

The emergency department is where two broken pieces of healthcare meet: obesity and poor access to care. Two recent studies illustrate the results of a phenomenon that weight bias researchers have documented for some time. People with obesity face an attitude from some healthcare professionals that verges on contempt. As a result, they avoid seeking medical care and frequently switch providers.

Heather Prendergast and colleagues from the University of Illinois at Chicago just published an analysis of the relationship between BMI and the diagnoses, vital signs, severity index of patients 65 and older who were seen in a urban emergency department. They found that patients presenting with hypertension, as well as neurological, pulmonary, or gastrointestinal complaints were significantly more likely to have excess weight or obesity.

The prevalence of obesity is growing in the older population Prendergast studied. Emergency departments are an important source of care for those patients. So she concluded that emergency departments can be “a previously untapped resource for screening and early referral exercise programs aimed at improving physical function/ functional status and quality of life.”

The second study, from Johns Hopkins, gets closer to the heart of the problem. Kimberly Gudzune and colleagues found that people with with excess weight and obesity were more likely to visit multiple primary care physicians, a behavior the authors label as “doctor shopping.” They also find that this difficulty in maintaining a relationship with a single primary care provider leads to more emergency department visits.

The authors note the extensive documentation of weight bias among healthcare professionals and that negative interactions with providers and staff that could be the cause of this “doctor shopping.” Indeed, weight bias researchers have shown that this is the case.

But in the end, the solution Gudzune prescribes is to change the behavior of the patient with obesity:

For example, future interventions could target health plan beneficiaries to educate them on the benefits of continuity of care and assist them in finding and maintaining a relationship with a single primary care physician. Interventions targeting doctor-shopping behavior could decrease inappropriate use of high cost services such as ED visits and hospitalizations.

From the perspective of patients with obesity this seems like telling patients they need to suck it up and tolerate bias from a primary care provider, instead of shopping for one who will treat them with respect. We wonder if bias permits a focus on doctor shopping as the problem, rather than a symptom. Is it not possible that primary care physicians and their staffs might need some education, too?

Physician, heal thyself.

Click here to read the Prendergast study, and here to read the Gudzune study.

Emergency Room, photograph © Rosser321 / flickr

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