Why Is Obesity a Hidden Disease?
How can it be that obesity is a hidden disease? In a 2009 study of patient records, Jun Ma and colleagues found that healthcare providers seldom diagnose obesity. Of patients with a BMI in the range of obesity, 70% do not receive a diagnosis.
Misperceptions in Rural Patients
In self reports, people consistently say that they are taller and lighter than they are. A new study in the Journal of Health Care for the Poor and Underserved looks at the gap between actual and perceived weight status in rural patients. This study does a fine job of showing that men and African American patients are especially prone to underestimate their weight status.
But they are mistaken about one thing. Education “to help individuals accurately self- assess their weight” will not solve the problem.
Weight Bias Below the Surface
Quite a bit of energy goes into studying weight misperception. Repetitive studies showing that parents don’t label their kids with obesity are getting tiresome. Just below the surface lies an undercurrent of weight bias. “What is wrong with these people? Why don’t they recognize the problem?”
This might be the only aspect of obesity that’s not very complex. It’s simple ego protection. People with obesity face bias every day that is overwhelming. Kids face it from a very early age. In our culture – obsessed with thinness – excess weight is not hard to recognize.
First Things First
What is hard, though, is figuring out what to do about it. Evidence-based care can help to improve the health of people with obesity. But access to such care remains very poor. And often, it’s hidden behind authorization rituals that serve to further stigmatize patients.
When a problem doesn’t have a good solution, people naturally focus on solving other problems first. Efforts devoted to persuading more people to worry that they have obesity are not helpful right now. First, we must clear the hurdles that stand in the way of people who are already seeking care. Also, we must develop better options for treatment and systems for delivering care.
Until we do those two things, promoting obesity recognition simply wastes limited resources.
Click here for the study of actual and perceived weight status in rural patients.
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March 3, 2017