Blind Spot Mirror

Our Ethical Blind Spot in Access to Obesity Care

There’s no gentle way to express this. We suffer from a huge ethical blind spot regarding access to obesity care. Today, as National Obesity Care Week focuses upon access to care, we must acknowledge just how big this gap is. Of course, we focus a lot on the issue of access to obesity treatment. We should. But the problem is much bigger than that.

Routinely, subtly, and systematically, people living with obesity are denied a decent standard of medical care of all kinds.

A Healthcare System That Can’t See Beyond the Fat

Writing in the New York Times, Gina Kolata described the problem bluntly:

The health care system – in its attitudes, equipment and common practices – is ill prepared, and its practitioners are often unwilling, to treat the rising population of fat patients.

People living with obesity are less likely to receive even routine preventive care. This happens for two reasons. First and foremost is the common biases of providers. Too many healthcare professionals openly express negative attitudes toward larger patients. In fact, some providers report being “repulsed” by patients with obesity.

In addition, based on experiences with discrimination, patients avoid healthcare. It becomes routinely insulting.

Obesity Society President Caroline Apovian describes the problem vividly:

Every day, I see overwhelming problems with access to medical care for people with severe obesity. The many issues range from no access to CAT scans to low rates of routine screenings. Things like pap smears and mammograms. But worst of all is the inexcusable reluctance to refer for bariatric surgery.

A Double Dose of Inadequate Care

So it is that the denial of coverage for obesity care is a double whammy. Already patients suffer from a lower quality of medical care because of obesity. On top of that, health plans routinely deny or restrict access to obesity care. In a recent review, Hillary Craig and colleagues describe the problem plainly. Denial of bariatric surgical care “constitutes a breach of each of the four principles of contemporary biomedical ethics.”

Disparities in health and healthcare are as routine as they are intolerable. But they’re even worse when they’re invisible. On the subject of access to a decent standard of care for people with obesity, we have an ethical blind spot. It must be repaired.

Click here for the review by Craig et al and here for more on quality of care for people with obesity.

Blind Spot Mirror, photograph © George Hatcher / flickr

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October 12, 2018