A Lifetime of Medical Neglect

Obesity presents many problems. But two of them rise to the top: access to care and bias. Yesterday, at the Harvard Blackburn obesity course, Caroline Apovian reminded us why. Too often, people with obesity endure a lifetime of derision and medical neglect.

With facts and case histories, she painted a searing picture of the suffering that results.

Objective Evidence

The evidence is unmistakable. People living with obesity receive poor medical care. Simply because of their size and the false assumptions healthcare professionals make about them.

Physicians have less patience with larger patients, less respect, and less time for them. A third of nurses say they don’t want to care for patients with obesity. A quarter of them say patients with obesity “repulse them.” Fully 90 percent of hospitals don’t even have the imaging equipment necessary for patients with obesity.

So these patients learn to avoid medical care. They are less likely to get routine preventive care. When they present with symptoms, providers attribute even unrelated problems to a person’s size. Health outcomes suffer.

In one study, for example, patients of different body sizes presented with shortness of breath. Physicians in training made less visual contact with larger patients. They simply told them to change their lifestyles to manage the problem. Lower weight patients received medical prescriptions.

Human Tragedies

Objective facts become human tragedies. A child with severe obesity from an early age gets little help from primary care pediatricians. Advice to eat healthier food and be more active doesn’t help. It does nothing to change the underlying physiology of a child with severe obesity. A pediatrician becomes frustrated as the problem grows worse. Parent and child avoid the doctor because it’s an unpleasant experience.

So the child becomes an adult with class three obesity. As an adult, she receives even less care and compassion from most health providers. An orthopedic surgeon misdiagnoses her with “obesity pain.” But he fails to see her scoliosis. That was the real source of the pain.

A surgeon refuses to repair a hernia because of a patient’s weight. She receives no referral for obesity care that might actually help her overcome the underlying disease of obesity. Nope. “Instruct the patient to lose weight” is the standard practice. And it’s utterly ineffective.

As time passes, medical complications become more severe and require hospital stays. Apovian offered case histories. Because hospitals are not prepared to give good care to patients with severe obesity, the experience is nothing short of inhumane. To understand this, read the obituary of Ellen Maude Bennett. Medical neglect is too mild to describe what she endured.

Rationalizing It

These problems don’t materialize overnight. They accumulate over a lifetime. Medical neglect of patients with obesity starts early and the complications add up. Everyone contributes to the rationalization. We don’t tell people with diabetes or cancer to eat less and move more. We give them good medical care.

But somehow we can live with blaming people for the physiological problem of obesity. And thus, the problem snowballs until it’s overwhelming.

We must stop. Stop blaming, shaming, and rationalizing. Obesity is no different from any other disease. Nobody wants it or chooses it. But we can do things to make it better. Better care and more compassion is a good place to start.

Click here for Apovian’s presentation and here for more on the impact of bias and stigma in healthcare.

The Hidden Struggle, photograph © Alex Proimos/ flickr

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June 23, 2019