Out of Reach

Systematically Putting Obesity Care Out of Reach

For most people, it’s invisible. But looking at the world through the eyes of a well-informed person living with obesity, it’s easy to see. Healthcare is not for us. Obesity care is mostly out of reach. Bariatric surgery is for the privileged. In fact, new research from the University of Georgia tells us that people with private insurance are the most likely to have the surgery. Then come the folks who pay cash. People who depend on Medicaid and Medicare are the least likely to get it.

More Diagnosis, Less Care

Janani Thapa and colleagues studied the diagnosis and treatment of obesity among inpatients in the U.S. over time. Their study is the first to break it down by payer type to understand utilization and costs.

What they found was the highest rate of diagnosis for patients with public insurance – Medicare and Medicaid. But they found the highest use of bariatric surgery among patients with private insurance and patients who paid cash. Thapa noted that lower income patients tend to have less access to obesity treatment:

The hoops that they have to jump through may be more to access the surgery and that was our motivation to look into this.

Physical Barriers to Care

For folks living with significant obesity, the barriers are not just economic, either. New research in the Disability and Health Journal identifies four distinct barriers to care. First, physicians are not equipped to routinely monitor the weight of patients with obesity. They might not have the right equipment. Or they might do it in a way that humiliates patients. So they often just forgo it.

Scorecard on UK Obesity Policy

Then there is the issue of accommodating large patients on exam tables. Inadequate equipment makes for inadequate clinical exams. Likewise, diagnostic equipment is often inadequate. One neurologist told the researchers:

I have had patients I have to send to the zoo to get an MRI done or a CT scan because they don’t fit into the machine.

Others described zoos as the only places with adequate scanners, but obviously inappropriate.

Finally is the issue of weight stigma. It is pervasive. Physicians express open disdain, lamenting cultural acceptance of obesity. Said one physician, “I am pretty much the only one [in my practice] who would take care of an obese person.” In short, obesity marks a patient as undesirable and healthcare systematically reflects this bias.

Healthcare for the Healthy and Privileged?

This kind of systematic bias is not limited to the U.S. Obesity care is largely out of reach in the UK, as well. Most of the talk about addressing obesity there centers around food marketing. That’s well and good. But meanwhile patients who need bariatric surgery in the NHS can find themselves waiting years while they tick boxes and jump through hoops. Thus a recent scorecard on addressing obesity in the UK reflects a failing grade on access to weight management services.

When healthcare systems favor the wealthy and the well, it’s no surprise that disparities grow wider and people with obesity grow sicker.

Click here for the study by Thapa et al and here for the study of barriers to care for patients with obesity.

Out of Reach. photograph © Mike Maguire / flickr

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July 16, 2020