Access Denied

Not OK: Denying Medical Care Because of Obesity

Make no mistake about it. The times are changing. A new order is coming and old ways of doing things will not suffice. We are not merely talking about a change of leadership in Washington. We are talking about bigger changes. These changes come from people fed up with an old order of things that never made sense. Certainly we know that racism and gender discrimination are no longer acceptable. But another change is way overdue. Denying decent medical care to people because of obesity needs to stop.

Third-Class Care

The reality of this situation is stark. From beginning to end, people living with obesity get shoddy medical care. Research provides objective data and facts about this problem. Children experience it from an early age. Studies have shown us that pediatric care providers may harbor significant implicit weight bias. Allen Browne, a pediatrician, surgeon, and obesity medicine physician, tells us of taking a memorable case history:

“I asked a routine question ‘Who is your child’s pediatrician?’ The mom looked at me somewhat sad or chagrined. She said ‘He won’t see this one any more because of his obesity.’

This becomes a lifelong pattern for encounters with healthcare. Some Ob/Gyns refuse to care for women with obesity. The excuses vary. Some providers say they’re not equipped for larger patients. Some say that women with obesity are too risky for them. The examples of substandard care are many and well documented. In a 2015 review, Sean Phelan et al summed it up:

“Many healthcare providers hold strong negative attitudes and stereotypes about people with obesity. There is considerable evidence that such attitudes influence person-perceptions, judgment, interpersonal behaviour and decision-making. These attitudes may impact the care they provide. Experiences of or expectations for poor treatment may cause stress and avoidance of care, mistrust of doctors and poor adherence among patients with obesity. Stigma can reduce the quality of care for patients with obesity despite the best intentions of healthcare providers to provide high-quality care.”

It’s worth noting that weight discrimination adds to other disparities in health. Black, Brown, and poor patients bear a greater burden from obesity.

Seeing Nothing But Obesity

In short, people living with obesity get less care and less empathetic care because many doctors don’t look beyond the fat. Quite naturally, many patients avoid healthcare as a result. Then health problems multiply. Even worse, this shoddy treatment creates self stigma. That in turn, leads to even worse health outcomes.

Yet Not Providing Obesity Care

Although obesity may dominate a provider’s assessment of someone in a larger body, patients seldom receive care for obesity. Very often, primary care providers only dispense instructions to simply lose weight. Effective obesity care requires more than this. Obesity is a chronic condition driven by biology and the environment. Behavioral strategies can help. But by themselves, they are often inadequate to maximize a person’s health. Health should come first in good obesity care.

So yes, we are fed up with substandard medical care for people with obesity. We don’t do this to people because of cancer, heart disease, or diabetes. Everyone deserves a decent standard of care. Black or White, rich or poor, big or small. It’s just not right to discriminate in healthcare. Every one of us must demand change.

For further perspective, click here, here, and here.

Access Denied, photograph © Onascht / flickr

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November 21, 2020

2 Responses to “Not OK: Denying Medical Care Because of Obesity”

  1. November 21, 2020 at 8:32 am, M. Cooper said:

    Self fulfilling prophesy here. The studies say obese people have worse health outcomes which is a given if they get substandard care. Those worse outcomes are then used as an excuse to provide even less in the way of effective health care and round and round we go.
    This does not just apply to large people, it is also to be observed among any group who does not fit into the preconcieved notion of what a healthy person is.
    Meanwhile not one of the great and the good making these judgements can provide an adequate definition of health.

  2. November 21, 2020 at 2:27 pm, Allen Browne said:

    Some denials stem from frustration. Who wants to tackle a problem they don’t think there is any solution to. But now we have tools – Intensive lifestyle management, pharmacotherapy, weight loss devices, metabolic bariatric surgery – and we have guidelines – Endocrine Society, Obesity Medicine Association. – and even guidelines for children with obesity – AAP, Obesity Medicine Association. It is time for weight management to “come out of the closet”. It works and it improves the health of patients with a bad, incurable, chronic disease.