Coding Weight Bias into Health Systems
Weight bias envelopes us. But especially in healthcare systems it is jarring at times. Pervasively, weight bias is coded into health systems. Sometimes it’s subtle. Other times it smacks a patient right in the face. Change is slow because systems evolve slowly. Electronic medical records systems, for example, take years to design and implement. So the systems healthcare providers are using today have implicit bias of a decade ago coded into them.
And a decade ago, weight bias was even worse than it is today. It was more explicit and unabashed.
Making Up a Weight Goal
To understand how weight bias is built into health systems, consider the case of a patient seeking help with a cardiovascular problem. This is a patient with a history of bariatric surgery, who subsequently developed lipedema and lymphedema which are very challenging to manage.
The discussion between patient and provider was good. They discussed a procedure she needed to correct a heart arrhythmia. That included a helpful discussion of alternatives.
But as she left, she received a printed summary of the visit. It included a goal weight for her. That “goal” would represent losing more than half of her body weight. The electronic medical record system fabricated it. The summary had nothing to do with the actual consultation. In this visit, patient and provider did not discuss the treatment of lipedema, lymphedema, or obesity. So the “summary” bore no resemblance to the reality of the visit or her health needs. The patient, OAC Board member Sarah Bramblette, explains the problems with this:
“Goals should include patients. After care summaries should accurately reflect the discussion during the visit. This leaves a bad taste in my mouth after an otherwise good productive visit.
Defaults are good, but healthcare should be individualized and personal – not simplistic defaults. And last, but not least, NOTHING is ‘meaningful’ about reporting BMI without any additional access to care or treatment.”
Cookie Cutters Don’t Work for Obesity
When this health system came to life, the default thinking was that obesity is a simple behavioral problem. Advise the patient to eat less and move more. Set goals for weight loss. One size fits all.
Fortunately, the thinking about obesity is evolving away from that. The science of obesity tells us that it’s a heterogeneous condition – quite literally a different challenge for every patient.
But providers are saddled with systems built around those more simplistic notions. Those notions assumed that just advising the patient to lose weight would do the trick. And if not? Well, then the patient must be noncompliant.
Electronic medical records are helpful for reducing medical errors. They can be a tool for quality improvement. But when they promote cookie cutter advice about obesity, they’re not helping. They’re hurting.
Click here for more on engaging patients to improve the quality of care. For more on the how electronic medical record systems have and have not helped, click here and here.
Solidity of Fog, painting by Luigi Russolo / WikiArt
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May 5, 2021
