The Gap Between Health Services and Obesity Care

We have a problem in healthcare. It’s really quite simple. Health systems have grown better at delivering health services than they are at delivering health care. It’s worse for people living with obesity, because prevailing bias leads health professionals to care even less for people with obesity. Add in racism and the problem grows larger still. Since women of color more often live with obesity, the deficit in care can be especially daunting. For a person with obesity, it’s hard enough getting health services, but getting real obesity care can seem like a near impossibility.

And yet, care should be at the heart of healthcare. When you stop to think about it, this gap is astounding.

Bad, Noncompliant Patients

When working with marginalized patients, implicit bias comes into play. It gets worse when the condition might have connections to lifestyle risks. In obesity, it’s quite common to falsely assume that a change in lifestyle would cure the problem. The American Heart Association even describes BMI as a behavior rather than a biometric outcome.

So poor outcomes from lifestyle advice alone can easily lead to a provider assuming “the patient is non-compliant.” This recent thread on Twitter struck a nerve:

Dehumanizing People with Obesity

Research has shown that physicians build less rapport with patients who have obesity. Inge Kersbergen and Eric Robinson documented what lies at the root of this deficit in caring:

“People with obesity are not only disliked and stigmatized but are blatantly dehumanized. Consistent with this, we found some initial evidence among U.S. participants that the likelihood of a person favoring actions that prioritize the reduction of human over animal suffering is reduced when they believe that those actions will reduce the suffering of people with obesity.”

In short, it is not uncommon to regard people with obesity as less than human and thus offer less care for their suffering.

The Response to Declining Empathy in Healthcare

This deficit of caring comes in health systems that are failing on measures of delivering empathetic and compassionate care. Writing in Medical Ethics, Angeliki Kerasidou and colleagues describe the problem:

“Despite the value and importance of empathy and compassion in healthcare, in recent years there has been a notable decline of empathy among healthcare staff. Studies have followed the loss of empathy among medical students as they move through their years of training, empirical studies have demonstrated the low levels of empathetic engagement in clinical settings, and reports following care malpractices have highlighted a deficit of empathy in current medical practice.”

Thus health systems can be quite good at delivering billable health services, but rarely deliver empathetic and compassionate obesity care. Bias and stigma stand in the way. Adding to this problem is a broader deficit of empathy in health systems.

Delivering billable health services is not good enough. Compassionate, empathetic care is emotional labor for healthcare professionals. But without that effort, they are not delivering care. And every patient has the right to expect care from a healthcare provider.

Click here for more on the need for empathetic health systems and here for perspective on the effectiveness of teaching clinical empathy to medical students.

Care, photograph © Nithi Anand / flickr

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June 20, 2021