Fat prejudice in Health Care
 

I'm a health professional and have had a few bad run-ins with doctors who seem to think that being overweight means you are also stupid. I've looked into this and discovered there are many, many people who have had doctors ignore their actual problems in lieu of telling them to lose weight. While acknowledging that there is a place for weight loss, I'm appalled at the implication that an overweight person must lose weight before other problems are taken seriously.
Happily, top public health programs have begun to study fat prejudice and how it interferes with care. If anyone feels like sharing experiences, I'd love to hear them, as well as any insights you have as to how it affected your own behavior and health.

Unfortunately the doctors are probably right in many cases. Being overweight can have many affects on a persons overall health. Often times weightloss can turn around so many problems such as depression, stress, issues with many vital organs including the heart, bad cholesterol, blood sugar, aches & pains, sexual problems, etc, etc.

There's a reason why the obese cost the health industry more than people of a normal BMI. Same reason why a persons build is factored into life insurance premiums. A heavier person is more likely to have health issues that could affect their life span than that same person with a healthy BMI.

I DON'T think that doctors put enough emphasis on weight control. Being overweight has become "the norm" and is real epidemic in our society. People are living longer because of the advancement in medicine, not because they are taking better care of themselves. There is a drug to help many issues because it's easier to take a pill than it is to take responsibility for our weight.

Wow.
 

So obese people don't have a right to have their medical issues addressed the way other people do? So it's appropriate to be demeaning toward people and reduce them to one aspect of their being? How exactly do those behaviors improve anyone's health?

I'm not sure on what you are basing the statements about health care costs but there is some disagreement on the matter. There are many assumptions made based on correlation rather than causality. The following book was pretty eye-opening for me:

Bringing up weight loss is an entirely different matter. Are you familiar with change theory? A person who wants to change, will. A person who is not ready, won't. A physician can provide education if needed and open the discussion but cannot make someone lose weight (which as I'm sure you know has a poor long term success rate and can lead to dangerous yo-yo fluctuations).

By the way, how much physician behavior do you witness? Because I was appalled by some of things I heard out of my attendings during medical school.

I completely agree that there is discrimination based on weight, although I don't believe it's epicenter lies in the medical field, as it's abundantly practiced across the board. I was treated like a stupid person for years, while admittedly I did not have a firm intelligent grasp on how to control my weight, in almost every other aspect of my life I was either in complete control or ahead of the game. Somehow or another for society at large it is inconceivable that a short fat white girl with a cheerful disposition can also be very intelligent and resourceful beyond the norm. As a result I have been underestimated for the majority of my life.

I also agree with Mike, doctors do not stress weight loss enough. My own doctor has never once in 18 years mentioned it to me and it has been a factor the entire time. I did ask her about it and she basically said that she doesn't tell all her obese patients that they are obese because if she did, she wouldn't have any patients left. In essence it's bad for business. That might be changing, as the hospital system she works within is preparing some sort of "Healthy Lifestyle" program. I will say that although my doctor hasn't seemed to be prejudiced toward me for my weight, she has run all sorts of tests on me for conditions related to obesity, that I probably could have avoided with a lower weight.

We don't have to agree, but don't put words in my mouth.

I can quickly see that you have a reading and comprehension problem, which is pathetic for someone that went to medical school. You obviously have an issue with reading or you would have known not to post a link spamming this website. That alone can & does usually result in being banned. Comprehension is not your strong point either... or you are trying to twist what I'm saying? Where did I say ANY of the following?
I didn't.

When it comes to health care costs...
I don't care what you've read in some book. Take a group of 200 people (100 of normal BMI and 100 of obese BMI). Run a battery of test on them all. Comprehensive blood work, EKG, stress test, BP, lung capacity test, etc. and the numbers will show that the obese group is in poorer health... WHICH DIRECTLY AFFECTS HEALTH CARE COSTS!

NEXT TIME YOU TRY TO CALL SOMEONE OUT, READ WHAT THEY ARE SAYING AND TAKE IT FOR FACE VALUE. ADDING TO SOMEONES STORY TO MAKE YOURS MORE INTERESTING IS B.S.!

Well, it's not just BS it's poor debate skills. Whether or not it's intentional is always a matter of debate.

But in this case it's definitely insulting. Which is interesting because the OP is claiming being insulted by the healthcare industry. :cool:

"Unfortunately the doctors are probably right in many cases."

That is a direct quote in reply to my talking about doctors being prejudiced, demeaning and condescending. I was not talking about bringing up weight, although people here seem to think that's what I meant. Nice ad hominem, though. And I'm wondering how including a reference is "spamming." It's interesting how multiple people keep hitting the idea that doctors don't do enough to encourage patients to lose weight. That is a completely separate issue from treating people as lesser beings due to their condition. Your own reading comprehension doesn't strike me as all that impressive.


"I don't care what you've read in some book. Take a group of 200 people (100 of normal BMI and 100 of obese BMI). Run a battery of test on them all. Comprehensive blood work, EKG, stress test, BP, lung capacity test, etc. and the numbers will show that the obese group is in poorer health... WHICH DIRECTLY AFFECTS HEALTH CARE COSTS!"

First of all, on what do you base this? Second, what 200 people? Would you be including the obese people that have avoided routine health care for years because they were so turned off by the way they were treated? Finally, why do you think that an entire group having higher health care costs justifies giving them worse health care? Wouldn't it be more logical to try to *improve* the health care of such a group? There are definite risks associated with obesity, but there are also many confounds in the figures including delays in care whether from lack of access or having poorer care offered.

To provide an analogy, imagine a smoker who wants to start an exercise program and experiences knee pain. Do you think it would be appropriate to deny care for the knee until the person stops smoking?

To the person who talks about fat prejudice elsewhere: yes, but that's not what I was addressing.
I seem to have really touched a nerve here, which doesn't surprise me. I would have provided more references to back up what I've said, but apparently this forum doesn't allow that. As I'm not interested in participating in a forum where people's preconceptions hold more weight than scientific evidence and shouting/ad hominems are acceptable behavior, this most likely not the forum for me, which is a shame since I've had great success with the fitday logs for years. And yes, I *did* read the rules. If posting references is spamming, again this is not the place for me. I wish you all the best of luck.
P.S. Here's a final "spam" so you can ban me with no regrets:
Study on physicians’ (dis)respect of fat patients
BRIEF REPORT
Physician Respect for Patients with Obesity
Mary Margaret Huizinga, MD, MPH1,3, Lisa A. Cooper, MD, MPH1,2,3, Sara N. Bleich, PhD2,
Jeanne M. Clark, MD, MPH1,3,4, and Mary Catherine Beach, MD, MPH1,3
1Division of General InternalMedicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore,MD, USA; 2Department of
Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 3Welch Center for Prevention,
Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; 4Department of Epidemiology, Johns Hopkins
Bloomberg School of Public Health, Baltimore, MD, USA.

What I said was...I didn't say fortunately or definitely and I didn't say all the time. Why did you twist my words?

What you included was a DIRECT link to buy a book on Amazon.com. Was it not? In case you missed the rules. Here they are for you.

1. No Advertising or self promotion
2. This forum is used to share support and is not to be used to advertise other websites or any other type of advertisements which intend to sell products or services for personal monetary gain.
3. You may link to a personal blog so you can share your weight loss story. Other links might be removed, at the discretion of the moderators. We will not support any type of affiliate link advertising & postings by individual users on our forums other than the affiliate partnerships set up by Internet Brands and Fitday.com
11. Posting links that violate the terms above may be removed at moderator's discretion. This includes links within posts, profile links, and signature links.

Does this clear it up for you? I hope so.

A random batch of 200 people, different demographics, isn't that how most test are done?
There you go again, putting words in my mouth. Where did I say they should get worse health care? I didn't!!!
Absolutely. I never said anything that would make you believe I felt differently.
That's what I said, almost verbatim. My words were... Is there anything that I said that you could say is untrue? Probably not, so why are you arguing with me?

No, I don't and I never insinuated that I did. If an obese patient comes in because his knees hurt, hasn't had any trauma and the X-Rays don't show anything I think the doctor SHOULD advise his patient that this could be due to the extra weight that his knees have to carry!

You touched a nerve because you are putting words in my mouth and twisting what I said. I speak my mind, there is no reason for you to turn it into something that it's not.

Once again, what you included was a DIRECT link to buy a book on Amazon.com.

Nobody is asking you to stay, feel free to leave an anytime.

If you read the rules before posting that link to the book being sold on Amazon and you still don't think it's spam, then I do feel you have a comprehension problem. I clearly spelled out the rules that you broke. B/C I feel that some times people have the right to voice their opinion, even when I don't agree with them, I DIDN'T ban you for it. I wanted to give you a chance to reply to my response to you and you once again are twisting my words.

Once again, I never said that. What I said was that being overweight/obese and cause a number of health issues, which we both agree on... you just want to argue me down about it.

The twisting of one's words is trollish behavior indeed. And to do it in three separate posts is trollish X3.

So let me clarify this, I think they everyone has the right to be treated for their illness. I firmly believe that poor health, including obesity, is a huge expense and we all pay for it one way or another.

I say it how I feel it. If you feel the need to twist what I say, then don't bother referring to me. If you want to take what I say at face value and disagree or debate, go right ahead, I don't mind.

I'll close with my favorite quote from Tony Horton.

Your poor health is ruining this country!

It's not the Democrats and it's not the Republicans, it's YOU! Your inability to move your ass and eat right is a burden on the rest of us. If you've turned things around, I thank you for your courageous effort. Just keep going. If you have not then find a way. Now! I'm tired of listening to all the whining and finger pointing from people with no discipline and bad habits. Good Health Care starts with YOU taking care of your health!
-Tony Horton

Re Twisting words
 

"I didn't say fortunately or definitely and I didn't say all the time. Why did you twist my words?"

No, you didn't, but to say that in some cases they are right is to say that the behavior is acceptable to you. Whether it happens all the time is irrelevant.

I'm sorry I got distracted by the side issue of excess weight being unhealthy- that belonged to another discussion. The link was simply the quickest and easiest way to provide the reference as it had complete information. Your rules talk about posting links for personal or financial gain- my motive in posting had nothing to do with that. Interesting interpretation from a moderator of a site that has an "affiliate program," though.

A lot of things have gotten conflated here. My original post was about prejudice and disrespect, and somehow you went off on costs of obesity to the health system etc...

Again, this seems not to be the forum for me and I'm sorry to have disrupted things.

neurogrrl, the problem I see with linking to a book is that before anyone can understand your point, they have to buy the book and read it. Expense and time, not everyone has it.

Better to make the point in your own words or point to a free website that provides the information that you want to provide.

Point taken
 

Agreed about the time and not normally the way I would choose to do things. I was probably a bit disconcerted by the way my post about prejudice was transformed into a discussion of the effects of obesity on health and finances, and I've apologized for getting drawn into that discussion. As to expense, one can go to a library or bookstore and read the book, or relevant sections, without spending any money. If I had spent money on every book I read I would be living on the street.

Handcycle, I appreciate the advice you gave me in the other thread and I *really* appreciate your calm words here. ((((respect))))

I'm not saying it's acceptable, if fact I thought I made it clear that I didn't think it was.
I guess I could have been more specific in my response to you b/c it seems that you mistook what I said. Maybe I should have worded it as..
What I was saying is in many cases the doctors are probably right about the weight may be the issue. I'm not advocating ignoring the problem. I am advocating acknowledging that the weight CAN be the problem, or at least PART of the problem.


The rules don't say that ONLY those links are a violation. Rule #1 states No Advertising or self promotion <-pretty cut and dry
#3 states Other links might be removed, at the discretion of the moderators. <- not much of a grey area here either

Me removing your link wasn't anything personal towards you, although you seem to have taken it that way by you getting so defensive. Handycycle or anyone else can tell you that usually when someone shows up on the forums posting links to ANYTHING being sold (including books) they get banned. This isn't because we are a bunch of hard asses, it's becuase the spammers run rampant and are a nuisance. The members hate the spammers, that's why the thread to report spam in the biggest thread in the Feedback and Support section. Many times things to even get a chance to get reported b/c we remove it before the members see it.

Yes I did talk about cost of obesity and the health issues that could send you to your doctor or your grave. I've had clients lose a parent due to health issues brought on by obesity. I thought when you said ... that you wanted to hear OUR personal experiences. Personally my doctor has never discriminated against me because of my weight. In fact, like Amy, my doctor didn't say anything about it (when he could have). I guess you can say that he IN FACT did disrespect me by NOT bringing it up... until my cholesterol was really high. I think this happens all too often b/c weight is a touchy subject, more so with women. Doctors are supposed to look at the big picture, right?

To be honest, some doctors have better "bed side manners" than others. I'm sure that people of average BMI have been disrespected by their doctor.

Crossed wires?
 

I absolutely do not think physicians should ignore weight. I was not advocating that at all. However, medical training is more than science- it involves learning to leave one's own prejudices at the door, in other words not to *prejudge* a patient. Addressing a patient's weight going forward can be done without alienating the person- again, in the same way that smoking can be handled. Out of their own frustration, many doctors (not all by any means) resist examining or treating a patient for other issues- which could be a bad knee or tonsillitis- in favor of trying to make the patient feel bad about being obese. Being condescending or shaming doesn't cause improved health or long-term weight loss (if someone has evidence to the contrary please share it) however, it makes the doc feel better in the short term, which is why it happens.

(and BTW if anyone here has felt I treated them that way I will personally apologize).

You did share your personal experiences and I don't think I expressed any issues with them- or anyone else's. I'm not in the habit of arguing with people's personal anecdotes lol ;-) They are what they are.

Regarding the link, yes, you've reserved the right to arbitrarily remove links and I'm not disputing that. However, the posts specifically forbidden are those that self-promote, advertise, etc.. I am used to other communities where the site of that unnamed bookstore, because it has such complete information, is routinely used by people to provide references. That bookstore site is also used by other, major, book-related sites- again, because their information is so complete it serves as a sort of library and not because anyone is promoting their business. Admittedly it wasn't the best link I could have provided under the circumstances- it wasn't even the reference I really would have preferred as it's kind of old- but I was distracted, lazy or whatever- mea culpa.

This whole thread is making me tired. I've never been accused of trolling or bad community behavior *ever* on any other forum, but I have and will take what you have said into consideration.

Have a good night.

Not to get off subject... but I will, sort of. I agree doctors shouldn't make their patients feel bad or treat them with disrespect. I'm sure they do it... because they can. They know the patient will likely be back b/c many doctors aren't taking new patients (at least around here) and so what if the patient leaves? Doctors are usually double booked anyway, so it's not like they are hurting for business. It's a shame but I'd bet there's a lot of truth in that.

Straying from the original subject but stick to "prejudices".
As far as "...leave one's own prejudices at the door, in other words not to *prejudge* a patient." I agree here but I think sometimes a little prejudice IS needed. I don't know how long you've been in the medical profession, but I'd bet you know of or have heard of someone that is a pill head. There is ALWAYS something wrong with them, even when nothing is wrong. If the meds are regulated properly and it's caught, they'll be back with their spouse or child that got hurt. There are many things that can't be easily detected (I believe soft tissue damage may be one, I'm not a doctor) so it's easy for someone to go to the doctor and say their back or neck or whatever is hurting just to get a Rx. Doctors are quick to write prescriptions. If pain wasn't so hard to disprove there would be a lot less attorneys that chance an ambulance. ;)

I didn't leave because...
 

I didn't want to go out on a bad note. I'm still not feeling comfortable with the culture I seem to have jumped into and hope that it is possible for me to delete my profile and posts after we work this out without deleting all my log information.

I'm still baffled by what happened in that thread even between my initial post and your response but I am wiped out tonight. Tomorrow I hope to pick it up again and if you're willing perhaps we can figure out how we've been misunderstanding each other.

We are fine, you are not on a bad note with me. I was pissed but I'm okay now, I think both of us just misunderstood each other.

I personally like a good debate. IMO that's how a lot of good information and point of views are uncovered. I was ONLY upset b/c I felt you were twisting my words. Maybe I was clear on my initial response. I think we both agree on a lot of points. On the points that we don't agree on, we can agree to disagree... or we can pick it back up where we left off. :) Either way.

As far as "I'm still not feeling comfortable with the culture I seem to have jumped into and hope that it is possible for me to delete my profile and posts after we work this out without deleting all my log information." I want you to feel comfortable, and like I said, it was a misunderstanding, I have no issue with you. You can delete your posts if you chose to but that is totally up to you. As far as deleting your profile, that would require admin to delete your account. That generally doesn't happen unless it's a premium (paying) member. The food side and the forum side are separate so your food logs should always remain.

And for the record, you're not being "accused" here either. There's a big difference in what I said and how you've interpreted it. But if you want to play the victim, be my guest.

I've taught youth. Sometimes when the situation warranted, I'd say "Stop acting foolish". The kid would turn around and say "You called me a fool!". So, read between the lines.

VitoVino,
 

the distinction you made in your example about working with youth is one of behavior versus being. My protest was about your saying my *behavior* was trollish; I did not say you said I was *a troll.*
Anyway, I suspect you will agree with me that that part of this discussion is pretty inane. There were some misunderstandings earlier that led to some of us getting a little offended and it's being worked out.

I don't know too much about fat prejudice in health care. Perhaps I have been lucky, but even at my heaviest, I never felt judged by any of my doctors. Once I decided to lose weight, I simply did, and my doctors didn't mention that much to me. The most that was mentioned was when I moved to my current state a couple of years ago, my OBGYN said "Your weight puts you in the obese category. Would you like to talk about that?"

I wasn't really ready to talk about it at the time, so I just told her no, thank you, and that was aware of my weight. That was about it. Apparently, she had put in my notes that if I had not lost weight by my next visit (6 mos. later) that she would speak to me about referring me to a nutritionist. Within those 6 mos. I started losing weight (I flipped my own switch) and by the time I got back, the doc saw my progress and never did give me the referral, though I was told by her partner that she'd written the note to herself.

I'm sure that doctors talk amongst themselves in a derogatory or non-PC fashion once in awhile. I'm sure this sort of things happens in many professions. It's not right, and it's not fair, but I tend to give doctors (and others) some slack due to the stress of their profession. I'm sure it's easy to become frustrated with a patient who might be in constant/chronic pain because of a bad back, and whose condition is worsening, when that patient is also morbidly obese. The doctor is likely aware that the patient's weight is contributing to the problem, but it's likely that the patient isn't ready to address his or her weight or becomes defensive (I know I certainly did when I wasn't ready). The doctor, probably trying to think of the patient's health, may resort to tough love, shaming, etc. I'm not saying that's right -- it's not -- but it's understandable, especially for a doctor who day in and day out is saving people from the many mistakes that we make every day -- from weight problems, to mishandling equipment, to having unsafe sex, etc. etc. etc. I'm sure there is likely no profession on earth as frustrating as being a doctor sometimes.

Heck, I'm a neuroscientist, and I get frustrated sometimes. I don't work with people, but you can bet your butt on a bad day I'm cussing out the rats for being stupid dumb creatures. Do I mean it? No. It's not their fault. I'm just having a bad day. Is my behavior right? Probably not, but I'm only human.

I guess what I mean to say is that speaking in a not-perfect way to obese persons is probably happening due to frustration as much as it is due to any other reason. That doesn't make it right, but I think I can understand it, from my own point of view. I certainly think that obese persons (and ANY person, ever) has the same right to medical care for their problems as any other person. I think there is often prejudice because many people (including doctors) view obesity as a preventable problem, or a problem that the patient can more easily correct (versus, say, a genetic disorder or a cancer that is not due to environmental reasons). Maybe it's put into the same category as those who get other "preventable" diseases, I don't know. But I know the general public certainly has a view that obese persons are simply lazy, and it might carry into the medical profession as well. I don't know. I hope it changes, but I'm willing to understand the doctors' points of view as long as they're providing the same care to every patient, no matter the source of the medical problem. I'm all for, and would rabidly support, anything to help doctors and patients treat each other in the most careful and compassionate way possible.

Oh! I also wanted to say (after my long-winded reply here) that I understand the want to reference the source of your viewpoints (being in basic science, I reference everything too! :)) but posting a link directly to the page where amazon sells the book is considered advertising for the book, that's all, because it's got a price right there. :) Maybe try a wikipedia page or an author's page if you want, or just post the name of the book for others to look up.

Well, it was IMO. I've been in forums where members jump all over someone at the drop of a hat. I believe that's what you did here, and that is "trollish", without being a troll (specifically though, putting words in someone's mouth always goes against fair play).

I think everyone is guilty of "trollish" behavior from time to time; I've even done it. It's easy to misunderstand what someone has written, as typing on the internet is an inefficient way of communicating. Also, sometimes we just have a button pressed that makes us give a knee jerk response. So it's nothing personal on you.

That's fine, as I did not, so we are in agreement.

Again, I agree. So no problem. I agree it's being worked out. So stick around and participate. :)