At her next appointment, she went crazy and withdrawn. She gained her 7 pounds. I printed out packets with information about the Mediterranean diet and she glanced through them and was defeated. Sensing her hesitation, I suggested starting metformin, a drug used to treat prediabetes, but she declined. “Weight loss is hard,” I say.
After that she never came back to my clinic.
I often think about how I failed that patient and how doctors always failed patients like her. The training I and most other doctors have undergone dictates that weight loss is as easy as taking calories in and burning them out. Eat less and move more. The underlying message delivered to a hall full of mostly lean medical students is that weight is a matter of willpower, something fat people clearly lack.
I’m considered medium-sized, but I have a BMI that indicates I’m part of the 70% of overweight Americans. Even I remember bending my head in shame during these lectures.
The truth is, doctors are poorly taught about nutrition and weight management, and lack of education means that fatphobia that persists outside the clinic is amplified within the clinic.
And the results are disastrous: in my short stint as a doctor, I’ve treated several patients who went to the doctor with symptoms that required standard work-ups, were turned down, and were told to lose weight. Did.
By the time I saw them, whether in the emergency room or doctor’s office, their symptoms were usually progressing. Another overweight patient with stomach pain was found to have inflammatory bowel disease.
The doctors they saw paid more attention to the numbers on the scale than to the symptoms, so they either had complications or were traumatized by the delayed diagnosis.
Doctors treat overweight patients differently
Obesity is associated with significant discrimination. Studies show that doctors treat overweight patients differently, often perceiving them as less adherent and less adherent. motivatedand overall, not very deserving sympathy.
Over the past few years, I’ve made an effort to educate myself by reading books and following social media accounts that discuss body neutrality and fat phobia. I find myself facing the same truth over and over again: Many people with obesity associate doctor visits with great harm.
A friend who accessed her childhood medical records learned that her beloved doctor described her as unnecessarily “stocky” in a note. Several accounts discuss intentionally avoiding doctor visits to avoid being dismissed or rejected for being in one’s body.
Among them is nurse practitioner Suzanne Johnson, who describes herself as a “fat-positive harm-reductionist.”
“Medical organizations love to equate weight gain with poor health, but they don’t seem to consider what it’s like to be on the receiving end,” she says.
She goes on to say that fat shame in medicine, such as suggesting that chronic disease is always a function of body weight, can lead a person into a “spiral of shame that undermines the goal of actually treating it.” They are also less likely to return for continued care, she says.
A study of weight stigma conducted in the United States and five other countries shows the global problem of such stigma.
Patients should feel the force to skip the scale
For obese patients, seeing a doctor can feel like a minefield. First and foremost, patients should feel empowered to question the often stigmatized routine weigh-ins at doctor’s appointments. There are certain conditions in which there is no agreement and in such cases shared decision-making can be adopted.
Second, patients who want to lose weight should ask their doctors about their options, including new drugs that may be covered by insurance. It has been shown to have additional effects on disease. If your doctor is unfamiliar with weight loss options, ask your doctor to do some research or ask for a referral.
Third, patients should not be dehumanized in their interactions with the medical team. If a patient feels judged or that their care is disproportionately influenced by their weight, they should try to find more empathetic care elsewhere.
And finally, our society, doctors and even patients, must stop seeing obesity as a matter of willpower.
It wasn’t until four years after graduating from medical school and starting a fellowship in cardiology that I discovered the intricacies of weight management.
Dr. Silvana Pannain is an endocrinologist, chicago weights, Weight Loss Program and Support Group at the University of Chicago School of Medicine. As part of my cardiovascular prevention elective, I cycle through her weight management clinic.
When I describe my patient as “obese,” she is the equivalent of a verbal wrist tap. “they Have Obese, they’re not obese,” scolds Dr. Panine.
“Obesity is the new hypertension,” she later explains. Similar to hypertension, it is a complex, chronic, relapsing, progressive condition that is lifestyle-related rather than lifestyle-dependent and is recognized by multiple prominent medical societies, including the Centers for Disease Control and Prevention and the American Medical Association. Definitions supported by Society and Obesity Medicine Association.
New patients who don’t want to talk about their weight
Even before I met Dr. Panine, I knew I needed to change my approach to obese patient care.
In my final year as a medical resident, I met a patient who asked me to help him manage his high blood pressure.
A medical assistant at my clinic informed me with some annoyance that the patient had refused to be weighed prior to the visit.
But instead of insisting she get on the scale, I used this as a stepping stone to connect with her. Told.
we talked about her instead sleep quality, healthy eating, and other physical activity Activities that may keep her from needing additional blood pressure medication. Given my limited education in her nutrition, I also referred her to a nutritionist.
In the space of a year, my patient went from walking just two blocks to doing four laps a day around the local track. By respecting her autonomy and not morbidly evaluating her body, I was able to help her work towards a better quality of life.
Shirlene Obuobi is a second-year cardiologist at the University of Chicago Medical Center. Her cartoons about her healthcare can be found on her Instagram @ShirlywhirlMD. She is the author of the novel “On Rotation” about a Ghanaian-American medical student.