I have no doubt that my obesity compromised my health care. I'm not referring to my health, but to my actual health care. When I weighed 250 pounds, I felt dismissed and looked down on by many doctors. I felt disrespected. So it was gratifying to see that my experience was not unique, and indeed is quantifiable: scientists reported in the November issue of the Journal of General Internal Medicine that the higher the patients' body mass index (BMI), the less respect doctors have for them. The irony is not lost on me that the patients with the highest BMIs might also be the people most likely to be in dire need of quality health care from an empathetic practitioner.
Being an obese patient caused me enough anxiety that I searched online databases of "fat-friendly" doctors to try to find a practitioner who wouldn't make me feel like a freak. Some of my concerns were very tangible and practical: Would they have a gown big enough to fit me? Would they weigh me in a public hallway? But what really worried me was the disdain that I often encountered.
Upon seeing an internist for the first time, he chided me about my weight and told me. "If you just reach for baby carrots instead of Oreos when you're hungry, you'll lose weight." I nodded sheepishly, my cheeks burning. What I really thought was, "You dumbfuck. Congratulations! You just solved America's obesity crisis. Who knew it was that simple? Wow, carrots instead of Oreos. What a chiddush [insight/epiphany]!"
Another barrier to health care for the obese is the presumption that anything wrong with you must be directly or indirectly related to your obesity. I saw a jerk of an orthopedist shortly after a car accident in which I sustained whiplash. After ruling out major injuries with an MRI, his #1 recommendation to me was to follow the South Beach Diet. My pain persisted, and I sought follow-up care from him, but he was very dismissive. "If you'd just lose the weight, your back wouldn't hurt," the mean orthopedist said. Here I am, 102 pounds lighter. To be fair, my back is substantially better, but I still need chiropractic care. By the way, I ran into the aforementioned orthopedist on the street last year. He didn't recognize me at my new weight, and I seriously considered pulling him aside to tell him how hurtful and harmful his derision was to me, and to tell him how I finally did get a handle on my eating disorder (not with the South Beach diet). I chickened out.
Before losing the 102 pounds, I asked my ex-chiropractor if he thought my weight was causing my back problems. He replied, "Look around my waiting room. Most of my patients are not overweight." I'm not arguing that obesity does not cause or aggravate some health problems; just that the assumption that this is always the case is erroneous and damaging. I have run into this assumption so many times, it's infuriating. I feel like obesity is the biggest scapegoat in health care; it's far easier for a doctor to say "lose weight" than to take the time to address the complex factors that might be causing the complaint.
I'm sympathetic to health care providers who have to walk the fine line of counseling patients on their health -- which includes information on attaining or maintaining a healthy body weight -- but who risk angering their patients. I think whether or not a doctor broaches this subject with patients depends on their relationship, the patient's health, and other factors. However, if doctors choose to go there, they have to be tactful when broaching the subject, and I have some tips for them:
1. Context is everything. If I'm going to a dermatologist because of an acne flare up, it would be inappropriate for her to offer unsolicited advice about my weight.
2. I think doctors need to acknowledge how difficult weight-loss is, especially for obese people. I give my old internist, Dr. Graves (no, that's not a made up name!), a lot of credit in this area: he would suggest that I lose weight but always said, "I know it's so hard, Sarah. In fact, I haven't had any patients who have really been successful in the long run, but please keep trying." I found this simultaneously comforting and discouraging at the same time, but I appreciated his candor.
3. Providers should be prepared with suggestions beyond trying Weight Watchers or the latest fad diet. Those might be helpful tools for some people, but I personally believe that most people who are as obese as I was are true food addicts, not merely people who need a cheerleader and a public, weekly weigh-in to motivate or shame them into compliance. Many of you know that the Overeaters Anonymous-H.O.W. Concept was and is my gateway to recovery. I don't think it's an answer for everyone, but I do my best to educate my doctors about OA-HOW and its role in my recovery. Therapists and nutritionists with specialties in binge-eating disorders are other resources doctors could refer patients to.
4. Doctors in glass houses should not throw stones. It was very hard for me to take seriously any exhortations for me to lose weight when the doctor nagging me was overweight or obese himself.
5. Finally, health care providers should approach obese patients with the understanding that no one in this country thinks that his/her obesity is not a problem. Often doctors would speak to me as if they were the first person to bring this up, when in fact, they were the hundredth. This is akin to smokers; there are no smokers left in this country who don't know that smoking is dangerous to their health and their social lives. The same is true for overweight people. They understand the danger, but don't know how to control the compulsion that leads them to overeat, or how to overcome the deeply ingrained lifestyle habits that contribute to their body mass.
I am grateful that Dr. Huizinga published her research on doctors' disdain for obese patients. I hope that it sparks some soul-searching on the part of doctors to think about how they relate to their fat patients and how their attitudes might compromise the care of this already vulnerable population.