Fat shaming by medical providers

[thinkertdm]

Has anyone seen this article?

New research shows fat-shaming can be a health hazard

Now, I agree that many people, providers included, treat obese people with disrespect, but this line in the article caught my eye:

Quote

In extreme cases, it can also cause a doctor to assume that a patient's weight is responsible for a myriad of health conditions and lead to a misdiagnosis, researchers said.

Myriad of health conditions?  Like diabetes?  cardiovascular risk?  sleep apnea?  Hypertension?

Here's the next one:

Quote

“Recommending different treatments for patients with the same condition based on their weight is unethical and a form of malpractice,” Chrisler said. “Research has shown that doctors repeatedly advise weight loss for fat patients while recommending CAT scans, blood work or physical therapy for other, average weight patients.”

So...I'm going to get sued when I recommend weight loss for someone who is 400 pounds, can't fit in the MRI machine, and has 10+ pitting edema, but I don't recommend weight loss for someone with a BMI of 26 who exercises daily?

Finally:

Quote

In the review, researchers called for better training for healthcare providers so that patients of all sizes are treated with respect.

I understand, many, many MD's do not treat their patients with respect.  But I'm not sure this crosses the line into "malpractice". 

Now, I didn't read the original study, just the ABC news article.

[thinkertdm]

13 minutes ago, mcclane said:

 

Don't read news articles summarizing research.  The insane biases and twisted interpretations generated by journalists who read primary literature is extremely well documented.

 

Yeah, thanks.  The problems is the contribution to the already skewed perception of science and of medical scientists by the general population, many of whom  demand antibiotics a daily basis to a point they actually scream profanities at me.  These are people who think colds are caused by the cold, put "salves" on various rashes, and think medical providers are hucksters.  

So I'm not debating the general validity of the study.  I'm concerned about the portrayal of science and medicine to the masses.  I would like to explain the disease process to my patients, but instead spend most of the time defending my self to people who think since they paid a copay they are entitled to whatever they want.  

[Marinejiujitsu]

We got to a place in society that fat is beautiful and not looked down on. This is spawning the acs/diabetes. Seeing my kids grow up, I never hear them say that kid is fat but I am thinking in my head child abuse.

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[Marinejiujitsu]

I think we are the only ones telling people anymore. I get some is us are not the best at it. But just telling someone something negative about them will come across like that no matter what

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[sas5814]

"Fat shaming" has become one of those buzz phrases that gets attached to a lot of things that don't apply. Telling someone about the health benefits of weight loss and exercise isn't fat shaming its health care. It isn't like we point and laugh and sing "fatty fatty". 

Yes it can be done in constructive positive ways and yes it can be done in a way that turns people off but it needs to be done. Obesity runs neck-in-neck with smoking for causing mortality and morbidity and the cost in dollars is incalculable.

I have an advantage. I used to be fat. I had uncontrolled diabetes, uncontrolled HTN, uncontrolled hypercholesteremia, chronic joint pain,and sleep apnea. I felt like splattered crap most of the time. Then I lost 140 pounds. I went from taking about 20 pills and insulin every day to taking Lisinopril. Almost all my problems went away.

When I was in family medicine I kept a book of before and after pictures that included facing pages showing the meds I was and am currently taking, and facing pages with the costs of those meds. The idea was to say "I have been there. Let me show you what weight loss did for me."

No everyone won't get those results because there are other factors in play like genetics but it points outs the potential benefits not to mention the incredible change in quality of life. So let the PC police have "fat shaming". We are in the business of health care.

[MCHAD]

It's my job to tell someone that is overweight/obese that they need to lose weight (myself included).  Just like I tell people who are slim that "skinny doesn't equal healthy".  Why is it becoming politically incorrect to tell someone that's 50lbs overweight that if they lost the weight their diabetes, hypertension, or arthritis might improve??!!

[MCHAD]

Next I'll get in trouble for "tobacco shaming"

[sas5814]

What is PC has nothing to do with right/wrong/good/bad or anything else. It is about "feelings". It is about "tolerance" and it has become a form of bullying because you are trying to argue facts with the faithful and you can never win.You can get screamed down by the vocally wrong because you aren't meeting the current (for the moment) definition of tolerant.

Mocking someone for being overweight is wrong. Trying to educate and motivate someone to improve their health and quality of life certainly isn't.

[Boatswain2PA]

I didn't read the article, but I suspect this is just leftist garbage from abc news.

The same author will write his/her next article about how medicine slut-shames women with PID by discussing the risks of promiscuity (am I allowed to still use that word? Or do I have to call it "the 'p' word" like we have to say "the 'n' word").  

Next article will be how we gender-shame trans- people by walking into the exam room and saying "Good morning Mr/Mrs. Smith, what brings you in today?".

If you're fat, you deserve to be treated with respect.  The greatest respect you can give someone is telling them the truth.

If you've slept with 15 people this month and contracted PID, I will respect you enough to tell you the risks you're engaging in.

If you are born with a penis then I will respect you enough to tell you that you are, indeed, a male.  If you don't have a penis, then I will respect you enough to tell you that you are, indeed, a female.  And for the very rare patient who truly has ambiguous genitalia, then I will tread very carefully and respectfully.

[MCHAD]

9 minutes ago, Boatswain2PA said:

I didn't read the article, but I suspect this is just leftist garbage from abc news.

The same author will write his/her next article about how medicine slut-shames women with PID by discussing the risks of promiscuity (am I allowed to still use that word? Or do I have to call it "the 'p' word" like we have to say "the 'n' word").  

Next article will be how we gender-shame trans- people by walking into the exam room and saying "Good morning Mr/Mrs. Smith, what brings you in today?".

If you're fat, you deserve to be treated with respect.  The greatest respect you can give someone is telling them the truth.

If you've slept with 15 people this month and contracted PID, I will respect you enough to tell you the risks you're engaging in.

If you are born with a penis then I will respect you enough to tell you that you are, indeed, a male.  If you don't have a penis, then I will respect you enough to tell you that you are, indeed, a female.  And for the very rare patient who truly has ambiguous genitalia, then I will tread very carefully and respectfully.

Well now you're just being intolerant! (Sarcasm font unavailable)

[BruceBanner]

There has to be a societal "hall pass" that is given to providers when giving health advice. It may sting a little. No need to be rude of course, but fat is fat. 

"Fat shaming", paradoxically, is a term that is used to shame the person acknowledging someone's obesity.

 

[CAAdmission]

This is just another representation of the utter repudiation of personal responsibility in our society. Not only is it not someone's fault for letting themself become a fat slob, now they are also entitled to a victim complex if someone notices it. Weakness, helplessness and victimhood is now celebrated, as well as the full on belief that you have a right to have someone ride to your rescue.

Heaven help us. Our crash is going to be worse than the Roman empire.

 

[sk732]

I tell people "my job is to tell you things you don't want to hear...how you take it and what you do with it is up to you". 

SK

 

[Zach]

I guess I feel like many people are missing the point of the study and the summarizing article?

I didn't see "you can't tell people they're fat"... I saw that there's a dangerous bias in medical professionals when dealing with obese people to see everything through the lens of obesity... that perhaps it's possible that "drop 50 pounds and you'll be good to go" might not always be the case. I believe that is what is being referred to when they're tossing around the word "malpractice" because that is in fact bad medicine. I think it's in the same vein of treating a patient with a mental disorder and assuming everything has to be psychosomatic or something. 

And there are of course more tasteful ways and less tasteful ways to have a discussion about a patient's obesity, and unfortunately too many providers lack that tact. I don't know if any of you have seen that article recently featured on SDN, but it was something to the effect of "Doctors, you have a serious problem..." The gist of the article was that patients trust their nursing staff almost 2 to 1 compared to their physician. Something tells me it has something to do with the communication style... 

Perhaps the responses in this thread are why we see so few PAs in bariatric medicine... 

[fishbum]

http://www.apa.org/news/press/releases/2017/08/fat-shaming.aspx

http://www.apa.org/news/press/releases/2017/08/sizeism-health.pdf

Closer to the source than a TV news article.

I didn't see anything in there that implies that providers shouldn't counsel their patients about weight loss. Looks to me like the take-home points are 1) be respectful and 2) don't just assume that all of an obese patient's complaints are a complication of obesity. Seems reasonable enough.

I do think the authors overstep when they say that "Recommending different treatments for patients with the same condition based on their weight (e.g., weight loss for fat patients; CAT scan, blood work, or physical therapy for other patients) is unethical and a form of malpractice". Diagnostic and therapeutic choices are tailored to individual patients based on their characteristics and I'm not sure how social science researchers claim authority in medical decision making. 

[EMEDPA]

1 hour ago, sk732 said:

I tell people "my job is to tell you things you don't want to hear...how you take it and what you do with it is up to you". 

SK

 

next you will be meth-shaming...it's a slippery slope!

[sk732]

8 hours ago, EMEDPA said:

next you will be meth-shaming...it's a slippery slope!

And??? 

Maybe you'll see my name and face on some other article entitled "Telling people how it is", unless Dr Phli has that copyrighted.

:-D

 

SK

[EMEDPA]

I hope you read my response as being in jest...:)

[sk732]

Indeed I did. :-D.  I should have added "you make it sound like a bad thing" :D.

SK

[rev ronin]

You know, I think in some ways the scale serves as a mental illness detector.  How many patients do you have who refuse to be weighed, or who allow themselves to be weighed but refuse to look at what the number is?  That's pretty hardcore reality avoidance right there.

I have observed a rather strong correlation that someone who doesn't consent to be weighed is going to be a difficult patient with whom to work.

[CAAdmission]

1 hour ago, rev ronin said:

 That's pretty hardcore reality avoidance right there.

Many people find reality troubling.

[True Anomaly]

I sincerely doubt anyone could make a case of actual malpractice from providing advice on weight loss to an obese patient

[fishbum]

On 8/8/2017 at 9:41 AM, mcclane said:

Clearly you are correct here, however without a carefully tailored example or two, I don't feel it refutes the author's bold claim.  Can you design two patients that differ only by weight in which one would receive laboratory testing and one would not?

Maybe, but I don't have anything particular in mind.

[ajnelson]

Just to play devil's advocate here a bit. I, at one time, was that patient that was 'fat shamed'. Early teens-early 20s. Active, played sports. Weighed 120-130#. Considered obese BMI because of my height. Though, because of my build, I'm quite muscular. I remember hearing all the time that I was fat. Needed to lose weight. That I was unhealthy. Needless to say, I started dieting and being more unhealthy trying to get that number down. Looking back, I was probably a little overweight. But, given my activity level an build, I was fairly healthy. And honestly, hearing how obese and unhealthy I was at that age, led me into years of even worse and unhealthy behavior. There's a right and wrong way to approach weight and it's relation to health. And not all health issues are weight related.
The news article may have been going a little far with its generalizations, but, I do feel many providers just want to sit and blame everything on weight

[sk732]

We used to have an issue with people using/abusing the BMI in and of itself for determining "fatness"...BMI  is supposed to tell us to look a little closer at things.  The fine print says body composition is supposed to be taken into consideration, but, like many people, few read the fine print.  I'd seen people with 1% body fat put on career probation in the military because they were "overweight" because of the their BMI, yet if they did a caliper or dunk test, they strangely passed -  they were simply lean and mean, but big.  Note I didn't say they were fit - a lot of those behemoths couldn't run to the washroom without getting out of breath...they just weren't "fat" or "obese".

SK