Yes, doctors can shame obesity. Here’s what to do about it.



My patient is in her early thirties, soft-spoken, soft-bodied and determined. She was diagnosed with prediabetes on a work health check.

Diabetes and high blood pressure run in her family, and her father died in his fifties from heart disease. As a primary care physician, my role is to help her avoid a similar fate. We talk about her goals: She wants to avoid medication, and she wants to lose weight. I advise her on diet and exercise, and then schedule a follow-up appointment for her in three months.

At her next date, she felt groggy and withdrawn. I have gained seven pounds. I print packets of information on the Mediterranean diet, and she looks at them, defeated. Sensing her hesitation, I suggested that we start taking metformin, a drug used to treat prediabetes, but she refused. I say “Losing weight is hard.”

She never came back to my clinic after that.

I often think about how that patient failed her, and how doctors let patients like her down all the time. The training that I and most other doctors have dictated that weight loss is as simple as calories in, calories out; Eat less, move more. The underlying message, delivered to halls filled with mostly thin medical students, is that weight is a matter of willpower, something that obese people conspicuously lack.

Why your doctor doesn’t seem to care about you

I’m considered average, but I have a body mass index (BMI) that strongly identifies me as part of the roughly 70 percent of Americans who are overweight. I even remember hanging my head in shame during these lectures, which rarely touched on the truth: Weight gain is governed by imbalances of hormones and metabolism often beyond patients’ control.

The truth is, doctors don’t learn much about nutrition or weight control, and a lack of education means that the fat phobia that persists outside the clinic is amplified within.

And the consequences are dire: In my short time as a physician, I’ve taken care of many patients who went to their doctors with symptoms that warranted a normal check-up, but instead were dismissed and told to lose weight.

By the time I saw them, either in the emergency room or clinic, their symptoms were usually developing. A patient who was told to lose weight after she complained of shortness of breath was already suffering from blood clots in her lungs. Another overweight patient with stomach pain was found to have IBD.

The doctors who saw them paid more attention to the number on the scale than they did their symptoms, and now they are suffering from complications or traumatized by the long delays in diagnosing them.

Doctors treat overweight patients differently

Obesity is associated with significant discrimination. Studies show that doctors treat overweight patients differently, often viewing them as less observant, less motivated, and less deserving of 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 obesity phobias. I found myself confronting the same truth over and over again: that many obese people associate doctor visits with great harm.

A friend with access to her childhood medical records learns her beloved doctor needlessly called her “obese” in a note. Several accounts discuss intentionally avoiding visiting a doctor to avoid being expelled and disavowing their presence in their own bodies.

Among them is Susan Johnson, a nurse practitioner who describes herself as a “positive lipid damage reducer.”

“The medical establishment likes to equate weight gain with poor health outcomes, but never seems to think about what it means to be on the receiving end of that,” she says.

She describes the consequences of fat shaming in medicine, such as implying that chronic disease is always a function of weight can send a person into “a spiral of shame that detracts from the goal of actual treatment”. It also makes it less likely that they will return for ongoing care, she says.

A study of weight stigma in the United States and five other countries shows the global problem of such bias

Patients should feel able to step off the scale

For patients with obesity, navigating doctor visits can feel like navigating a minefield. First and foremost, patients should feel empowered to question the routine scales in appointments, which are often a stigma. There are some conditions in which weight tracking is important and has little to do with weight loss management, and in those cases, joint decision making can be used.

Second, patients who want to lose weight should ask their doctors about options, including new medications that, in some cases, can be covered by insurance. These medications, known as GLP-1 agonists, have been shown to have additional benefits with regard to diabetes, as well as kidney, cardiovascular and liver diseases. If doctors aren’t aware of your weight loss options, ask them to do some research or look for a referral.

Third, no patient should be dehumanized while interacting with the healthcare team. If patients feel judged or as if their medical care is being overly affected by their weight, they should try to find more compassionate care elsewhere.

Finally, we must as a society—as well as doctors and even patients—stop portraying obesity as an issue of willpower.

Body Shame on Yourself: How to Resist the “Feeling That Something’s Wrong About You”

I only learned of the intricacies of weight management after I started a fellowship in cardiology, four years after I graduated from medical school.

Silvana Banin, an endocrinologist and director of Chicago Weight Loss, a weight-loss program and support group at the University of Chicago Medicine. As part of my choice in cardiovascular disease prevention, I take rotations at her Weight Control Clinic.

When I describe a patient as “obese,” she gives me the verbal equivalent of a rap on the wrist. “that they You have Obesity, they’re not fat,” says Bannon.

“Obesity is the new hypertension,” she later explained. Like high blood pressure, it is a complex, chronic, relapsing, and progressive condition related to, but not dependent on, lifestyle, a definition that has been supported by several prominent medical societies such as the Centers for Disease Control and Prevention, and the American Medical Foundation. Bariatric Society and Society.

A new patient who does not want to talk about weight

Even before meeting Pannain, I knew I needed a systemic change in bariatric care.

In the final year of my internal medicine residency, I met a patient who asked me to help manage her high blood pressure.

The medical assistant in my office informed me, with some annoyance, that the patient had refused to be weighed before the visit.

But instead of insisting she get into Libra, I used this as a springboard to connect with her. She described herself as fat and told me openly that she did not want to discuss her weight.

Instead, we talked about her sleep quality, healthy foods and extra physical activity that might keep her from needing additional blood pressure medication. Due to my limited education in nutrition, I also referred her to a dietitian.

Over the course of the year, my patient went from not being able to walk more than two blocks to doing four laps a day around a track. By respecting her independence and not picking on her own body, I was able to help her work towards a better quality of life.

Sherlyn Oube is a second-year cardiology fellow at the University of Chicago Medical Center. Her comics about navigating healthcare appear on her Instagram @tweet. she is the authorwhen spinningA novel about a Ghanaian American medical student.

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