This is an article from January, but it’s well-worth reflecting on. Apparently fat women are more likely to be undertreated with chemotherapy for breast cancer. For reasons that aren’t totally clear, doctors are more likely to give fat women (and poor women as well) doses of chemotherapy below what the guidelines say they should.
I want to pause on one sentence in particular:
Obesity is controversial as a risk factor for breast cancer; studies haven’t shown that obesity causes breast cancer, but obese women are at increased risk of dying from the disease.
This raises the ominous (if unsurprising) possibility that whatever “excess risk” fat holds, may at least in part be due not to its effect on our bodies, but to its effect on our doctor’s brain.
We’re continuously being told of the health risks of weight, but one of those risks is a function of what happens when you show up in your doctor’s office. Fat people need to be aware of and proactive about the attitudes that healthcare professionals may hold towards us because of our weight, and how that can affect our care.
To put some numbers on the problem, look at this 2003 survey on physician attitudes towards “obese” patients. There are a number of interesting findings in it, and I encourage everyone to look at it directly, but here are some takeaway messages:
About half (49.5%) of doctors rated fat patients as “noncompliant” About a third rated us as “sloppy” and “lazy.” 44% rated us as “weak-willed.” And 44.5% thought that psychological problems were “very important” or “extremely important” causes of “obesity.”
Translation: Almost half of your doctors will think that your weight is an indicator of your character and mental health.
- 34.5% of doctors said they have “negative reactions towards the appearance of obese patients.” 9.1% said they felt uncomfortable when examining an obese patient. 7.5% said it was difficult for them to “feel empathy” for fat patients.
Translation: Your doctor may be uncomfortable with your body, and this could affect how thorough they are in examining you. A small but significant percentage won’t be able to empathize with you because of your weight.
44.5% of doctors believed that “most obese patients could reach a normal weight (for height) if they were motivated to do so. 13.5% believed it was acceptable to use “scare tactics” to obtain compliance of the fat patient
Translation: Despite all the data, half your doctors think it’s realistic for you to be normal weight. And the problem? You’re not motivated enough. A fraction of these will think trying to bully and scare you is a good “motivator.”
- 95% of doctors feel it is “necessary to educate obese patients on health risks” and only 48% thought that “most obese patients were well-aware of the health risks of obesity.”
Translation: given the opportunity, your doctor is virtually guaranteed to lecture you on how unhealthy your weight is, and there’s a strong chance he thinks you’ve never heard of this before.
11% of doctors did not feel that a “10% reduction in body weight is sufficient to significantly improve obesity related complications”
Translation: Whatever you feel about the “5 to 10% weight loss” recommendations found in most healthcare guidelines, you should be aware that 1 in 10 doctors are telling you to lose weight without having a clue what the current guidelines on weight loss even are.
I’m not trying to make a sweeping condemnation of the profession, or make you paranoid about seeing your doctor. It’s important to notice that while 50% of doctors did associate fat with negative traits, almost half didn’t. And for traits unrelated to appearance, the majority didn’t.
And let’s put this in perspective. In surveys, even fat people show negative attitudes about fat people. Also, in this survey doctors also tended to associate fat with a few positive traits – specifically “honesty” and “pleasantness”. And most importantly, for every doctor who said endorsed a bigoted statement, there were plenty who didn’t. In my own experience, there are a lot of great doctors out there.
Just looking at these results, and assuming these answers were more or less honest (another issue in itself), I’m ballparking (completely unscientifically, of course) that about 30-50% of doctors are probably more or less reasonable; 30-50% seem worrisomely bigoted; and 10% should be regarded as absolute no-fly zones for fat people.
If only they wore signs.
But the real tragedy would be if anxiety about confronting negative attitudes scared us away from doing what we need to to take care of ourselves. As a case in point, another recent study claimed that very fat women actually were more “noncompliant” with breast and cervical cancer screening (routine mammograms and pap smears). That is, despite having been told to get our cancer screening tests, we were less likely to follow through than women in “normal” weight ranges. This may be or may not be accurate, and if so, there’s many possible explanations – not the least of which is the general alienation many of us hold towards the health profession. But if we let that anxiety and alienation get in the way of our own care, at the end of the day, it’s we who have to live with the consequences.
Instead of being cowed by potential bigotry, we need to turn around and be MORE proactive about our health. We need to be more informed, more probing, and more assertive. The next time your doctor tells you that the solution to your carpal tunnel syndrome is weight loss, don’t walk away resigned and annoyed. Just ask her, “what would you do for a thin patient?”
If you think your doctor is not doing an adequate physical exam – it’s ok to ask her about it. Even if they’re uncomfortable with your body, don’t take on the body-shame. If you must feel ashamed, do it in the privacy of your own home. The doctors office is where you need to be professional, even if they aren’t.
Also check out:
Cat-and-Dragon’s Tips on Obtaining Good Healthcare
MaryMc’s Health Resources has links to a number of useful articles
Big Folks Health FAQ