Taking Care of Our Healthcare

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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

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10 Responses to “Taking Care of Our Healthcare”

  1. wriggles Says:

    I am continually surprised at how forgiving we are about doctors. Even though the profession dispensed with basic medical practice, gave the bullying of fat people a legitimacy it would have struggled to attain, esp. among our family and friends etc., we always have to remember that there are many good ones.
    Really, well where are they? When are they going to declare enough is enough? I am not comforted by the ‘good’ ones, why aren’t they making any headway? Do they even care?

    When I was prepared to go against the ‘advice’ of docs, the whole edifice of fat hatred was able to come crashing down.
    I am to blame for pursuing it to such an extent, but it could have ended at lot sooner, without their seemingly rigid insistence that weight loss is the duty of all fatties. If they understood how much respect they could lose when/if the shit hits the fan on this one, it might give them something to chew on.

    I expected better of them, I don’t think it is too much for them not to pass off social fascism as medicine. Meanwhile we attack the paper tiger that is the diet industry, ‘cos someone out to make money is supposed to do better than professional healers.
    The d.i. contains a lot of former fatties, who have made maintaining weight loss the centre of their lives. They believe what they are doing is right, but they are labelled corrupt, whilst the m.p. that speaks out publicly on other things it considers to be bad for the health of the public, continues to promote weight loss at any cost for fat people.

    They are behind almost every stupid diet craze, or was Dr. Atkins not a doctor?
    Who prescribed amphetamines as the ultimate solution?
    Remember the ‘cabbage soup diet’ courtesy of nurses apparently. And let’s not leave out the contribution of the scientists and their ‘new’ diet drugs that make you shit yourself.
    Oh and the surgeons that think it is acceptable to butcher fat people to ‘save’ them.

    I do not hate docs, or believe that they have to be perfect, but I expected better and a lot of people’s faith in them has done them untold harm, this cannot be overlooked.
    If we are more accepting of their failings ‘cos, well, we all need docs and the others, fine, let’s say that, rather than pretending they don’t have a case to answer or that there are some bad apples……
    I think that they owe fat people an apology.

  2. celsou Says:

    I have been pretty lucky with doctors. Male doctors can be patronising but the only time I’ve actually seen disdain was in the eyes of a female doc, oddly enough.

  3. celsou Says:

    Also, it is frightening to think that some doctors cannot empathize with fat people. Do these doctors see us as mounds of flesh, devoid of feelings or intelligence? This really scares me.

  4. Meowzer Says:

    I think there are some doctors (and nurses) who can’t empathize with any people. I mean, my mom is a size 4, has never been fat a day in her life, and could tell you stories that would make your hair fry. My doctor is pretty good, I found him on the Fat-Friendly list!

  5. crankybee Says:

    None of this surprises me at all. I have always refused to answer questions about my weight with Drs – a lot of them have NO IDEA.

    My fiance saw a Dr to have a blood test done when we first got together (very responsible we were, checking for any nasty STDs from past partners) and the Dr knew he was having the test done because we were serious about each other. After I left the room to wait for Chops outside, he lectured him about his weight, saying that if he lost 20kg (45 pounds?) he could have his PICK OF ANY WOMAN HE WANTED! Chops was SPEECHLESS! He said “I’m very happy with the one who’s just left the room!” and the Dr. replied “Well, I was just letting you know your options!”

    SHOCKER! LOL!

  6. PastaQueen Says:

    Taking an active part in your health care is a good idea for everybody. I recently read “How Doctors Think” by Jerome Groopman and he had some good advice about questions you should ask your doctor to get them to think about your problems differently.

    One of his stories that I found most interesting was about an atheltic patient came in who was in very good shape but had some chest pain. The doctor sent him home because he seemed so fit and healthy, but later he came back in with a heart attack, a diagnosis the doctor hadn’t seriously considered because he associated it with people who ate more poorly or exercised less than this guy.

    So biases can hurt everyone, fat or thin.

  7. La di Da Says:

    I’m quite interested in my own health, that’s how I came to actually read up on what the real story was behind fat and health. A doctor with a clue saw my history of dieting and pointed out “Look, you’re smart, go look do some research – dieting’s rubbish and being fat’s not going to hurt you nearly as much as you or the papers would have you think. But keeping up this starvation nonsense will.”

    And one time I went to the health centre to get a prescription, I knew exactly what I needed because it was something that had happened before, and I got a locum doctor who decided to only write me a script for medication that would do the exact opposite of what was needed, then proceeded to lecture me on how I was too fat and probably had lots of diseases and ordered me to come back for blood tests in the morning. I didn’t even bother to tell him my blood panel of three months ago came back as perfect health, sighed, left, and went to a more competent doctor.

    That’s why I don’t trust doctors quick to blame and assume things about patients based solely on weight or appearance. If they’re so incompetent or ignorant in one area, what else are they screwing up?

  8. fatfu Says:

    Pastaqueen – yup you’re right. Fat is definitely not the only thing that can cause your doctor to leap to the wrong conclusions, and I’m glad Groopman wrote his book and it got so much media attention. There are other groups of people who are also at particular risk – poor people (as seen in the breast cancer study), minorities and older women for example. In fact EVERYONE needs to be proactive about their health in that way.

    But I think if you fall into a category where your doctor is more likely to see you in a certain way, or treat you in a way that’s potentially harmful to your health, you should be specifically aware of it and plan for how to handle it. My feeling is fat people need to be aware of these attitudes and be prepared to manage them, rather than avoiding the doctor’s office or getting caught unawares when it happens.

    LaDiDa – What shocks me is when I get a doctor that literally knows nothing about the biology of fat beyond it being a risk factor for various diseases they DO understand.

    Yeah, I too will tend to use their knowledge of fat as a barometer for their fund of knowledge as a whole – and I think it’s a reasonable barometer, esp since there’s been such an explosion of research in the past decade, that it’s one of those things that the intellectually curious doctors have educated themselves about, and the losers are 100% clueless about.

  9. fatfu Says:

    wriggles – yup, at times i share your outrage, although generally i don’t tend to blame practicing doctors, since they basically sit in their CME courses and learn to do as they’re told. And one of the things they’re told to do is get fat people to lose weight.
    On the other hand I think there are people in public health who are really quite aware about the problems with weight loss but don’t share that with the public because they think it’s in our interest to “keep trying” to lose weight and to believe it’s 100% “lifestyle.” I’d finger them for a lot of outrage, because I think there’s a lot of very knowing slanting of the discourse and careful ellision of facts to keep us in weight loss mode.

    For instance when the FTO gene was announced there were public health advocates who claimed it shouldn’t be publicized because it would “make fat people complacent.” That’s the type of person who needs to check their hubris at the door. I think most of them think they’re improving the public health in only talking about fat in a certain way, but this simply isn’t their call to make for us, and a lot of people are being harmed by it. And the practicing doctors are being harmed by it too, since we may not realize it, but they get handed down much the same tripe we do.
    cranky – holy god.

  10. Cancer Survivor Says:

    Many of the ways we try to loose weight — diet soda and diet foods laden with chemicals, etc – are cancer causers. That being said, as a breast cancer survivor, I was told to loose weight or die…just like that. I’ve connected with many women of my wieght and height at http://www.cancermatch.com and I have learned to accept my size, be happy and focus on survivint cancer with the body of me that I love.


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