Overcoming Obesity Bias in Healthcare

A woman’s obituary has recently gone viral. After suffering from inoperable cancer,  a Canadian woman named Ellen Bennett passed away. In her obituary, she criticized healthcare professionals for discriminating against her due to her obesity. According to the news outlets, it took many years to receive her cancer diagnosis. She had felt unwell for several years, but apparently was told to lose weight. There has been a wave of sympathy from other self-proclaimed “fat” women who share stories of how diseases and ailments went untreated because healthcare providers encouraged weight loss instead of other treatments.

I can imagine a discussion Mrs. Bennett must have had with her primary care doctor. Perhaps she complained of general fatigue and malaise. If she wasn’t puking, bleeding, or passing out, it wouldn’t be considered an emergency. Unexplained weight loss is usually the biggest red flag for cancer (in my experience). Providers may have assumed depression or fatigue related to her weight. “Lose weight you’ll feel better,” seems to be a pretty common response.

Obesity has been linked to increased risk of several diseases including heart disease (CAD), diabetes, sleep apnea, and high blood pressure. Many have argued that obesity does not indicate health. At age 18, I was nearly 200 lbs. with a BMI of 27 (considered overweight, though I have my issues with the BMI measurement). I had no significant health problems. My heart worked well, and my BP was normal. For all intents and purposes, I was a healthy adult. Though obesity may not indicate general health of a person, studies have shown that even having extra weight can put you at risk regardless of lifestyle. Being obese can also put you at risk during procedures and surgeries. My hospital will often refuse elective surgeries for patients with a BMI over 45 (with the exception of bariatric surgeries).

There’s a dangerous stigma associated with obesity. Many people feel that obesity is the result of “laziness” or “not caring enough” about their health. For some people, this may be the case. For many others, there are multiple unseen issues at work. I once met one woman who had a BMI of 56. A tragic miscarriage had resulted in depression and finding comfort in food (in addition to the weight gained during the pregnancy). Psychological problems, stress, genetics, disease processes, income, and many other factors affect weight.

Our responsibility as physicians is to provide the best care. We cannot approach patients assuming that they do not want to get better. It is irresponsible to place the entirety of a problem on a patient’s weight. When I worked with orthopedics, weight was often a discussion of topic. Surgeons performing knee replacements mentioned weight to alleviate strain on the joint, but also provided medications and injections prior to surgery. Weight was addressed, but not a reason to discriminate or withhold most treatment options. A spine provider encouraged weight loss for a healthier overall lifestyle, not necessarily to alleviate back pain. In his words, “skinny and fat people both have back pain.” Their weight wasn’t the cause, so it likely wouldn’t do much to help alleviate the problem.

Since I used to be overweight, I remember being sensitive about my weight. The training I’ve received at my clinic regarding obesity has been focused on sensitivity. No one wants to be wheeled in the “big” chair, so we’re supposed to refer to it as “bariatric” when necessary. Though we’ve improved hospital and clinic facilities to be more size-inclusive, sensitivity training doesn’t address the stigma associated with obesity. We need to look at weight management as part of the treatment plan, not the only treatment plan.

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