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Extra pounds, and attitudes about them, can affect doctor-patient relationships

October 22, 2009 | 11:23 am

Stethoscope Doctors can be fairly significant, one would think, in helping people combat obesity-related health problems. But a good working relationship usually begins with respect. And that might be a stumbling block.

In a new study, researchers at Johns Hopkins University School of Medicine report on their questioning of  238 patients -- and their physicians -- from 14 medical offices about their encounters. The patients for whom doctors said they had little respect just happened to have higher body-mass index scores. 

Here's the news release. The study is to appear in the November issue of the Journal of General Internal Medicine.

And here's a recent L.A. Times column from Dr. Valerie Ulene suggesting that doctors might be at least partly to blame for those weight problems: What the doc doesn't say: You're overweight

Plus, an article exploring the effect of a physician's excess weight on patients: Does a doctor's weight matter?

Apparently, attitudes about weight can affect both sides of the doctor-patient relationship.

-- Tami Dennis

Photo: Daniel Acker / Bloomberg


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Comments (11)

Weight discrimination of patients is a well-known phenomenon. It sometimes reaches rediculous proportions. One friend of mine, shortly after she got pregnant, was told that she WOULD (no mights or possiblies, the doctor was certain) miscarry solely because of her weight (her daughter is currently adorable).

It extends well beyond doctors. 20 year old women who weigh 300 lbs are unable to get life insurance, despite the fact that they statistically will live longer than men of any category.

Weight discrimination is a fact of life for millions of Americans who are genetically heavy.

Doctors, by virtue of their profession, should console people who are overweight. They should counsel people who are overweight on the hazards of being overweight. They could narrate cases where overweight people have had to suffer from various diseases. Doctors should impart education to their patients as to how one could cut their weight. Doctors are supposed to be noble and kind hearted. Let not the doctor community abuse people who are overweight. SDome may be overweight due to family history and other factors.

What I love is the fact that almost every nurse in the doctors office is overweight, some severely. So it would seem that doctors should practice what they preach, or not preach as the case may be!

I had a partial spinal cord injury two years ago. I have been suffering severe pain from this and am at risk for re-injury because I refused surgery as my chances of surviving the surgery were only 50%. Upon review of my long term disability after two years my primary care physician gave my diagnoses as morbid obesity (320 lbs at a height of 5 feet 8 inches) and deconditioning (i.e.; fat and lazy). The claims analyst denied my continuing long term disability benefits saying that I should be able to sit in my wheelchair 8 hours a day and work a sedentary job.

Thank you for the item on patient perceptions of physicians' weight. I have been to a couple of female physicians who were definitely overweight and out of shape. I simply had trouble believing they took their own health as seriously as I take mine.

I am fairly thin, exercise, eat well, but have some unusual health issues which relate to congenital scoliosis. One of these physicians--who totally failed to take my musculoskeletal issues on board--liked to imply that in effect I would not have any of my problems if could be less intense and laze around more--like her, I presume. I personally found this attitude obnoxious and possibly harmful. I could never tell if she realized how ridiculous she was making herself in the patient's eyes.

I am a male, 57 years of age, 5'8" tall, and I weigh 234 pounds. By my BMI I am obese. I get up at 4:00 AM to work out before I go to work. I work out every morning, sit ups, free weight, and on weekend I use a tread mill. I have improved greatly on my eating habits but I can still do better. I have been on this program for 3 years now. I take 3 types antianxiety medication and all have the side effect of weight gain. I have brought my concerns about my weigh to my doctor's attention several time but he onlyrecommend diet and exercise. I ask for appetite suppressant medication but he will not give it to me. He cites that I have hig blood pressure. Well I do and it is controlled with medication. At my age I am 120/80. Quite often I miss taking my blood pressure meds. I feel that it should be possible to try appetite suppressants cautiously but he won't buy it. So... I am being treated for anxeity with medication that makes me gain weight, I'm getting to the point where I'm getting really depressed about my weight, and I can't get medication to help my work out routine to help me lose weight. I really don't want to resort to buying medication via the internet - I relize the risk, but I need help. Do you have any suggestions?.

I think there are two sides to this. Doctors are tired of patients not listening to them and taking them serious when it comes to being obese. However, I believe many obese people are very defensive and over react to being told to lose the weight. This creates a hostile relationship and makes it harder for either to reach some kind of effective communication.

If my doctor told me to lose some weight or make other changes to my lifestyle I would do the unthinkable, I would listen and not be such a crybaby.

BenD, said "...despite the fact that they statistically will live longer than men of any category."

So you think statistically a 300lb woman will live longer than a fit man simply because she is female? You can't be serious.

I agree with you KV Suryanarayanan on the fact that doctors should be kind and noble but they should tell the truth too. I find it hard to believe doctors these days in the land of overly PC behavior are this brash but if they are they should be left and another doctor be selected.

Being obese is a choice unless that person is a rare medical anomaly. Family genetics are barely a factor considering the fact ancestor roots in those genetics showed little to no influence in obesity. One look at people in the 1920’s to 1960’s and the reality hits you that being overweight is a lifestyle choice.

Jack Wert, It sounds like you are in a pickle so until they can give you a decent answer I suggest munching on veggies on the go. This may sound overly simplistic but it helps with curbing the munchies and if you have to dip them in ranch dressing it is still a good step. I also carry around a water bottle with non-calorie drinks in it to fill in the empty stomach feeling. I hope this helps some because it works for me.

Doctors are as puzzled about obesity as the rest of society. I know this because I am a physician and I am also obese.

For the doctors, you give patients all of the wisdom you gained from years of studying, the best coaching you can muster, and they fail to improve. After awhile, simple human nature takes over. Obese patients seem unable to follow directions, fail to lose and maintain weight loss, keep getting sicker, and they ruin your day. For the doctor that means frustration that turns into anger, then resentment, then resignation and apathy.

The real problem for doctors is that they don't have the proper tools for treating obesity. Current treatment for obesity addresses lifestyle - portion size, food selection, exercise - all necessary for weight loss. But actual obesity is a brain disease - disordered neurotransmitters trying desperately to manage a very stressed supersized body with toxic and inadequate nutritional substrate for fuel. Pushing the gas pedal harder doesn't get a broken car to run faster or better. The good news is that brains are plastic, they can heal.

So what can the obese patient do? Your doctor hates fat. If that's true, you are partners, and can forge ahead trying different options together. Some will work for you, some will not, some will work for awhile. Address the addiction and depression/anxiety and emotional eating that invariably accompany obesity. Watch out for medications that increase your appetite. Move a little, change something everyday, reawaken your curiosity, eat the highest quality food you are craving - you will eat less of it.

Hopefully your doctor is mature enough not to hate fat people. If that is the case, change doctors. You do not need to endure additional suffering.

Go forth in good mental health!

Sara L. Stein, M.D.
Author, Obese From The Heart: A Fat Psychiatrist Discloses


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