The U.S. health care system is not prepared to treat the more than 15 million Americans who are categorized obese by a body mass index of 40 or more. The attitudes of doctors, failure to invest in equipment and out-of-date practices often fail these patients.
Fat shaming at the doctor's office is startling. One doctor stopped a patient from sharing her concerns with a "let me cut to the chase. You need to lose weight." A quick diagnosis of "obesity pain" can miss or delay a diagnosis of the actual underlying cause. Studies have found that physicians in general spend less time with severely obese patients. What can be done?
The New York Times recently followed up with patients who suffered when a doctor dismissed their medical problems as a consequence of weight. One patient could not find out how much she weighed, because the scale only went to 350. She was forced to go to a junkyard to find a scale. CT and MRI imaging machines may not accommodate a patient - in one case a physician sent a patient to a local zoo for a scan.
As waist lines increase, more of these stories occur. Many in the medical field, however, fail to recognize obesity as a disease similar to diabetes.
Denied procedures and dosing issues
Surgeons frequently refuse to do a hip or knee replacement when a patient is obese. A group of surgeons who looked at the issue found that heavy patients should be counseled to lose weight to reduce stress on joints. But they also found that a BMI over 40 shouldn't be an excuse for blanket refusals (consider a 6'0 man who weighs 300 probably has a BMI over 40).
If a physician does agree to operate, drug dosing may not be calibrated based on weight.
Recognizing that there could be a bias, you need to be prepared when you go to the doctor. Write down the following before an appointment:
- When the problem started
- How often it has bothered you
If your concerns are dismissed, you need to be assertive. Keep asking questions. If a doctor is not responsive, find a new doctor who is willing to treat patients with high BMI.