Take on the problem of obesity with dignity and respect

At at time when 2 out 3 Americans are overweight, a story about black women and fat has gone viral. Perceptions about what women see in the mirror, feel about their bodies  and others tell them about beauty is not sufficient for health. The opinion that “many black women are fat because we want to be” may nurture bias that can hinder health care for those who are overweight or facing obesity.

Just like cancers and cardiovascular disease there are striking disparities in health for minorities especially vulnerable are black women. Growing diversity in America creates an opportunity for research as well as dialogue to help us understand differences with sensitivity. The U.S. Department of Health & Human Services has identified focus areas revealing significant disparities in health access and outcomes among racial and ethnic minorities that need be addressed with interventions found within health systems beyond, but not excluding the patient-doctor relationship.

I grew up among five generations of black women who worked hard and laughed often to live long lives.  My great-grandmother was a midwife in South Carolina. Many of the  black women in my life have battled and overcome all sorts of illness including obesity.  Black women and men often face health challenges with diagnoses occurring at later more serious stages of disease leading to more preventable deaths than expected. This is true over life course and is the hallmark of health disparities. For example, among black women health doesn’t follow wealth as it should, education and socio-economic achievement does not improve our odds against infant mortality, the causes are considered unnatural.

I invite the author of the story who is a novelist along with others to consider a more imaginative context shaping unhealthy environments making healthier eating and physical activity a dilemma instead of a matter of habit. The rich storytelling in Toni Cade Bambara’s The Salt Eaters where the cost of healing is considered with this question:  “Are you sure, sweetheart, that you want to be well? … Just so’s you’re sure, sweetheart, and ready to be healed, cause wholeness is no trifling matter. A lot of weight when you’re well.” This question invites an individual response in the context of a community where healing (beyond cure) is matter of transformative relationships, support and structures for health and well-being.

Those who strive to lose weight with a combination of healthier eating and more physical activity may find challenges where the physical environment is out of shape for health. For example, there’s a connection between obesity and food deserts, it’s a complex disease of ill nutrition as well as poverty for some. This is an indication that obesity requires us to move beyond stigmas, dispel myths and open our minds to consider matters of research, policy and practice in health care and beyond along with individual lifestyle choices. The Institute of Medicine (IOM) has just released “Accelerating Obesity Prevention” a consensus report with actionable items, calling on all heath providers to consider:

“Adopting standards of practice (evidence-based or consensus guidelines) for prevention, screening, diagnosis, and treatment of overweight and obesity to help children, adolescents, and adults achieve and maintain a healthy weight, avoid obesity-related complications, and reduce the psychosocial consequences of obesity. Health care providers also should advocate, on behalf of their patients, for improved physical activity and diet opportunities in their patients’ communities.”

IOM report staff study directory Dr. Lynn Parker says “we and our committee members also are concerned about the lack of curriculum in medical schools on nutrition and physical activity for patients and the community.”

This is a conversation worth having whether or not you are a patient or health professional, overweight or not,  we should all weigh-in and be moved to take on the problem as a nation with dignity and respect.

Katherine Ellington is a medical student who blogs at World House Medicine.

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  • Sophie Zhou

    One of the best stories that I’ve heard is from a professor regarding an overweight woman that he had worked with. She was offended when the resident told her her diabetes was an effect of her weight. But when Dr. Haynie told her that her issues were a result of PMS (pentose monophosphate shunt), she was immediately taken with him. Sometimes, the social stigmas that are related to medical terms stand in the way of proper treatment. It’s important to help patients understand and accept what they need to do in order to be more healthy. Acceptance is half the battle.

    - alittlehappi.blogspot.com

    • katellington

       When you consider that almost half of Americans face challenges with health literacy barriers can be found.  Patient navigator programs can help, but more needs to be done to help patients manage the complexity of illness.

  • karen3

    I think one part of the equation is to understand that nastiness towards the obese is now the new PC hate.  And there is a substantial overlap between the non-PC bigotry and anti-obesity bigotry.  All you have to do is read a bit of Nurse K and it doesn’t take long to figure out the code words.  So, if you sound even the least bit like her, patients will shut down and assume you are just a jerk beyond words, regardless of what the patient’s skin color is, and completely blow you off. 

    If your patient is African-American, there is a good change that there are endocrine issues underlying the obesity and it would behoove you to do a midnight cortisol test. Also, if you have a rote phrase of “improve your diet and excise” you will have a certain percentage of patients who want to throttle you.  If the patient has weight issues because of side effects from meds you prescribed, joint issues, PCOS or a whole host of intractable problems, you will also get labelled an imbecile by the patient on the way out the door, lose credibility and lose your ability to treat the patient as best you can. 

    Just sayin…

    • karen3

      Just in case its not understood, African Americans have a flattened diurnal variation of cortisol — an impaired HPA axis can be passed down from generation to generation.  That flattened diurnal variation is similar to what is seen in  Cushing’s disease.  The results of Cushings look very much like the health problems that plague the African American community.  Hard to control high blood pressure, premature heart disease, resistant to treatment brittle diabetes, kidney failure, addiction to control the high steroid levels, cancer, and central obesity.  If we could stop the blame and focused on the science, imagine what we could do.

      • katellington

         As we approach the age of personalized medicine there may be more to learn about the epigentic contributors to obesity.   The diurnal variation of cortisol and impaired HPA axis you describe is perhaps the drive of stress on the endocrine sys.  This medical condition like others you describe affects Americans while disparities in health persist for African Americans due to unexplained health inequalities.

  • dsblanchard

    My experience in the Black community is that Black men like women with a “big back.” It leads me to believe that beauty has a lot to do with culture and that what I (a Caucasian woman) consider unhealthy and unattractive is not perceived so in the Black community. This idea is reinforced to me when all the White women I see with Black men are “big-backed,” also. Please, at least, humor me here, Ms Ellington, and give me an adjustment if needed.  This is truly my view on the subject. I wouldn’t say Black women are fat because they want to be. I’d say they want to be beautiful and attractive and this is the way to it in their community.

  • davemills555

    Dignity and respect? Here’s a start! Set a BMI goal of nothing above 24.9 and if that goal is reached, the patient pays no copay for the visit. Any amount about 24.9 and the patient pays their normal copay. It may not sound like much of a reward but it’s a step in the right direction to incentivize healthy choices. Or, maybe set the same BMI goal and the reward would be a coupon for discounts to join a local health club. Either way, we need to find ways to encourage healthy lifestyles, something that’s sorely lacking today. 

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