Empathy is the cornerstone of quality patient care. It is no surprise that the fundamental moral code that has facilitated human kindness for thousands of years is what drives physicians to commit to their oath today: Treat others as you would have yourself treated.
When it comes to the disease that is obesity, I can empathize. I’ve struggled with obesity for as long a time as I can remember. There are many factors that cause obesity and it is rarely solely the fault of the individual that they are obese. There is generally some mixture of genetic metabolism, knowledge, resources, eating habits, and activity level.
For me specifically, though, it’s overeating. I can’t claim knowledge is a barrier as I work in health care. I know what is healthy to eat and what is not. I practice emergency medicine in community hospitals through out West Virginia (one of our most obese states). I know the dangers of obesity as I see patients in my ED suffering daily. I just eat too much. I’ve never been able to help myself. Either I stress eat when I shouldn’t be eating, or I continue to eat after I’m full.
I know I can lose weight. I’ve lost it before: I lost 40 pounds in college, 115 pounds in medical school, and 80 pounds in residency. The weight just always comes back when the diet ends. For all of my, and every other physician’s, preaching about a lifestyle change, I can’t do it. If I don’t actively count every single thing that I consume, then I will inevitably consume too much and end up back where I started.
I’m an addict. My obesity is a disease like a drug addiction is to another patient. Don’t get me wrong. Drug addiction is horrible. There are particular interpersonal and legal consequences associated with illicit mind altered substances that I can’t fathom relating to, but there are five challenges in being addicted to food that people tend to overlook:
1. I never had a choice of trying unhealthy food for the first time. I can’t remember a time as a child when I wasn’t eating. I can remember turning down cigarettes and drugs as a teenager (with at least some sound mind and body to make my own decisions).
2. I have to eat to something to survive. Every time I eat, I’m forced to deal with my addiction head on by eating healthy and eating a measured amount.
3. Food is everywhere (the ED, on the street, in my house, at a social event, etc.) I can’t escape the temptation by a change in scenario or friend pool.
4. I can’t hide my problem. Other addicts are great at hiding their addictions. I can’t hide mine. As someone who’s been to the mecca that is thin privilege and returned, trust me: Obese people are treated differently by society.
5. It will kill me. That’s right. My current BMI is 37.5, which is class 2 obesity (teetering just below morbid obesity). Throw in my family history of heart disease at a young age, and I’ve likely got up to 10 to 15 more years left if nothing changes.
As of this year, my obesity and long-term health now directly affect more than just me: I recently got married. Every new path in life adds new challenges to weight management. Marriage is no different. Before it was hard for me to keep the weight off. Now, I’m having difficulty losing it in the first place. Marriage means you have increased your social pool. It means more birthdays, more weddings, more tailgates, more dinners/parties, more group vacations, more holiday celebrations, etc. Food, as I mentioned before, is everywhere. It’s ingrained in every social event in American life and makes things harder for anyone who engages in social activities.
I’m not alone in my struggle. 32 percent of health care and social assistance workers are obese. The number dips to 22 percent when narrowed to practitioners. Though we certainly shouldn’t act as if we’re above it, we still do. We are nowhere close to being immune to the obesity epidemic, yet we are just a much, if not more, judgmental than society at large. Physicians often assume an obese patient’s symptoms are just a result of them being fat without exploring other pathologies for their symptoms (often pathologies that the patient is sometimes obviously at risk for). Sometimes when we do diagnose ailments; we blame the patients for their disease, which impedes on empathy. Frankly, we are giving these people (my people, our people) worse care because of said biases. There’s data to prove this.
If you learn anything from my experience and perspective, then I’d want it to be this: We obese people didn’t choose to be obese. Obesity is complex. Let’s not think, “Oh, they did it to themselves so whatever. “ The disease is not that simple. Despite the body positive trends in social media, we don’t want to be unhealthy. We don’t want to be looked at differently. We don’t want simple tasks, like sitting on an airplane and putting on the seatbelts, to be difficult. We don’t want to go home and cry with our spouses every few weeks. We don’t want our significant others to be judged. We don’t want to die early.
This New Year I’ll make, essentially, the same resolution I make for every year. I’ll try to address the bane of my existence and hope things work out. I’d like ourselves, as physicians, to make a resolution too: We will empathize with the obese in 2017. We will accomplish this inside, and outside, of the patient encounters.
Stephen Spencer is an emergency physician.
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