We are all guilty of having biases. Some of them we know about and proudly flaunt. Some of them have been ingrained so deeply that we do not even know they exist. Weight is an issue that brings out strong biases, and multiple studies have demonstrated a high level of bias from physicians against overweight and obese patients. Obese patients are often treated rudely and are not given the same level of medical care as non-obese patients. One study even showed that as a patient’s weight increases, physician respect for the patient decreases. Think about that — the more overweight you are, the less value you are perceived to have as a person. As both a physician and someone who has until recently been obese for my entire adult life, I can personally attest to the prejudices that exist within our field.
I myself, even as a doctor, have been fat-shamed by other physicians. (Note: by fat-shamed I do not just mean told to lose weight. Discussing weight loss is part of our jobs! I mean that my treatment as a patient was of poorer quality than if I had been of normal weight). There is so much stigma and negativity around obesity, and it leads many care providers to blame every patient complaint on their weight. Let me be very clear: yes, many, many complaints and health issues are actually due to obesity and can be improved or cured with weight loss. And absolutely every chance we get we should counsel our patients on weight loss.
But our job as physicians is to help guide patients down the right path with support and encouragement. To individualize recommendations that will help our patients succeed. To give them resources and ideas. To be compassionate. Not to just judge patients at face value and dismiss them. Empathy and understanding go a long way. Even if you find it hard to relate to someone struggling with obesity, treating every patient with respect and dignity is the bare minimum requirement!
In my time during medical school, residency and now as an attending, I have been privy to many discussions among providers about obese patients. A prevailing attitude through the years has been that obese patients “did this to themselves.” Meaning, the patient is at fault for being fat and therefore at fault for having whatever complications and comorbidities befall them. This is the same attitude I see towards drug abusers and alcoholics — that their medical problems are somehow less important because they are “self-inflicted.” Just as many factors contribute to drug and alcohol addiction, so is true of obesity. If we just focus on providing empathetic, nonjudgmental care, we will have better relationships with our patients, and their health outcomes will improve. So let’s all put our biases to the side and focus on providing the best care possible to each and every patient.
Jenny Hartsock is a hospitalist.
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