“font-family: Verdana; font-size: 13px;”>Shortly after moving to St. Louis to begin my fellowship in geriatric medicine, I started moonlighting in the weight management clinic at our medical center. Although you are officially a physician after graduating from medical school, the salary you earn while training as an intern, resident and fellow is somewhat modest, especially when you have thousands of dollars in student loans to repay.
“font-size: 10.0pt; font-family: Verdana;”>My responsibilities in the weight management clinic were fairly straightforward. Patients who were interested in the program had to have a medical evaluation prior to starting the program and I took the history, performed the physical exams and ordered any necessary tests. I enjoyed working with the staff and the patients, many of whom had been trying to lose weight for 10 years or more. The amount of weight that the patients needed to lose ranged from 30 pounds to over 300 pounds.
“font-size: 10.0pt; font-family: Verdana;”>During my second week in the clinic, I was surprised when one of the patients said ‘You are the first doctor to touch me in years.’ I initially thought that she meant she hadn’t seen a doctor in years so my response was ‘I’m glad that you have decided to start getting regular check-ups so you can get healthier.’ She then explained that she had a primary care doctor and had been going to the appointments every three to four months for many years. The problem was, per the patient’s report, that the physician no longer examined her. As she continued to gain weight, she outgrew the exam gowns so the nurses stopped asking her to remove her clothes.
“font-size: 10.0pt; font-family: Verdana;”>At first, the doctor would lift her shirt to listen to her heart and lungs. He then started listening to her heart and lungs by placing the stethoscope on top of her shirt. Eventually, he stopped listening because he said it was too hard to hear her heartbeat and breath sounds due to her size. I could see the pain in her eyes so I told her that was I sorry that she had that experience. I encouraged her to tell the physician or someone in his office about her concerns and to request that they provide gowns that would fit her. I was disappointed to hear that another physician had treated the patient so insensitively but hoped that it was an isolated case.
“font-size: 10.0pt; font-family: Verdana;”>Unfortunately I was wrong. During the next few months, two other patients told me similar stories about health professionals not examining them because of their obesity. Again I was disappointed but there wasn’t much I could do about it. I spoke to one of the other physicians in the clinic. He thought it was more common that than I might imagine but emphasized the importance of us treating them differently so that they would have better experiences and better care.
“font-size: 10.0pt; font-family: Verdana;”>It’s been years since my time in the weight management clinic but I began to think about my experiences when I read some recent publications about health professionals’ attitudes towards obese patients.
“mso-spacerun: yes;”> physicians who responded, more than half of them had negative views of obese patients including that they were lazy and non-compliant. A second study found that doctors believed that patients’ attitudes and behaviors were the reason for obesity while patients believed that low income and medical conditions were the causes of obesity. These differences likely make it difficult for doctors and patients to communicate openly about weight management.
“font-size: 10.0pt; font-family: Verdana;”>Of course, negative views and attitudes about obesity don’t just occur in the health profession. If we are going to tackle the increasing rates of obesity and its complications, it will have to be a collective effort. One that doesn’t perpetuate stereotypes but also doesn’t applaud obesity. We must embrace strategies that promote health and healthy lifestyles for all shapes and sizes. Ideally, we will provide a supportive and nurturing environment to allow everyone to achieve optimal health.
