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Kill the assumptions - and treat the patient

I’d never read a fat- or size-acceptance blog, and knew little of the Health at Every Size philosophy, before Kate Harding and Shapely Prose came into the Shakesville orbit. Since then, SP has served me as a portal to other blogs in the fatosphere. It’s also provided a needed check against the gestalt of hostility and general wrong-headedness that informs societal judgments about health and self-worth.

Because the Wurlitzer effect of that hostility is so loud and ongoing - not unlike Phil Spector’s “Wall of Sound” - correctives tend to get drowned out and lost. Good news, then, to see an article in the Washington Post that addresses a key barrier to health care: the anti-fat bias of many physicians.

Two studies in the journal Obesity Research in 2003 found that many physicians harbor negative attitudes toward fat people: A University of Pennsylvania study of 620 primary care physicians found that more than half reported viewing obese patients as “awkward,” “unattractive,” “ugly” and “noncompliant”; a Yale study reported that health professionals strongly associated being overweight with being “lazy” and “stupid.”

Such negative views, some experts charge, may be helping to drive patients away: These experts point to a 2000 study of 11,425 women, which found heavy women less likely to obtain cancer screenings such as Pap smears and mammograms even though they’re at higher risk of dying from cervical cancer and breast cancer. Newer research has produced similar findings: A 2006 study of 498 women, published in the International Journal of Obesity, found that obese women delayed cancer screenings more than other women. Negative attitudes of health-care providers and disrespectful treatment were among the reasons cited for postponing care.

Some readers will point out that even this article, specifically devoted to the effects of physician attitudes, can’t help but toss in a general reference to the “increased health risks” of being fat, as a director of research and anti-stigma initiatives put it. But she goes on to draw the harmful effects that doctors themselves may have on their patients.

Puhl said she is concerned that physician attitudes may be harming patients’ emotional well-being as well as their physical health, undermining self-esteem and possibly triggering the very destructive behaviors doctors want to discourage, such as binge eating.

The core of the article should make things clear…even for readers who aren’t fat.

“Part of the problem is that primary care physicians don’t really have a lot to offer [to obese] patients,” said Arthur Frank, medical director of George Washington University’s Weight Management Program. The standard advice to eat less and exercise more isn’t very helpful to obese individuals, some of whom are increasingly believed to suffer from a metabolic disorder rather than a failure of will, he said.

So, many physicians feel frustrated. They may make assumptions about an obese patient’s lifestyle and may, rightly or wrongly, hold the patient responsible for the weight problem, said Lorenzo Norris, a psychiatrist who is director of the Medical Wellness Program at George Washington University Hospital and screens patients for bariatric surgery. Patients, meanwhile, feel chastised, blamed and judged.

This problem begins and ends with assumptions made even before a patient walks through the door - and can be addressed by removing those blinders and actually seeing the patient.

There is a long history, predating even the horrific Tuskegee syphilis study about thirty-five years ago, of distrust in the African American community towards the health professions. Many factors play into that dynamic, but the unified effect have been as clear and cold as an actuarial table. Much work has gone into bridging the trust divide between blacks and the health industry, with admittedly much left to do. The institutional acknowledgment of the divide between fat people and the biomedical community, in comparison, is light years behind - but the kind of research described in the WaPo article, and the article itself, point the way toward a better outcome.

At the very least - how does the phrase go? More like this, please.

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