DR. PONDER: Weight can affect treatment as well as health

Well before the current obesity epidemic was upon us and when I was in my medical training, one of my very senior mentors once said to me, “Ponder, if a fat kid ever walks into your clinic, stand up and walk in the other direction.” His comment was partly made in jest, but it reflected a reality that is still present today: Some doctors carry strong biases about treating obese people.

While being overweight or obese can negatively affect your health or the health of your child, it can also negatively affect how the medical care system treats you as well. This may be more detrimental to your health than the obesity itself.

The problem is called “weight bias.” American culture tends to promote negative attitudes about being overweight. Some are indirect, such as in how we glorify thinness in fashion, while others are more direct, yet couched in late-night humor. Obese children have long suffered bullying on account of their weight.

Doctors are not exempt from these kinds of biases. If the doctor carries a negative attitude towards a patient because of weight, that doctor may tend to be less tolerant, inpatient, and make more errors in judgments that can result in errors in diagnosis or treatment. It has been estimated that doctors make mistakes in diagnosis in up to 15 percent of their non-obese patients. Weight bias drives that figure up higher, and in some of those cases, serious harm may result.

Here is an example of how this bias can affect your care. Since being overweight has many possible signs and symptoms, there is a tendency for some doctors or nurses to “blame the obesity” for your problems and stop thinking of other possibilities they would consider sooner in a leaner person. Experts call this mistake an error of attribution. The doc or nurse carries a stereotype of obese people and may unwittingly fit all the symptoms to his stereotypical thinking about obesity. The bottom line is that the doc stops thinking of other possibilities. Being too quick to judge or dismissing problems as all related to obesity is a sign of this common error in medical thinking.

Being obese also makes it harder for a doctor to evaluate patients since it’s difficult to feel or listen to certain areas of the body during an examination. This could result in some cancers going undetected longer, or not getting proper preventative care such as an annual pelvic exam and Pap smear. Large patients may not fit into CT or MRI scanners. X-rays and ultrasound studies can be of lower quality because of the obesity. In the case of CT scans, it also takes more radiation to get clearer pictures, but that adds more radiation exposure to the patient.

Having less than ideal information in a seriously overweight patient puts even the best-intentioned doctors in a difficult position, since lack of quality imaging studies on a patient forces them to make treatment decisions often based more on intuition than solid facts.

Many surgeons have also had to change their surgical procedures in obese children or adults. Often this means more use of laparoscopic procedures. But some doctors may prefer not to operate on obese people at all or delay surgery longer than they would in a thinner patient. Because of high risks of post-operative complications, some obese people are denied kidney and liver transplants until they can get their weight down.

One study showed that fat discrimination by doctors can begin when a woman is only 13 pounds over her ideal body weight. In one study, over half of primary care doctors privately considered obese people as unattractive, awkward and noncompliant. About a third of these same docs also thought obese people were lazy, sloppy and lacked willpower. And another study found that as the weight of their patients increased, doctors liked their jobs less, had less patience and had a lower desire to help the obese patient.

It is unlikely this bias will change overnight. Is choosing an overweight doctor one answer to this problem? There is no information about that out there. Make sure, however, that your doctor discusses all the possible diagnostic considerations with you, and challenge the doctor if your weight is quickly blamed for all your symptoms. It could be something else. If the doc seems unwilling, find a new one.

Dr. Stephen Ponder has had type 1 diabetes since 1966. He has been a pediatric endocrinologist for 24 years. He is located at Lone Star Diabetes and Endocrinology. Email lonestarendocrine@gmail.com and phone 432-582-2414 or follow him at twitter.com/dr_steve_ponder.