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Doctors' weight bias causes some people to avoid medical care

“My experiences at the doctor's office have not been good.

"I have had recurring headaches for four years now and I can't count the number of times that I have been told that maybe if I lose weight and exercise more my headaches might go away (this, despite the fact that exercising frequently results in a headache).

"I do have high blood pressure . . . However, my mother, who weighs 115 pounds, has also had difficulty keeping her blood pressure within normal limits. She is never made to feel like it is her fault."

These are the words of a client who came to therapy with realistic goals. She wanted to manage her weight in a reasonable way in order to improve her health. Despite taking medication, her blood pressure was still too high.

When I asked why she hadn't returned to her doctor, she told me that she felt all the doctor wanted to address was her weight. This made her feel embarrassed and hesitant to pursue her medical concerns any further.

My client is not alone. According to the Rudd Center for Food Policy and Obesity at Yale University, 69 percent of 2,449 surveyed overweight and obese individuals had experienced weight bias by doctors. Consequently, these patients are reluctant to seek care, delay appointments and put off routine health screenings.

One factor behind weight bias is the belief that if someone is overweight or obese it automatically means that they are not eating healthily and exercising. Another misconception is that overweight people don't care about their health and aren't trying to do something about it.

But in reality, many factors can cause obesity, and there are plenty of thin people with terrible health habits.

Some overweight individuals eat a nutritious diet, some work out regularly, others don't eat much more than thinner people and many have tried diet after diet, putting enormous effort into trying to manage their weight with little success. Another subset of patients has diagnosable eating disorders, which are emotional problems, not mere lack of discipline.

And of course, many people are overweight or obese because they eat too much and move too little.

But no matter the person's weight or individual circumstances, it appears that focusing less on weight and more on health is the best approach in addressing any patient's concerns.

A healthy diet and activity level are good for everyone, heavy or thin. So of course doctors ought to discuss these subjects with their patients.

But it needs to be done with sensitivity, particularly when the patient is overweight. Certainly, excess weight contributes to many maladies, and a doctor who doesn't point that out isn't doing his or her job.

Just as important, however, is listening to the patient. An honest and compassionate exchange might lead to the knowledge, for instance, that the patient needs special help addressing behavior change, and the doctor could help find that help.

Lavinia Rodriguez is a Tampa clinical psychologist who specializes in weight management. She can be reached at drrod@fatmatters.com or (813) 240-9557.

TIPS FOR PATIENTS

Patients also have a role to play in establishing a good relationship with their doctors. Here are a few things you can do to make sure that your medical concerns are addressed in the right way:

• Think of your doctor visit as an information-gathering session. You are not a naughty child there to be scolded. You have control over what happens. You are seeking answers to your questions and you are screening the doctor to see if you want him or her on your team of professionals to help you manage your health.

• Let the doctor know what healthy behaviors you engage in. Come to your appointment armed with a list so you don't forget. The doctor won't assume you don't exercise if you let him or her know from the start that you walk for 30 minutes daily, for example.

• Ask the doctor if your problem can be caused by anything other than weight and ask how these other possibilities can be ruled out.

• If you disagree with the doctor, respectfully say so and explain why. For instance, my client might have said, "I can see why you attribute my high blood pressure to my weight, and I'm working on that. But my mother is slender and she also has high blood pressure.''

• If despite your efforts to communicate calmly and respectfully your doctor seems not to be listening (which, by the way, is not the same as agreeing with you), consider changing doctors rather than avoid going to the doctor.

• Make your needs known. I referred my client to a doctor I know whom I thought would be sensitive to her needs. Even so, I made sure to contact the doctor to tell her about the patient's concerns and experience. I even talked to the doctor's nurse to make sure that she was sensitive also. The appointment worked well and my client is happy with her new doctor.

Doctors' weight bias causes some people to avoid medical care 07/15/11 [Last modified: Friday, July 15, 2011 5:30am]
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