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When the American Medical Association declared obesity a disease last week, an article in The New York Times proclaimed that, among other benefits, such as expanding insurance coverage for treatments, that declaring obesity a disease might allow doctors to more easily address weight issues with their patients.
Frankly, I don’t think many doctors need an easier time bringing up overweight and obesity to patients. I recently had an experience that convinced me that—even after losing 120 pounds and having a normal BMI—that some doctors feel pretty darned comfortable bringing up weight to patients.
I went to the dermatologist to have a mole looked at and get an overall check. With a family history of skin cancer and a youth spent lying in the sun coated in a mixture of baby oil and iodine (I think that may be a Southern thing), I try to be careful and proactive in my 40’s.
The doctor said everything looked fine and commented that I had very little visible sun damage for someone who’d spent as much time in the sun as I reported I had. He asked me if there was anything else, and I told him that I was being bothered by a skin tag in my underwear line and was wondering if he could remove it while I was there.
He had a couple of objections to removing it (it wasn’t particularly irritated, so my insurance might not cover it, etc.), but the one that stood out to me was an issue he had with my weight. Yes, my weight. I asked him what on earth my weight had to do with removing a skin tag. He said that because skin tags were caused by weight fluctuations and that I clearly wasn’t at my ideal weight he was hesitant to remove it. Frankly, I got the feeling that the skin tag was just a convenient reason for bringing up my weight. That day, I weighed in at 169 pounds, and I’m 5’ 8.” Do the math.
I told him that I was actually below the weight my dietician had recommended. Because I dropped all that weight a few years ago, I have quite a bit of loose skin; most of my doctors have hypothesized that if were to ever have that skin removed that I might actually be underweight. I also have arms that are sometimes referred to as “manly,” which means I’m toting a lot of muscle. He swiftly informed me that he disagreed with my dietician. Specialities be damned, I suppose. Dermatologist knows best. I hope the next time I have a suspicious mole that my dietician doesn’t try to evaluate it.
The sad part is that I’ve had these kinds of experiences for my whole life, as have many large people. When I was heavier, I often got lectures from many doctors about my weight even if I was seeking medical care for something totally unrelated to weight—like the flu. Taking a lecture about weight is always unpleasant, but it’s especially tough with a fever and a stomach that’s doing somersaults.
And, frankly, it’s unkind and stupid on the part of doctors to deliver those lectures at such moments. One thing I try to emphasize to my writing students is to know their audience. Some doctors seem to need a refresher course in bedside manner and how and when to deliver a message so that it has any chance of being received.
Let’s face it. Even for someone who truly believes that obesity is a disease (yes, I’m skeptical, as are others), it’s not contagious in the sense that other people are not going to be infected if a doctor doesn’t immediately address it. It’s also not likely to kill someone so immediately that there wouldn’t be another opportunity to have that conversation. Even if it were the case that the danger was immediate, there doesn’t seem to be much empirical evidence that a person hearing that he or she is fat—be it from a doctor, nurse, family members, society, you name it—does much to make him or her lose weight. And then there’s the fact that even the committee charged by the American Medical Association to consider the matter suggested that calling obesity a disease was problematic.
Over the course of my life, I’ve taken so many lectures from doctors that I can’t recall them all, and all they ever did was make me angry and defiant and ashamed. Never once did I leave a doctor’s office after one of those lectures and resolve to lose weight. I did, however, always resolve not to go back to that particular doctor. Sometimes, like others large people, I just avoided medical care altogether.
Maybe there are people who hear those lectures and decide to lose weight, but I’m willing to bet that those folks are few and far between. Maybe there are doctors who completely ignore the fact that their patients are large people and never mention weight at all, but I doubt it.
I think I can say for certain that people who are large know that they are large, and they are bombarded every day with messages that they’re unworthy, unhealthy and unwelcome in our society. They don’t really need a doctor to underline that message and certainly not a dermatologist.
