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Have you ever gone to the doctor for one problem only to be reprimanded about something completely unrelated? This happened to Rebecca Hiles and, as she wrote about on her blog, the experience nearly killed her. When she was 17 years old, she started struggling with a chronic cough. Her doctor prescribed some medicine but told her that the problem was really being caused by her "excess" weight and if she lost weight the cough would resolve itself. Rebecca saw several doctors over the next 5 years and, despite her worsening symptoms, they all attributed the cough to her being "overweight" and prescribed weight loss. Finally, 5 years later a doctor thought to order a CT scan of her lung and that is when she was diagnosed with cancer.
For the over 160 million Americans classified as "overweight" or "obese,” fat shaming and misdiagnoses are common experiences at physician visits. Patients are routinely diagnosed as “fat” and scolded for their body size while the medical problems that they are seeking help for go untreated. It leads to subpar medical treatment for over 2/3rds of the U.S. population who frequently leave their doctor’s office with feelings of shame and guilt rather than a prescription to cure what ails them.
The Institute of Medicine and American Academy of Pediatrics recommend routine screening for overweight and obesity in children, adolescents, and adults. Insurance reimbursements are often tied to these assessments and interventions, further incentivizing physicians to discuss weight with their patients. Unfortunately, most medical professionals are ill equipped for this task. Physicians frequently report that they lack the time and training to engage in discussions about weight with their patients. Despite feeling unprepared to discuss these sensitive issues, pressures from insurance companies and medical societies encourage physicians to blunder forward, often resulting in clumsy and damaging conversations in which patients suffer from “diagnosis= fat.”
Too frequently, I hear stories from my patients about the insensitive and shaming ways in which their physicians admonish them due to their body size. Regardless of the ailment that brought them into the doctor’s office, the only problem that the doctor sees is their weight. Fat patients are given a seemingly simple but nearly impossible prescription—lose weight—while the medical problem that brought them in remains untreated and ignored. They are given little guidance in how to accomplish this lofty goal of weight loss. Eat less and exercise more is the common recommendation--perhaps the doctor hastily mentions a specific diet plan before scurrying off to the next waiting patient--despite ample research demonstrating the diets and exercise don’t work for long-term weight loss. Unfortunately, physicians don’t know any more than the rest of us what the magic sauce is to accomplishing long-term sustainable weight loss.
So, what are the consequences of being diagnosed as fat? Research indicates that it may increase the risk of eating disordered behaviors. A study by Kass et al (2015) found that being identified as overweight by a medical professional was significantly associated with increased risk factors for eating disorders and disordered eating thoughts and attitudes. Perhaps even more problematic is the fact that being shamed at your doctor’s office leads to patients avoiding medical care. "Obese" patients are less likely to go to the doctor for preventative care and non-emergency issues. They wait until medical problems are more severe and further progressed to seek treatment. Which is understandable because, who wants to visit a place where you are consistently mistreated? When these patients do finally resign themselves to seeking medical care, there medical concerns are often pushed aside and their weight—and by extension their moral character-- is seen as the problem. We hear a lot about obesity-related medical problems and assume that these problems are caused by obesity. But the research doesn’t support that assumption. These problems that co-occur are often the result of other underlying factors (such as poor nutrition or poor physical fitness) including the lower level of medical care that "obese" patients receive.
Health at Every Size is a movement that advocates access to health for people of all sizes. All people deserve to be treated with respect and dignity, regardless of their BMI. Weight loss is not the cure to all medical problems. In fact, ineffective recommendations to diet can trigger both physical and emotional health problems. A myopic zeal to see obesity as the root of all medical problems and weight loss as a panacea of health results in misdiagnoses for fat and thin people alike. Health care should refocus on caring for people’s health, not being a salesman for the multibillion dollar weight loss industry. Intensive lobbying and funding from the weight loss industry makes this separation difficult to obtain and confusing for patients (and doctors) to understand what is truly behind medical recommendations. I think its time we all shift our focus to improving health and wellness across the weight spectrum.
For more information on Dr. Conason and Mindful Eating, please visit her website www.drconason.com, follow her on twitter @ConasonPsyD and like her on Facebook.
