For Better Treatment, Overweight|
Folks Must Stand Up To Doctors
Cox News Service - By reporter Diane Lore|
Cox News: August 01, 2000 — Judi Dandy remembers her worst trip to the doctor. She went to see an internist because, in the course of a few hours, she lost all feeling in her left thigh.
After poking pins into her legs through her pantyhose, he told her his professional opinion: She was fat. His prescription: She should lose weight. Then he charged her $75 for the visit.
She left, still numb - now mentally, as well as physically. There is a fairly common condition, "meralgia paresthetic," in which the thigh can lose feeling because of excess weight. But Dandy was angry that the doctor didn't explain the diagnosis, examine her or order any other test to see whether the cause might be linked to a more serious problem.
Her left side did return to normal within a few weeks, but the incident left her wary of the health-care system. Now, she screens doctors to try to make sure she's going to get the care she needs, not just a lecture about something she's already painfully aware of.
"Too often, (obese) people cannot go to a doctor without having them tell us that everything, everything, is related to our weight," says Dandy, a 57-year-old Roswell, Ga., resident who is about 100 pounds overweight.
Such experiences, medical professionals say, are keeping many overweight patients from doctors' offices and making them forgo preventive services in order to avoid ridicule.
"Even though every doctor's office now has obese and overweight patients, we still find there is a problem of some people really being treated with disrespect," says Susan Yanovski, director of the Obesity and Eating Disorders Program at the National Institutes of Health.
Few studies have examined how many obese people may avoid medical treatment, out of embarrassment or because of doctors' insensitivity. But with half of Americans now considered overweight and one in five classified as obese, according to a recent study by the Atlanta-based Centers for Disease Control and Prevention, it's an issue that's getting a second look by public health agencies.
It's not a minor concern: Obese men and women have significantly higher rates of heart disease, diabetes and some cancers, numerous studies have shown. Consequently, it's in the best interest of both doctors and patients with weight problems to see one another in a consistent, scheduled manner.
And yet doctors must, in some ways, be like neighborhood cops. They should be friendly enough to foster trust and communication with those at risk. But at some point, they also have a responsibility to point out - and try to stop - dangerous behavior.
Occasionally, it's difficult to find that balance. And sometimes, doctors bring prejudices about weight to the office, which can make a patient's visit a gantlet of humiliation and shame.
Lynn McAfee, director of the Council on Size & Weight Discrimination, a New York-based advocacy group for the overweight, has collected several such incidents of disrespect, such as:
- A woman sprained her ankle but was initially unable to convince her doctor that she needed treatment. Finally he agreed to prescribe anti-inflammatory medicine, telling her, "Take this with food, which shouldn't be a problem for you."
- Another woman, who wanted to get pregnant, was told by her doctor that if she succeeded, he would recommend abortion.
- A grandmother, berated by her doctor about her weight, confessed that she started fasting and drinking a bottle of laxatives before stepping on the scale at the doctor's office. A heart patient, she did this every other week.
Forty-two percent of obese patients say that a health care worker has suggested that they lose weight, with the most likely candidates for such advice being middle-aged women with higher education, according to a study published in October in The Journal of the American Medical Association.
But too often, the advice is to diet, even though studies indicate that less than 5 percent of dieters keep off the weight they've lost for more than five years. Miriam Berg, the weight discrimination council's president, for example, has lost more than 300 pounds through the years on diets, and she's gained every pound back. Dandy has been on more than two dozen diets.
"I think if I told patients I had a cancer cure, but it had less than a 10 percent success rate and it was going to cost a bundle of money, I'd be laughed right out of the office," said Dr. Allen King, a California endocrinologist who has been working with diabetic patients, many of them obese, for almost three decades. "And yet, we keep trying to sell this to overweight patients, and they're supposed to take it seriously."
Instead, experts say, doctors and patients should discuss more lasting lifestyle changes - to move more, eat less - that go beyond fad diets and short-term solutions. Such discussions remove the stigma of obesity and instead center on advice everyone should follow, regardless of what the scale says.
For example, federal guidelines say that people should eat five servings of fruits and vegetables a day, along with two servings of animal protein and two to three servings of low-fat dairy products. And everyone should exercise for a minimum of 30 minutes three times a week.
Yet, according to a new poll conducted by The Atlanta Journal-Constitution, three out of every 10 Southerners say they never exercise, and another two of every 10 exercise only one or two days a week. One-third of the Southerners polled said they eat no fruit or vegetables on an average day or consume one serving at best.
"Health is not always necessarily a size issue," said Dee Hakala, who weighs 220 pounds and is a winner of the Nike Fitness Innovation Award and runs aerobics classes for the overweight. "It's a movement issue. ... it's a healthy-lifestyle issue."
And doctors can create a more hospitable environment for obese people just by making a few changes in their offices, experts say. Instead of tiny chairs with armrests, they could include love seats or larger chairs without armrests. They could offer gowns and blood pressure cuffs that actually fit.
"You need to keep saying, `I may be bigger, but I deserve equal treatment,"' Hakala says. "You cannot let them bully you around."
Overweight people can get better medical treatment if they're willing to become more assertive about their needs. Experts recommend:
- Call a new doctor before a scheduled appointment and simply ask whether he or she is comfortable with heavier people. The doctor may not tell the truth, but a patient might be able to sense any significant discomfort.
- Acknowledge that weight might be playing a role in an illness or injury, but remind the doctor to check other factors as well. It is not acceptable to get a diet speech when you need treatment for the flu.
- Don't be combative. Instead, patients should work with their doctors to try to find a way to improve their health that feels comfortable to both.
Moderation is the key. "I am from India," says Bowman, "and we have a saying that if consumed in excess, even the nectar of God is a poison."