Obesity: bigger beds in hospital & better bedside manner needed

Sharon Kirkey

Canwest News Service
Sunday, February 03, 2008

Montreal surgeon Dr. Nicolas Christou says the most frequent complaint he hears from his weight-loss surgery patients is they couldn't get a referral from their doctor.

"They say, 'he doesn't believe in this, he thinks I'm a big, fat slob and should go on a diet.'"

Christou says he's among the first to have his operations cancelled when an emergency comes up. "Nobody thinks about these patients. It's, 'Ah, Christou's fatties again.'"

Weight bias is a serious problem among health professionals, experts say, from "dangerously antiquated" waiting rooms that lack plus-sized chairs that can support more than 300 pounds, to attitudes that all obese patients are lazy, undisciplined and "non-compliant."

The concern is obese patients are being rushed through appointments and misdiagnosed, or that some patients are so reluctant to see a doctor because of weight discrimination they're avoiding contact altogether, making it more likely they'll get sick - ultimately adding more costs to the health system.

Studies have found obese women are less likely than healthy weight ones to be screened for breast and cervical cancer. One survey found nearly one in five doctors admitted to being reluctant to perform pelvic exams on overweight women.

"We know there are numerous health risks associated with obesity and it's very important for these patients to be seeking care," says Rebecca Puhl, director of research at the Rudd Center for Food Policy and Obesity at Yale University.

Despite the headlines about an "obesity epidemic," she and others say too many health-care settings and health professionals haven't come to grips with the fact many patients are overweight. According to the most recent estimate from the 2004 Canadian Community Health Survey, 59 per cent of the adult population is overweight and one in four, or 23 per cent, is obese.

"We live in a thin-obsessed culture. We place a high value on thinness and we perpetuate the message that if you just try hard enough you'll get the body you want," Puhl says.

Doctors aren't immune to those attitudes, she says. "It makes it very easy to blame the obese for their weight, rather than look at other causes and origins that may be contributing."

Puhl has helped create an online training program aimed at improving care for overweight and obese patient. Tips include creating a "respectful environment" with large, armless chairs in the waiting room, adequate space between chairs, "weight-sensitive" reading material, wide examination tables, bolted to the floor, plus-size gowns and blood pressure cuffs in size XXL and bigger scales. Only one in 11 doctors has a scale that goes over 300 pounds.

There's advice on "sensitive weighing procedures," including asking patients for their permission to be weighed, weighing them in a private location and even asking if they prefer to be weighed facing away from the scale.

Puhl says weight bias makes patients vulnerable to depression, anxiety, low-self esteem, social rejection and suicidal thoughts.

But in a recent study of 78 doctors, nurses, dietitians, psychologists and other health care professionals, the obese were seen as bad, lazy, stupid and worthless compared to thin people - and these were comments from people attending a one-day symposium on obesity at a teaching hospital in Halifax.

Other studies have shown that among health professionals, women and younger people have the greatest biases.

Last year, Puhl's group surveyed more than 2,000 overweight and obese individuals and asked them to choose from a list of 25 different types of people they might encounter who might be biased against fat people.

Doctors came out second, behind family. "To be citing physicians at the top of the list is very alarming," Puhl says.

One woman told Puhl's group that when she asked a gynecologist for help with a low libido, his response was, "Lose weight so your husband is interested." Another woman said when she miscarried, the emergency room doctor "acted like he didn't want to touch me and could not look me in the eye during the entire ordeal."

Christou, a gastric bypass specialist at Montreal's Royal Victoria Hospital, says some physicians do recognize obesity "really provides debilitating complications for their patients." But he says others believe "it's the patients downfall and the patient should be able to control it. Physicians think no differently about obesity than the average person on the street."

There are many factors that lead to obesity, says Dr. Richard Tytus. Genes play a role, says Tytus, a family doctor and associate professor at McMaster University in Hamilton. "It's how much you consume, your level of activity, how much stress you're under, your lifestyle habits, how you consume, do you eat breakfast every day, do you eat every three to four hours, do you eat one big meal?"

And Puhl says very few, if any, weight loss programs result in sustained, long-term weight loss.

"It's very difficult for patients who come into the office who have tried to lose weight repeatedly to face these kinds of attitudes from providers," she says.

Some console themselves with food. And the heavier they get, the less exercise they can do, the more depressed they get and the more they eat. "They're tumbling down the hill and not able to stop," Christou says.