Overweight Patients May Face Health Care Discrimination
Overweight patients may face a different set of challenges in the doctor’s office, according to a review of recent research presented at the 125th Annual Convention of the American Psychological Association.
The researchers found that the medical complaints of obese patients are often disregarded by doctors as symptoms of their obesity alone, and therefore not properly treated. In fact, according to autopsy reports, obese patients die with many more undiagnosed medical conditions than do average-weight patients. In addition, medical discrimination toward overweight patients can take a significant toll on a person’s physical health and well-being.
“Disrespectful treatment and medical fat shaming, in an attempt to motivate people to change their behavior, is stressful and can cause patients to delay health care seeking or avoid interacting with providers,” said Joan Chrisler, Ph.D., a professor of psychology at Connecticut College, during a symposium titled “Weapons of Mass Distraction — Confronting Sizeism.”
Weight bias can impact how doctors medically treat patients, since overweight people are often excluded from medical research based on assumptions about their health status, Chrisler said. For example, the standard dosage for drugs may not be appropriate for larger body sizes. Research has shown frequent under-dosing of overweight patients who were prescribed antibiotics and chemotherapy, she added.
“Recommending different treatments for patients with the same condition based on their weight is unethical and a form of malpractice,” Chrisler said. “Research has shown that doctors repeatedly advise weight loss for fat patients while recommending CAT scans, blood work, or physical therapy for other, average weight patients.”
In some cases, health care providers might not take heavy patients’ complaints seriously or might assume that their weight is the cause of any symptoms they experience, Chrisler added.
“Thus, they could jump to conclusions or fail to run appropriate tests, which results in misdiagnosis,” she said.
In a study of over 300 autopsy reports, obese patients were 1.65 times more likely than others to have significant undiagnosed medical conditions (e.g., endocarditis, ischemic bowel disease, or lung carcinoma), suggesting misdiagnosis or poor access to health care.
Studies also reveal that negative attitudes among medical providers can also cause psychological stress in patients, Chrisler said.
“Implicit attitudes might be experienced by patients as microaggressions — for example, a provider’s apparent reluctance to touch a fat patient, or a headshake, wince, or ‘tsk’ while noting the patient’s weight in the chart,” she said. “Microaggressions are stressful over time and can contribute to the felt experience of stigmatization.”
A medicalized view of weight sees obesity as a disease and weight loss as a cure, said Maureen McHugh, Ph.D., a psychologist who also presented research on fat shaming during the symposium.
“A weight-centric model of health assumes that weight is within an individual’s control, equates higher weight with poor health habits, and believes weight loss will result in improved health,” she said.
Chrisler also noted that there is no such research showing exactly how much weight is too much. Other predictors of illness, such as genetics, diet, stress and poverty, also play a role, yet being overweight often leads to the assumption that a person is unhealthy, she said.
Evidence confirms that fat shaming is not an effective approach to reducing obesity or improving health, McHugh said. “Rather, stigmatization of obese individuals poses serious risks to their psychological health,” she added.
“Research demonstrates that weight stigma leads to psychological stress, which can lead to poor physical and psychological health outcomes for obese people.”
The researchers conclude that it is essential for weight stigma to be addressed in psychology and the medical profession: in training, in theory and research, and in working with overweight clients. Importantly, treatments should focus on mental and physical health as the desired outcomes for therapy, and not on weight, McHugh concluded.