Doctors Who Do Not Discriminate Against Obese Patients

When Melissa Boughton complained to her OB/GYN about pelvic pain, the doctor responded by asking about her diet and exercise habits.

At the time, Boughton thought the question seemed irrelevant, considering the kind of pain he was feeling. But it wasn’t unusual coming from this doctor. “Every time he would go, he would talk about diet and exercise,” said Boughton, 34, of Durham, North Carolina.

On this occasion, three years ago, the doctor told Boughton that losing weight would probably solve her pelvic pain. She brought up the subject at least two more times during the date. And she said that she would order an ultrasound to calm her down.

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The ultrasound revealed the source of her pain: a 7-centimeter fluid-filled tumor on her left ovary.

“I hate that doctor for the way she treated me, like my pain was no big deal,” Boughton said. “He seemed to decide on me based on a very cursory glance.”

Melissa Boughton says her gynecologist asked her to exercise and diet at least three times during a doctor’s appointment and acted like her ovarian tumor diagnosis was “the most normal thing in the world.”

Research has long shown that it is doctors are less likely to respect overweight or obese patients, even though nearly three-quarters of adults in the United States now fall into one of those categories.

Obesity, when the body mass index (BMI) is 30 or more, is widespread in the South and Midwest, according to Centers for Disease Control and Prevention (CDC). The state with the highest rate is Mississippi, where 4 in 10 adults qualify as obese.

Obesity is a common and treatable condition linked to a long list of health risks, including type 2 diabetes, heart disease, and some types of cancer. Despite the prevalence of obesity, it carries a unique stigma.

Physicians often approach the practice of medicine with an anti-fat bias and they do not find it easy to communicate with patients whose weight exceeds what is considered the normal range. Some obesity experts blame a lack of focus on the topic in medical schools. Others blame a lack of empathy.

To counter both, the Association of American Medical Colleges plans to implement new diversity, equity and inclusion standards in June aimed at teaching physicians, among other things, about treating people diagnosed as overweight or obese respectfully.

That doesn’t happen to many patients, said the Dr. Scott Butsch, director of obesity medicine at the Cleveland Clinic Metabolic and Bariatric Institute. “It’s almost like bad practice… The stereotypes and misperceptions around this disease just seep into clinical practice.”

The problem, Butsch argued, is that too little attention is paid to obesity in college. When he trained and taught at Harvard Medical School for several years, Butsch said, students received no more than nine hours of obesity education, spread over three days over four years.

In 2013, the American Medical Association voted in favor of recognize obesity as a disease. But, Butsch said, doctors often approach it with a one-size-fits-all approach. “Eat less, move more” doesn’t work for everyone, he said.

“There are many different forms of obesity, but we are treating them as if we were giving the same chemotherapy to all types of cancer,” said Butsch.

All but four of the 128 medical schools reported covering content related to obesity and bariatric medicine in the 2020-21 academic year, according to data provided to KHN by the Association of American Medical Colleges, which does not represent osteopathic schools.

Still, research suggests that many doctors, around the world, have not been sufficiently trained to address weight problems. A survey completed by leaders of 40 schools of medicine in the US found that only 10% felt that their students were “very prepared” to manage patients with obesity. Expanding education in this area is not a priority, they wrote in a 2020 article about the survey.

butsch wants that Congress passes a resolution to insist that medical schools incorporate substantive training on nutrition, diet and obesity.

The Dr David Cole, president of the Medical University of South Carolina, said many topics should be covered more fully in medical school. “There’s a huge tome, it’s that big,” Cole said, raising his hand high. “The topic is: things I never learned in medical school.”

The Association of American Medical Colleges is trying to tackle the problem in two ways.

First, it developed a career readiness exam for aspiring medical school students, called PREview, designed to assess applicants’ cultural competence, listening and social skills, and their ability to analyze situations at hand. can be found in medical school and in clinical settings.

“We call them soft skills, but they are actually the hardest to learn,” said Lisa Howley, an educational psychologist and senior director of strategic initiatives for the association. More than a dozen schools now recommend or require applicants to submit their PREview scores along with their entrance exam scores.

Second, in June, the association will implement new competency standards for medical students, residents, and existing physicians related to diversity, equity, and inclusion. Those standards will address racism, implicit bias and gender equality, and will aim to teach doctors how to talk to people who are overweight.

After the source of Melissa Boughton’s pelvic pain was discovered, the same doctor acted as if the tumor was “no big deal.”

Boughton sought a second opinion from a doctor who advertised his practice as a “Healthy for All Sizes” practice. That doctor referred her to a surgical oncologist, who removed the tumor, her left ovary and part of a fallopian tube. The tumor was large, but it was not cancerous. And while the surgery to remove it was deemed successful, Boughton has since had trouble conceiving and is undergoing fertility treatment.

“It’s an emotional roller coaster,” he said. “I feel very young at 34 to be going through this.”

Boughton, who describes herself as someone who “doesn’t fit the BMI box,” said the experience taught her to choose her doctors differently. If the doctor asks if she diets and exercises, she just “starts looking for another one.”

KHN (Kaiser Health News) is the newsroom of KFF (Kaiser Family Foundation), which produces in-depth health journalism. It is one of three major programs of KFF, a nonprofit organization that analyzes the nation’s health and public health issues.




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