Prejudice Against Overweight Patients: An Issue To Ponder Prejudice Against Overweight Patients: An Issue To Ponder - pg.2 | allnurses

Prejudice Against Overweight Patients: An Issue To Ponder - page 2

Weight discrimination is the treatment of someone in an unfair manner due to the person's size. Even though extremely thin individuals are occasionally treated poorly due to their size, overweight... Read More

  1. Visit  Stephalump profile page
    #13 9
    Quote from tothepointeLVN

    But the advice to lose weight has no direct relation on the problem they went to see the doctor for. If the doctor said losing weight would help x condition or prevent y condition then that would be fine

    But simply saying losing weight would make "life" easier is not. Life as in people liking you as in finding clothes. What? Non specific and non helpful. Btw 279lb was my exact weight this morning and my "life" is fine. My health is good and all that other good stuff.

    And the "for the good of their health" is not a good reason to discriminate. People usually pay in some form or another for the Dr so it's a service its not a invitation to run their lives.
    So there's nothing to be said for "preventative health?"
  2. Visit  wooh profile page
    #14 8
    I think it it comes up in the context of overall wellness, good. "How are things in general? Energy? Sleep? How have you been eating? Getting any exercise? Stress?"

    When it's the ONLY piece of wellness information offered, or it comes in the context of: Patient: "I have a headache." Provider: "You should lose weight." Not good.

    Especially since I think all of the other wellness things have a huge impact on weight. If you aren't sleeping well, your raising your stress hormones which increases weight, and you're going to look to food to supply the energy you lack from lack of sleep. If you're under stress, stress hormones.

    If you're lacking energy, you can't exercise. Now part of the lack of energy may be from a lack of exercise. But I had a while that I could not get through a workout. Finally realized that I was really anemic. If my healthcare provider just told me to exercise, it would have been just another frustration. I was trying to workout. I couldn't do things that I could do just a few months prior. It took one of my coworkers pointing out to me how pale I was for it to finally click that I'd been eating ice and having restless legs like crazy. All signs of iron deficient anemia. Once I took a couple weeks off from trying to workout, focused on my diet and getting more iron, I was actually able to workout. If I'd kept up just trying to workout, exhausting myself even more, I wouldn't have accomplished much, because as little as I could do wasn't giving much in the way of results. I got that taken care of and now that I can work out, I don't dread it as the most frustrating time of day. Which means I stick with it.

    "Just lose weight" isn't helpful. Looking at creating an overall wellness plan that will help someone lose weight is.
  3. Visit  Double-Helix profile page
    #15 9
    Phrasing is everything. You can address a weight issue without saying, "You're fat." Addressing the reasons for the increased weight is different and more effective then just addressing the weight itself.

    It's the difference between:

    Patient: "My back has been hurting me."
    Doctor: "I think you would feel better if you exercised and didn't weigh so much."


    And:

    Patient: "My back has been hurting me."
    Doctor: "Lets talk about your daily routine and exercise habits. Maybe we can identify a few lifestyle changes that might help with this pain."


    In the first example, the doctor is making the patient's weight the issue. It comes across are more judgmental, because it doesn't really offer any practical help for the problem. It also doesn't involve the patient in the discussion, but is simply the doctor giving their opinion.

    In the second example, the doctor involves the patient in the discussion and makes the focus about lifestyle factors that an be adjusted in order to help with the problem and make the patient healthier overall. It's much less likely to come across as judgmental and biased.

    I think this philosophy of phrasing can be applied to many situations when discussing weight, such as when discussing health with teenagers. Many teenage girls feel an obligation to be skinny, like the magazine models and are afraid of gaining weight. When our educational sessions with these girls, focusing on weight, BMI and obesity can further reinforce the idea that gaining weight is bad and they need to be skinny. If we focused on the lifestyle choices that result in better health (balanced diet, regular exercise) instead of on the weight, I think our teaching could be more effective.
  4. Visit  Thujone profile page
    #16 1
    overweight patients do tend to be non-compliant with some physician orders. if they complied with an order like "exercise 5 days a week and eat this diet" then they would most likely lose weight. however, i do think that most people, whether they are overweight or not do comply with taking medications. most people in america view overweight and obese people as unattractive, not just in the health care setting, the cause of this is out of the hands of us healthcare workers, and more up to the zeitgeist of the time which, in today's time, is highly influenced by the media. the awkwardness of someone is totally subjective. many people say that physicians are some of the most socially awkward people out there, so what right do they have judging that trait in others? in the end though, it is common courtesy to not say offensive things like that. you can think it all you want, but when you speak it out loud, you run risk of not only offending someone, but also lowering their self-esteem which may cause some people to eat excessively and put on even more weight!
  5. Visit  2BRN123 profile page
    #17 2
    Exercising 5 days a week and changing your diet are not enough. The patient needs to be educated.

    If nutrition and human exercise physiology were such simple concepts to understand and execute, then obesity wouldn't be the problem that it is. If they were things that people could just read a pamphlet about and simply integrate into their lives, then personal trainers wouldn't need licenses to practice and colleges wouldn't offer bachelors and masters degrees in the topics to prepare people to do the job.

    The reality is:

    Many people who struggle with weight, do work hard and do not experience results. I see this every day where I work. Months and months on end coming into the gym to put in the work and experience marginal or non existent results.

    Anecdotally and in my personal experience, those who experience significant and meaningful results are those that see personal trainers, nutritionists and physical therapists. Not to say that obseity cannot be challenged without professional help, because it can, but long term results typically aren't anticipated without some kind of guidance.

    The problem herein lies, while health professionals may be able to identify that a person has issues with weight, there is little they can do about it aside from alert the patient to the fact and give them basic counseling. In my experience many health insurance companies, despite the recommendation or order of a Dr, get combative when a patient tries to control their weight with methods that the health insurance company would have to contribute to, regardless of the fact that it may help control the patients other healthcare costs.

    The burdon of one of our most basic but most difficult to manage health care practices has been placed solely on the patient both financially and in access to care.

    The exercise routines of MANY individuals, not just overweight people are hopelessly flawed. Incorrect form, in conjunction with incorrect diet execution or ideas is a hindrance to millions of people who are trying to change their lives.

    Honestly, there is little that a PCP can do to legitimately counsel a patient as to how they can experience significant weight loss, without the participation of other entities to help get the job done.
    Last edit by 2BRN123 on Jun 21, '12 : Reason: sorry so long.
  6. Visit  Multicollinearity profile page
    #18 5
    Overweight patients need to be addressed with respect, and healthcare providers DO need to be aware of their prejudices and bias. That said, I fear we are getting to a point of overly-politically correct enabling approaches where the issue will not be able to be addressed with overweight patients without "bias!" and "over-weight prejudice" being called.
    Last edit by Multicollinearity on Jun 21, '12
  7. Visit  Pets to People profile page
    #19 0
    Quote from rita359
    Issues, Issues. Now a doctor telling a patient it would be good for her to loose weight is discriminating against that person. OR is he addressing an issue in addition to the issue the patient presented for. I read somewhere that a lot of obese patients say they have NEVER had their weight addressed by a physician or nurse. If medical professionals don't address this issue who will?
    I understand what you are saying, but the way he addressed it was unprofessional...I can just imagine the tone it was said in. That approach does not address the pt's issue in any way.
  8. Visit  2BRN123 profile page
    #20 3
    Quote from Multicollinearity
    Overweight patients need to be addressed with respect, and healthcare providers DO need to be aware of their prejudices and bias. That said, I fear we are getting to a point of overly-politically correct enabling approaches where the issue will not be able to be addressed with overweight patients without "bias!" and "over-weight prejudice" being called.
    There is "prejudice" and "bias" though. Not necessarily on a patient care level but on a level of access to general services. It is ridiculous that as health care providers that we can sit here and call overweight people "non-compliant" when many of them have been given no legitimate materials or instructions to comply with!

    Now I'm not excusing the patient from personal responsibility. But it seems ridiculous to me that people can participate in all kinds of voluntary self-ordered care (like drug rehab and psychological services) but can't get their PCP to refer them to a nutritionist or get their health insurance to pay 30 bucks a week to see a personal trainer.

    There are MANY chiropractors, physical therapists occupational therapists nutritionists etc that provide services that can improve the lives and health of the obese. Until our healthcare systems are willing to better accommodate these physical and theory based medical services I wouldn't anticipate that we can see a decline in weight related health issues.
    Last edit by 2BRN123 on Jun 21, '12
  9. Visit  Multicollinearity profile page
    #21 2
    Quote from brian ruff, cna
    overweight patients do tend to be non-compliant with some physician orders. if they complied with an order like "exercise 5 days a week and eat this diet" then they would most likely lose weight. however, i do think that most people, whether they are overweight or not do comply with taking medications. most people in america view overweight and obese people as unattractive, not just in the health care setting, the cause of this is out of the hands of us healthcare workers, and more up to the zeitgeist of the time which, in today's time, is highly influenced by the media. the awkwardness of someone is totally subjective. many people say that physicians are some of the most socially awkward people out there, so what right do they have judging that trait in others? in the end though, it is common courtesy to not say offensive things like that. you can think it all you want, but when you speak it out loud, you run risk of not only offending someone, but also lowering their self-esteem which may cause some people to eat excessively and put on even more weight!
    i think we have shifted from a culture of doctors orders, and patients' compliance. that reflected prior generations' vested authority in physicians that no longer exists. now physicians and other healthcare providers are partners in creating and maintaining health. truly.

    i prefer educating and coaching from healthcare providers and patients' adherence or non-adherence, which is their choice.
  10. Visit  Multicollinearity profile page
    #22 2
    Quote from Leo*
    There is "prejudice" and "bias" though. Not necessarily on a patient care level but on a level of access to general services. It is ridiculous that as health care providers that we can sit here and call overweight people "non-compliant" when many of them have been given no legitimate materials or instructions to comply with!

    Now I'm not excusing the patient from personal responsibility. But it seems ridiculous to me that people can participate in all kinds of voluntary self-ordered care (like drug rehab and psychological services) but can't get their PCP to refer them to a nutritionist or get their health insurance to pay 30 bucks a week to see a personal trainer.

    There are MANY chiropractors, physical therapists occupational therapists nutritionists etc that provide services that can improve the lives and health of the obese. Until our healthcare systems are willing to better accommodate these physical and theory based medical services I wouldn't anticipate that we can see a decline in weight related health issues.
    Leo, I deleted my prior post as it was rambling and long. I described a scenario where a physician claimed many overweight people will be overweight no matter what they do.

    I agree there is prejudice and bias. I'm afraid, though, that fear of claims of bias will tie healthcare providers' hands when it comes to addressing the issue honestly and kindly.
  11. Visit  2BRN123 profile page
    #23 1
    Quote from Multicollinearity

    I agree there is prejudice and bias. I'm afraid, though, that fear of claims of bias will tie healthcare providers' hands when it comes to addressing the issue honestly and kindly.
    Their (and our) hands are already tied, unfortunately.

    Another poster previously said that a Dr. shouldn't constantly harp on someone about their weight. I think they should BUT they need to be able to refer them to someone or something or some way that the problem can actually be controlled. *sigh*

    sorry I'm posting so much, I just work in the health and fitness field currently and believe very strongly about these issues.

    Its just so hard to bear witness to the whole thing. Seeing Client A with adequate financial resources or agreeable health insurance be able to participate in our program and SERIOUSLY change their lives and then have to watch client B without those resources struggle on the eliptical reading health magazines every day not knowing if they will ever be able to turn themselves around.
  12. Visit  Pets to People profile page
    #24 4
    How can we expect overweight/obese people to loose weight? Most can get the excercise thing figured out, but as everone can agree diet is 80% of the problem. Ph.d's, scientists/researchers, physicists, M.D's and any other professional involed CANNOT agree on what diet is best for us to loose weight AND maintain a healthy weight. But they all agree that it is not simple at all, it is in fact so complex that we can reach the moon, yet we have not been able to get this figured out.

    Society critisizes overweight people, then gives them conflicting and often incorrect advice and they try and try and try with no success, or loose weight only to gain it back and what do we do? We tell them they are fat, lazy slobs and we cut out their stomachs...perfectly healthy organs cut out in order to try to force their bodies to accept a food lifestyle that perhaps people we not ment to maintain (aka carbs and high fructose corn syrup in nearly all the food we eat). Bariatric surgery is becoming, if it is not yet, the NUMBER ONE performed surgery in the U.S.

    Why are they tired all the time? Hmm, could it be that their cells are becoming insulin resistant (aka pre-diabetic due to the overdose of daily carbs that cause huge spikes and drops of insulin), so their bodies tell them they are hungry and so they eat, but the insulin is not able to get the energy/food into their cells so it turns it to fat instead...their cells still have not gotten the energy they require so it tells them to eat MORE. They are STARVING at a cellular level. Then we tell them to eat less when they are already STARVING. We tell them they need to eat less and work out more, hence the less calories in more calories out theory, but they have only a limited supply of carbs in their liver and muscles, so they will yet again end up STARVING. This is because the body requires fuel to work and if it is not getting enough carbs because we are restricting them and we store a limited supply; basically what we are attempting to do is to get our bodies to burn FAT yet our metabolism is set to burn CARBS, so if it even burns fat it does not do it well, obviously, we don't need a scientist to tell us this, we see it for ourselves everyday. And then we wonder why we are busting our butts in the gym and starving ourselves yet we are not loosing weight?!

    Think on this....our body requires essential fats and essential proteins but we DO NOT require any essential carbs. Then why are carbs our main food/energy source? Plus carbs give us short term energy and fat gives us long term energy. Think about long distance runners, they are fat burning machines, that is why they are so darn skinny! Don't say they carb load, because our bodies can only hold around 100g of glucose in our liver and around 300 in our muslces. Also sled dogs, they are omnivores just like us, yet they can run all day on fish, meat and fats. Also, forget the nonsense that the brain MUST have carbs, the brain works perfectly fine on ketones as does the rest of our body, and our muslces can store fat for energy just as well as they can store glucose. And let's not forget the nonsense about ketosis, it is NOT ketoacidosis, which is an entirely diffent metabolic problem.

    The obesity epidemic starting in the 1980's when a researcher (using only the data collected that backed up his claim, not ALL the data that showed his claim was not true across the board but in fact had a lot more factors involved than simply fat intake; this is a huge problem in research studies, they have to be taken with a grain of salt) claimed that fat and cholesterol where the cause of cardiac and health issues. The media took it and went wild with it and everyone changed the way they ate. What did we replace the fats with? Carbs, lots and lots of carbs and high fructose corn syrup (the generic replacement of sugar cane). I saw a presentation where an M.D (who is pro high fat, low carb diets and has successfully treated his clients who are diabetic, overweigt, etc.) showed data collected on the obesity rate in the U.S starting in the 1980's. It showed only a handful of states that had a >10% obesity rate, and low and behold we replaced fats in our diets with carbs and it showed the rates from then til somewhere in the 2000's and we are now at around half the states being >30% obese, and no state being under >10%. Yet "they" say it's FATS that are making us fat, hmmm.

    And before you argue that people are getting more fats in their diets, that's a load of bologne, just read labels. I do it all the time trying to find "healthy" stuff to eat (found that's a waste of time, because if it comes in a package, it's not going to be healthy...if it's low sugar they add more salt and sugar substitutes, if it's low salt they add more fat. I can by canned corn that has no added salt, or I can buy it with no added sugar, but I can't buy it without both). Carbs are in everything and I don't just mean a little, I'm talking 15 to 45 grams or more in a serving! And fat is usually minimal, surprisingly, reese's cups for example has twice as many carbs as fat per serving. Look at a big mac meal at mcdonald's...it's 56% carbs, then 35 % fat (unhealthy fats at that) and a minimal amount of protein at 9%. But everyone clings to the idea of the fat issue, not looking at all the additional carbs that a person gets throughout the day with donuts, cereals, icecream, sandwhiches, bread with dinner, etc.

    The Primal diet (many different versions, and it's not Atkins) is something I am have been researching lately. I am overweight and have tried so many different diets and none work. I can go to the gym for hours and kill myself til I can barely walk the next day because I enjoy working out. I have lost 20lbs here and there but it never sticks. But I refuse to give up. If the advice I am getting is not working and is not adding up then it's time to switch it up. I had always heard bad things about the Primal diet (not a high protein diet but a high fat, mod protein, low carb diet) until I started looking into it myself. It is hard to wade through all the false information, but I have looked up research studies, listened to M.D's, Ph.d's, etc who are pro on this diet and if I consider Occan's Razor, because it makes SENSE to me, then it just might be the right answer. Primal is eating all natural, non-processed or pre-packaged foods, so basically lean meats, healthy fats (avacado, coconut, EVOO, nuts), fresh vegetables and fruits, no added carbs (can get around 100 or so a day and still stay in ketosis). So you still get plenty of fiber, pleny of nutrients. I have started my own garden, bought chickens for meat and eggs, collect the berries the surround my house and bought a blueberry bush. Next year I plan to add even more with an indoor micro greens garden (it's hard to grow lettuce type stuff outside), enlarge my garden, etc; I would love to get a goat for milk and cheese! For the winter I plan to freeze and jar some fruits and veggies. It is saving me a lot of money at the store, because fruits, meats and veggies are expensive (not to forget the pesticides, and my issue with getting food that looks ripe yet doesn't taste like it!), yet I can get a lifetime supply of high fructose corn syrup and carb stuffed products for a fraction of the cost, and we wonder why poor people struggle with obesity and health problems. So this diet also appeals to me in the way that I have always believed that clean, natural foods are healthy, and it gets me back to nature and animals by tending my own garden and farm, which is excercise in itself for mind and body!

    FYI, I had always thought Dr. Atkins had "died from his diet" as we all heard in the media, but in fact slipped on a patch of ice and hit his head and later died from brain hemorrhage complications. His medical report listed that he had a "history of heart disease and HTN", which he did...he had a HISTORY of these conditions, which is why had started the Atkins diet. The physician treating him at his death said he was in excellent condition, no clogged arteries, etc were found on his autopsy. Crazy what we hear and believe til we find out for ourselves, huh?
    Last edit by Pets to People on Jun 21, '12
  13. Visit  not.done.yet profile page
    #25 2
    Atkins works beautifully when done correctly. Sadly few actually read the book, which stresses HEAVILY the importance of vegetables and fruits. Most people just start eating bacon and steak, don't eat any vegetables at all, don't bring fruit back in after the initial two week period the way they are supposed to....and then get sick and say Atkins is a failure.

    I lost all my weight on Atkins. I have kept it off 10 years now. Atkins is basically a whole foods diet. You go extreme to kickstart and then gradually reintroduce the body to whole foods. And nobody should be eating much bacon on it. At all.

close