Prejudice Against Overweight Patients: An Issue To Ponder

[TheCommuter]

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 and obese people are the most frequent targets. Weight discrimination occurs in families, hiring practices, schools, places of business, the media, and healthcare settings.

Yes, I said it. I have opened the can of worms. Many healthcare professionals harbor prejudices against overweight patients. Some of these biased people are remarkable in their abilities to keep their negative feelings in the closet, while others are more vocal about their animus toward people who have excess body fat.

Some physicians are notorious for their unfavorable attitudes toward overweight patients. In 2003, researchers at the University of Pennsylvania surveyed more than 600 primary care doctors and found that more than half viewed obese patients as awkward, unattractive and noncompliant (Ulene, 2010). Furthermore, a Yale study of 2,449 overweight and obese women, published in 2006 in the journal Obesity, found that they identified doctors as one of the top sources of negative comments about their weight (Rabin, 2008).

A number of nurses are appalled by overweight patients, too. A 2006 review of research focusing on nurses' attitudes toward adult overweight and obese patients reported that nurses consistently express biased attitudes toward obese patients, reflecting common weight-based stereotypes that obese patients are lazy, lacking in self-control, and noncompliant (Puhl & Heuer, 2009).

How does weight discrimination affect patients in the healthcare setting? Well, the effects can be rather detrimental because overweight patients may avoid seeking care due to the fear of being shamed or ridiculed. Several obese patients said in interviews that they went to see a doctor only when it was unavoidable and often left feeling that they hadn't gotten the help they needed (Rabin, 2008).

Are there any solutions to the issue of prejudiced attitudes against overweight patients? First, the healthcare provider must acknowledge that they have a bias. After all, a person cannot expect to solve a problem if he/she has not yet identified one. Secondly, the healthcare professional needs to practice the interpersonal skill of being nonjudgmental. Finally, the Golden Rule is applicable when interacting with patients: treat people in the same manner that you would want to be treated.

Weight discrimination is a significant issue in healthcare settings and in society as a whole. Together we can strive for equal treatment of our overweight patient populations. Although attitudes do not change overnight, the small changes that we make can snowball into profoundly positive results.

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[Stephalump]

Actually, it would fall under Eating Disorders, Not Otherwise Specified, or Binge-Eating Disorder.

As someone with a plethora of experiences involving psychology and eating disorders, I would absolutely be shocked if I came across a morbidly obese person who was not diagnosed with an eating disorder, barring some sort of other obvious medical condition.

[edmia, BSN, RN]

Oh get real. Stating that many/most obese are addicted to food like a crack addict is to crack is ok but defending that personal experience plus what you see on tv is not absolute fact is "hurtful" and I need "education"

Food addiction is not in the DSM IV but cocaine addiction is 304.20

There's many pathways to being obese but to say many people are x and many people are y without reliable data to back it up is incorrect. Observation is the least reliable scientific method.

It sounds like you have an intolerance to carbs not an addiction. I have a significant background in nutrition because thats what I was studying to be before I switched to being a nurse. The basic fundamental is you need to met people where they are at and not making sweeping assumptions and judgements which is the entire point of this thread.

And yes I accidently switched my verbs around on the excess/deficit but missed the edit deadline.

Sounds to me like your only interest is in being correct instead of being open to different ideas. Kind of goes against the point you're trying to make, doesn't it?

We're having a discussion, I don't have time to cite my opinions but there is proof out there regarding the general bad nutrition of the human race today when compared to the biological makeup of our gut.

And nutritionists do not know everything as they are limited by their western medical training model.

Peace out.

[tothepointeLVN, LVN]

It's passing off opinion as fact that I object to. This is WHY there are prejudices against obese people. If you can't see that then no amount of persuasive argument is going to change your mind.

ED NOS might be correct for some people, morbidly obese people in particular but think the numbers would be fewer than you think. In any case ED NOS ≠ Addiction.

[rubato, ASN, RN]

Just because you were in school for nutrition doesn't make you an expert. I am a certified personal trainer and a nutritionist, but I don't claim to be an expert.

I also don't think anyone but you is making these blanket statements. Being overweight is not the same thing as being a minority. A lot of overweight people are making the decision to overeat. I don't know any minority race that made the decision to be so. And, I don't like the fact that we're mixing up discrimination with concern for health.

Binge eating is in fact a disorder. And, a lot of my clients were binge eaters. They would work their butts off exercising to try to lose weight only to go home and lose all their hard work with their diets. It made them miserable and I felt horrible for them.

[Pets to People]

What I am seeing on this thread is something that is very common in my experience with health care providers and exactly the kind of prejudice that affects their healthcare: someone tells you what the eat, their level of activity, their experience with various diets and the immediate reactions is "Yeah, right....". The assumption is always that they are lying, that they couldn't possibly be doing all that and still be overweight.

QUOTE]

You know, after I logged off last night I realized that I never mentioned that although I overeat often to the extreme, unlike the other poster that only eats 350 or so extra calories a day, but I work out a lot, so my weight gain has been gradual as well. I have slowly added on 10-20lbs a year since the birth of my first child. So we see that there are so many factors to the equation that can affect the outcome.

Yes, I get that reaction a lot too. Someone will be like "There's no way you can eat all that!", or "How can you still be hungry?!" and I am like "You have noooo idea!" But I also know how to kill it in the gym. But that hasn't gotten me back into a pair of jeans in several years. I cry when I try to shop for a pair of jeans, so I just wear work out clothes instead. I can always find a pair of work out sweats to fit me lol. But anyway, hopefully that is about to change with this Paleo diet thing. I am planning to make it a lifelong change, and I don't see any issues with it, because it makes so much sense to me and works great with my lifestyle and way of thinking.

As another poster mentioned about carb cravings...I have had those too, they can make you go mad and leave you shoving half a cake down your throat in no time flat. That's why I do not believe regular diets work, or atleast one of the reasons. You take someone who is addicted to carbs and tell them to just have a little and that's it, look but only taste, one bit is all you need...WHATEVER! Try telling someone hooked on crack to just have a little taste! With the low carbs diet you do not take in any carbs that are not found in fruits or veggies. Once you adjust, you don't have that horribly strong physical craving, sometimes just the mental craving because you remember it as a comfort food. And there is no temptation because it's off the menu. Once your taste buds adapt, fruit becomes super sweet. I can barely eat a whole banana or even an apple because they tastes so super sweet. You should give it a try...do some research on it yourself, pros and cons from all sides...don't just take anyones word for it, collect your info and do your own trial run, but give it all you've got, you can't half ass it cause that will never work no matter what you are trying.

Another thing I was thinking...It could be possible that physicians do not address the issue because they just don't know how to...we think that as physicians they basically know everything. But when it comes to nutrition I believe they have like what, one nutrition class during their whole education? On top of that, there are so many different aspects of nutrition and weight loss and the information changes every year, sometimes several times a year. That's a lot of info to stay current with, especially when they have so many other aspects of human health to stay on top of. So that is why they should refer to those who do know!

[Pets to People]

It sounds like you have an intolerance to carbs not an addiction. QUOTE]

This certainly could be a valid possibility, it makes total sense...as I mentioned in another post, when our cells become desensitized to insulin and cannot absorb the glucose we take in, it is then turned to fat instead and our body tells us to eat more because it has still not recieve the energy it asked for. This could seem like an addiction or craving, when in fact it is just our starving bodies trying to get the only type of fuel we are forcing it to burn, carbs. And no matter how much of it we take in we are never really satisfied. Good point!

[Pets to People]

Actually, it would fall under Eating Disorders, Not Otherwise Specified, or Binge-Eating Disorder.

As someone with a plethora of experiences involving psychology and eating disorders, I would absolutely be shocked if I came across a morbidly obese person who was not diagnosed with an eating disorder, barring some sort of other obvious medical condition.

But of course they would diagnose it as a type of eating disorder. The medical community is notorious for having to put a label on everything in order to validate and understand it. If someone with a degree hasn't given it a name, it can't possibly be anything important or valid. Perhaps it is not an eating disorder, in many cases (not all of course, but quite certainly the majority) but in fact it is that we are trying to force our bodies to survivie on a diet that it was never ment to utilize in the first place and our bodies are very obviously tell us so, with the huge spikes in obesity, diabetes, inflammatory bowel disease, food allergies and so on. We are omnivores by our basic biology, yes, but we are not ruminants, so why do we eat so many grains and make them practically the staple of our diet?

How can, what 50% (or more?) of the US population have an eating disorder? Just think about that for a moment...everything has changed within the last 30 or so years; obesity is a very new epidemic. So what has changed?

[VivaLasViejas, ASN, RN]

What's changed? I can offer several ideas:

1) Portion sizes are larger than they were 30+ years ago. If you're over 45, you can remember when Coca-Cola came in those six- and 8-oz bottles. That was a serving size, and no one got fat drinking a single Coke. They got fat when the Big Gulp came along.

2) We've automated activity practically out of existence. Now we have to do make-work exercises in order to get what used to come naturally with hanging laundry out to dry, chasing kids around, cleaning house, even getting up and changing the TV channel.

3) We are bombarded with ads for fatty, sweet, salty, and otherwise unhealthy foods almost every hour of the day on TV, radio, even online. When was the last time you heard the slogan "Broccoli---it's what's for dinner"?

4) At no time in human history have more foods of so many varieties been available in so many places. You may not be able to find fresh strawberries in the ghetto Safeway, but chances are they carry Mexican entrees and hot pizzas.

5) Today's fast-paced world has created a culture of stress, which in turn has led to higher rates of eating disorders, as well as other psychiatric issues that sometimes require the use of drugs that tend to increase appetite. (Sometime I'll tell you about my Zyprexa experience and the 12 lbs. I've gained in 2 1/2 weeks. Hint: the sofa is starting to look pretty tasty, and I just ate lunch a couple of hours ago.)

6) A very large segment of our population is aging....and with the years come unwelcome pounds, AKA the notorious "middle-age spread".

7) Cheap, plentiful, easily available packaged foods. Need I say more?

[tothepointeLVN, LVN]

Just because you were in school for nutrition doesn't make you an expert. I am a certified personal trainer and a nutritionist, but I don't claim to be an expert.

Binge eating is in fact a disorder. And, a lot of my clients were binge eaters. They would work their butts off exercising to try to lose weight only to go home and lose all their hard work with their diets. It made them miserable and I felt horrible for them.

See what the problem is; is that your mixing the two issues up. As a personal trainer / nutritionist people come to you because they have identified their weight / fitness as an issue to work on and you are the appropriate resource person.

In a patient/doctor interaction as the OP mentioned the patient came for a problem not directly related to weight. It might be a secondary issue or a contributing factor but its not the reason why the person went to the Dr. Advocating for someone's health doesn't give us a right to take a paternalistic stance. Those days are over. I worked as a nurse in a public health services clinic and we had many unhealthy and overweight patients. But you have to be gentle most of the time. Tough love just means they don't come back and then who have you helped really? Them? Or yourself?

[tothepointeLVN, LVN]

What's changed? I can offer several ideas:

Absolutely its primarily an environmental issue. We didn't all suddenly become weak willed over a single generation.

[tothepointeLVN, LVN]

5) Today's fast-paced world has created a culture of stress, which in turn has led to higher rates of eating disorders, as well as other psychiatric issues that sometimes require the use of drugs that tend to increase appetite. (Sometime I'll tell you about my Zyprexa experience and the 12 lbs. I've gained in 2 1/2 weeks. Hint: the sofa is starting to look pretty tasty, and I just ate lunch a couple of hours ago.)

Depakote = 60lbs gain in 60 days

On the flip side Topamax = 14lb lose in as many days but it makes you stupid, your hands tingle and everything tastes like cough syrup but because of society its almost worth it. Almost it made me handwrite my letters backwards.

[Stephalump]

But of course they would diagnose it as a type of eating disorder. The medical community is notorious for having to put a label on everything in order to validate and understand it. If someone with a degree hasn't given it a name, it can't possibly be anything important or valid. Perhaps it is not an eating disorder, in many cases (not all of course, but quite certainly the majority) but in fact it is that we are trying to force our bodies to survivie on a diet that it was never ment to utilize in the first place and our bodies are very obviously tell us so, with the huge spikes in obesity, diabetes, inflammatory bowel disease, food allergies and so on. We are omnivores by our basic biology, yes, but we are not ruminants, so why do we eat so many grains and make them practically the staple of our diet?

How can, what 50% (or more?) of the US population have an eating disorder? Just think about that for a moment...everything has changed within the last 30 or so years; obesity is a very new epidemic. So what has changed?

I understand what you're saying, but I do need to point ours that I was referring to morbidly obese pts, not overweight pts. Morbidly obese pts are the minority. I defer to Viva for the answer to what has changed. A LOT has changed, and it's impacted our waistlines and our health.

As far as the constant medical diagnosing goes, yes, we label everything. But in psychology, we rarely label anything that doesn't cause distress or upheaval to the pt. For instance, homosexuality is no longer in the DSM because it isn't a natural detriment to one's life. Binge-eating is a struggle, a health concern, and can consume one's life. Eating Chinese food for breakfast, pizza for lunch, and BK for dinner, all in typical sizes? That's not a disorder. That's a lot of bad habits.