19 votes

How 'fat shaming' from doctors is leading to misdiagnoses for obese patients

35 comments

  1. [13]
    vakieh
    Link
    What absolute crap. Smokers, alcoholics, hell addicts of pretty much any kind get the moral treatment and will find doctors routinely pointing at the elephant in the room and saying 'deal with...

    with obesity being the only non-transferable disease doctors routinely "moralize."

    What absolute crap. Smokers, alcoholics, hell addicts of pretty much any kind get the moral treatment and will find doctors routinely pointing at the elephant in the room and saying 'deal with that, then get back to me'. If you were allergic to dairy, but kept eating dairy products, the doctor isn't going to listen to you if you tell him about your gastric problems, even if it turns out you had stomach ulcers or something. That's the reality of heuristics and pareto that allow us to be far more efficient with how we allocate scarce resources.

    With very, very limited time available to spend with patients, why wouldn't a doctor prioritise those people who they think will do better with that time? We make it explicit for things like organ transplants (if you are obese, your odds of being selected are pretty much zero), but it's somehow unacceptable for other limited resources?

    "I think family doctors can fairly ask patients if they themselves have any concerns about the impact of their weight on their health or their quality of life. If the answer is no, then I think we should respect the patients," he said.

    If your job is to make someone healthy, and you as an educated, experienced healthcare practitioner know something is unhealthy, why would you require any input at all from the patient before making your recommendation? Their part of it comes from deciding whether they want to do anything about it, the same as someone with a broken leg is allowed to ignore recommendations about it. However, if someone with a broken leg said 'I'm going to ignore your recommendations, but could you stop my leg from being so sore?' - chances are pretty good you're not going to send them in for an MRI to find that bone cancer.

    18 votes
    1. [6]
      Gaywallet
      Link Parent
      Except addiction is a mental disease which is treated by the healthcare system. The appropriate treatment for a patient is to refer them to a specialist if they're unable to control their...

      Smokers, alcoholics, hell addicts of pretty much any kind get the moral treatment and will find doctors routinely pointing at the elephant in the room and saying 'deal with that, then get back to me'. If you were allergic to dairy, but kept eating dairy products, the doctor isn't going to listen to you if you tell him about your gastric problems, even if it turns out you had stomach ulcers or something. That's the reality of heuristics and pareto that allow us to be far more efficient with how we allocate scarce resources.

      Except addiction is a mental disease which is treated by the healthcare system. The appropriate treatment for a patient is to refer them to a specialist if they're unable to control their behavior.

      This mindset is precisely the reason why many fields of medicine are decades behind other fields, especially weight loss. Why do you think obesity is such an epidemic in the united states, and not other countries? Clearly telling overweight people to just "lose weight and come back" isn't helping. Surprise surprise, nearly all of these people have already tried to lose weight and were unable to. Like addicts, they can't seem to find a way forward without relapsing into prior behavior (again, surprise surprise, we're finding more and more genetic markers, just like addicts, that support this).

      12 votes
      1. [3]
        Comment deleted by author
        Link Parent
        1. [2]
          Gaywallet
          Link Parent
          Weight loss science as a whole is headed this direction, but just like addiction science it's been a slow, long, hard fought battle. It's easy for people to dismiss behavior that doesn't match...

          Weight loss science as a whole is headed this direction, but just like addiction science it's been a slow, long, hard fought battle. It's easy for people to dismiss behavior that doesn't match with their own, especially when said behavior has some bad consequences.

          Maybe within the next 10-20 years we'll see some actual treatments, but right now we're basically just shooting in the dark.

          3 votes
          1. [2]
            Comment deleted by author
            Link Parent
            1. Gaywallet
              Link Parent
              Luckily for us, genetics is a hot topic science right now and weight loss is a gigantic industry. Both genetics and pharma research are both rushing to find aberrant biomarkers and drugs to "fix"...

              Luckily for us, genetics is a hot topic science right now and weight loss is a gigantic industry. Both genetics and pharma research are both rushing to find aberrant biomarkers and drugs to "fix" the issues they present.

              You're absolutely right, however, that weight loss science is a field which is very unique, in that nutrition science has been absolutely fucked by it's involvement with politics. Prior to the food pyramid, doctors did not have a recommended diet or spread of nutritional sources other than to say "eat a varied diet". They were forced into a narrative that was not backed up by science and it eroded trust in the system, opening it up to anyone who could present an "alternate truth".

              Unfortunately this hill to climb is going to take a long time to tackle, especially since genetic profile seems to be one of the major contributors to which macros are best for any one individual. I expect to see genetic profiling used to tailor a diet, soon, and likely by corporations selling a product (which will likely be of poor quality) before it is doctors prescribing a diet.

              2 votes
      2. [2]
        pseudolobster
        Link Parent
        Just an anecdote, but in my experience I've had plenty of doctors refuse to help me because I smoke. I think I have COPD, or some form of chronic pneumonia. I've had trouble breathing for decades...

        Just an anecdote, but in my experience I've had plenty of doctors refuse to help me because I smoke. I think I have COPD, or some form of chronic pneumonia. I've had trouble breathing for decades now, but no doctor has ever diagnosed me. They just tell me to stop smoking.

        So, in my case anyway, addiction isn't something they treat. They just tell me to stop smoking then come back. I've tried quitting smoking, it's really fucking hard. I know there are various expectorants, bronchiodilators etc they could prescribe me to make my life less miserable, but instead they treat me like a waste of human life, a drain on society, and tell me to go away and stop bothering them.

        So, yeah. Addiction is a mental health issue. Perhaps in a lot of cases, so is obesity. In any case, doctors need to be taught compassion, stop just dismissing people, get to the root of the cause. This is not specific to "fat shaming", but is an endemic problem in the medical field.

        5 votes
        1. Gaywallet
          Link Parent
          They absolutely should not be treating you this way. I don't mean to imply you haven't already tried many things, but I would heavily encourage you to directly ask your doctor for a referral to a...

          They absolutely should not be treating you this way. I don't mean to imply you haven't already tried many things, but I would heavily encourage you to directly ask your doctor for a referral to a specialist any time they tell you to do something you've already tried to do and were unable to make significant progress. They often make money off those referrals, so it shouldn't be too difficult to get one (gotta play the financial incentives).

          Most entities have some form of feedback as well - typically post visit questionnaires. If you ever receive one of these after a visit like that, I would highly suggest filling it out negatively with lots of detail and contact information. In fact, even if you don't receive one, call up the office and ask to speak with a clinic manager and talk about your issue. Chances are that they, or someone else in the office, will have a lick of compassion (or simply good medical practice) and figure out a way to get you actually treated. If you're lucky, they might even educate the doctor and this might not happen again in the future.

          2 votes
      3. Catt
        Link Parent
        Thank you! I think this sums up my issues with doctors that pass the buck like in the article.

        Clearly telling overweight people to just "lose weight and come back" isn't helping.

        Thank you!

        I think this sums up my issues with doctors that pass the buck like in the article.

        1 vote
    2. Catt
      Link Parent
      I believe this is the core of the issue. A doctor's job isn't just "to make someone healthy", if that were it, why deal with terminal or chronic patients at all? And I'm not sure that it's your...

      If your job is to make someone healthy, and you as an educated, experienced healthcare practitioner know something is unhealthy, why would you require any input at all from the patient before making your recommendation?

      I believe this is the core of the issue. A doctor's job isn't just "to make someone healthy", if that were it, why deal with terminal or chronic patients at all? And I'm not sure that it's your intention, but your phrasing implies that if you're overweight you're not worthy of any medical advice or treatment.

      Communication and trust is super important between doctors and their patients. I'm not fat, so I don't run into the same issues here, but as a woman I've definitely had concerns about my health ignored or washed away as being "pregnant", which I wasn't. Ultimately, I don't believe a doctor can properly do their job without input from their patient, they simply will be lacking information.

      5 votes
    3. Klame
      Link Parent
      Yeah this article is a good one. I like how medical advice is being transformed as "being mistreated". If you can't face the fact that you are unhealthy as hell and that you should drastically...

      Yeah this article is a good one.

      "If you delay seeking treatment or delay seeing a physician because you're afraid of how you will be judged or treated in the office, that would extend itself to every area of medicine,"

      I like how medical advice is being transformed as "being mistreated". If you can't face the fact that you are unhealthy as hell and that you should drastically change your eating habits to avoid a gigantic list of health issues, you shouldn't go and see a doctor and only live in your fantasy. Because it's going to be his job to tell you that.

      I actually wonder what is the percentage of obese people for which their top health concern shouldn't be their weight and its secondary effects.

      3 votes
    4. [4]
      patience_limited
      Link Parent
      I have personal reason to say that this is a facile explanation which excuses a great deal of bad behaviour, cruelty, and incompetence from "educated, experienced healthcare practitioners". My GP...

      I have personal reason to say that this is a facile explanation which excuses a great deal of bad behaviour, cruelty, and incompetence from "educated, experienced healthcare practitioners".

      My GP prescribed a medication which caused a 15-kg weight gain in 4 months. I hadn't been overweight before taking it, my weight hadn't varied by more than a kilo for a decade. I begged to be taken off the drug, but it required medically supervised taper and the doctor told me "just eat less and exercise more".

      I switched physicians and medications, but the weight remains despite controlled diet and exercise. It's a terrible pain to get competent care, without the judgement that this is solely my responsibility to fix, and something I did to myself through laziness or lack of discipline.

      I have nothing but sympathy for others who can't arrange their lives around weight control, who have underlying health issues that caused their weight problems in the first place, who can't afford healthy food, or are living such stressful lives that eating is their primary relief.

      It's time that doctors acknowledge their role is harm reduction and relief of suffering, not forcing "health" down our gullets as quickly and profitably as possible. We're all going to die from something, and it's inexcusable that obese people can't have their immediate health concerns addressed compassionately because the doctor wants an easier job.

      1 vote
      1. [3]
        Catt
        Link Parent
        It's just awful that you had to experience that. Doctors really should be more compassionate and practice more harm reduction. I know it's not the same thing at all, amd I'm not at all trying to...

        It's just awful that you had to experience that. Doctors really should be more compassionate and practice more harm reduction.

        I know it's not the same thing at all, amd I'm not at all trying to equate your experience to this, but I have a cat that was sick and her meds basically doubled her weight. I asked the vets about it and was told to ease up on her food. I more than halved her food and she was still gaining weight. Before that I never imagined how much meds can affect someone's weight.

        Thanks for sharing your experience.

        1. [2]
          patience_limited
          Link Parent
          Prednisone is the riot gun of medicine - it has no isolated system as a single target, and GPs can be very injudicious in overprescribing it, without being aware of consequences like weight gain....

          Prednisone is the riot gun of medicine - it has no isolated system as a single target, and GPs can be very injudicious in overprescribing it, without being aware of consequences like weight gain. Not only was too much given for too long, it wasn't the currently recommended course of treatment for the condition.

          There are a number of medications that have weight gain among their potential side effects - steroids, anti-histamines, seizure medications, psychoactive drugs (antipsychotics and antidepressants), blood pressure medications, and so on. Mechanisms of appetite regulation and intrinsic propensity to be active are very poorly understood, so it's hard to say who will be affected and how.

          Not all experts are expert, and the failure to recognize iatrogenic contributions to obesity is just one of the problems in healthcare.

          2 votes
          1. Catt
            Link Parent
            Prednisone was what my cat was prescribed! And she was on too high a dose for too long. A different vet actually dialed it back a while later and her weigh dropped naturally.

            Prednisone was what my cat was prescribed! And she was on too high a dose for too long. A different vet actually dialed it back a while later and her weigh dropped naturally.

            1 vote
  2. [16]
    demifiend
    Link
    I'm not surprised. Every time I see a doctor it's the same damn song: "You really need to lose weight." Do they ever ask why I'm such a grotesque lardass? No. They just assume I eat too damn much....

    I'm not surprised. Every time I see a doctor it's the same damn song: "You really need to lose weight." Do they ever ask why I'm such a grotesque lardass? No. They just assume I eat too damn much. Maybe that's the case, but again, do they ask why? No. They don't care. They see a fat guy and figure I'm not worth the effort. Likewise when I've sought psychological help to address the root causes of my tendency to overeat. The shrinks just see a fat dude, and assume that I'm not worth helping. At most they'll prescribe an antidepressant that doesn't do anything but make it impossible for me to come. As a result, I don't bother seeing the doctor unless I'm actually sick and it hasn't gone away after a week. Why should I, when I know how the visit's going to turn out?

    9 votes
    1. [4]
      F4iR33
      Link Parent
      I have to say I've had similar experiences. As a larger woman, the first thing any doctor tells me is I should work on my weight. Never asking me if I already am or if I am trying. And god forbid...

      I have to say I've had similar experiences. As a larger woman, the first thing any doctor tells me is I should work on my weight. Never asking me if I already am or if I am trying. And god forbid I go in for foot or leg pain, then it's just because my legs are carrying all my weight. Nope, turns out I broke my foot when a hammer dropped on it last Christmas. But thanks, now I know I have to find ANOTHER doctor who will actually listen to me.

      Although I will say I have found decently good therapists to help me work through it, as opposed to your experience. But having been to many over the years, therapists are a dime a dozen. You really gotta shop around to find one that works for you. If the first couple just overlook you because of your weight, they aren't good therapists anyways. And believe it or not, there are TONS of bad therapists out there.

      9 votes
      1. [2]
        Gaywallet
        Link Parent
        This is the exact reason that I got into medicine. As a child, I had a bunch of shitty therapists. There was maybe one among dozens who even gave half a shit about what I had to say. Most just...

        believe it or not, there are TONS of bad therapists out there.

        This is the exact reason that I got into medicine. As a child, I had a bunch of shitty therapists. There was maybe one among dozens who even gave half a shit about what I had to say. Most just cared whether my parents were happy with the results, and ignored my input.

        7 votes
        1. demifiend
          Link Parent
          I saw a dozen different shrinks as a kid, and not one of them actually listened to a word I was saying until I paraphrased the Pyramus & Thisbe myth out of Bulfinch as my "plan" for committing...

          Most just cared whether my parents were happy with the results, and ignored my input.

          I saw a dozen different shrinks as a kid, and not one of them actually listened to a word I was saying until I paraphrased the Pyramus & Thisbe myth out of Bulfinch as my "plan" for committing suicide. Then they got really interested. Fortunately, my parents knew I was trolling the shrinks.

          3 votes
      2. demifiend
        Link Parent
        First, I'd need to find a GP/internist who isn't a complete waste of ammo. Then maybe I can ask if they know any therapists who are worth a damn. And, to be honest, I don't see why I should...

        You really gotta shop around to find one that works for you.

        First, I'd need to find a GP/internist who isn't a complete waste of ammo. Then maybe I can ask if they know any therapists who are worth a damn. And, to be honest, I don't see why I should bother.

        At this point I'd just be trying to take care of myself so I can live longer, but why should I want to live longer? Every year I add to my lifespan is another year I'll have to spend making rich assholes richer in order to justify my continued existence.

        I'm not interested in living longer. I'm just not willing to kill myself outright, because then the bastards would win.

        2 votes
    2. [2]
      Catt
      Link Parent
      That's just terrible. Ultimately, I believe it is part of the doctor's job to have compassion, which I think is just part of being a professional. Also being a professional - properly diagnose...

      That's just terrible. Ultimately, I believe it is part of the doctor's job to have compassion, which I think is just part of being a professional. Also being a professional - properly diagnose issues and offer solutions. There's a difference between being frank and being negligent.

      How would this apply in a different scenario - oh you didn't get vaccinated, so don't come to me about any coughs or running noses?

      5 votes
      1. demifiend
        Link Parent
        It wouldn't fly, but it's still "OK" to look down on fat people.

        It wouldn't fly, but it's still "OK" to look down on fat people.

        2 votes
    3. [7]
      Gaywallet
      Link Parent
      What a shitshow. I'm sorry doctors have treated you this way. I know I'm probably singing to the choir, but have you asked to see a nutritionist or a weight specialist? GPs and psychiatrists...

      What a shitshow. I'm sorry doctors have treated you this way. I know I'm probably singing to the choir, but have you asked to see a nutritionist or a weight specialist? GPs and psychiatrists probably have it worst of the doctors in terms of pressure to see more patients in less time, and often gloss over issues or ignore them completely.

      3 votes
      1. [6]
        demifiend
        Link Parent
        Used to see a weight specialist. He put me on amphetamines to curb my appetite. It helped, but the speed made me much more aggressive, and I ended up getting fired when I told a boss who asked me...

        I know I'm probably singing to the choir, but have you asked to see a nutritionist or a weight specialist?

        Used to see a weight specialist. He put me on amphetamines to curb my appetite. It helped, but the speed made me much more aggressive, and I ended up getting fired when I told a boss who asked me why I wasn't taking phone calls after 6PM that it was none of their business and that they should go fuck themselves with a rusty bazooka.

        Basically, I'm fat because I eat my emotions.

        3 votes
        1. [4]
          Gaywallet
          Link Parent
          Oh man, that's really like the worst possible side effects of a medicine. It's unfortunate because losing your job likely meant losing your health coverage, so you couldn't go back and say "lets...

          Oh man, that's really like the worst possible side effects of a medicine. It's unfortunate because losing your job likely meant losing your health coverage, so you couldn't go back and say "lets try something else".

          I eat my emotions too, I just lucked out and eventually found what worked for me before it got too bad. I don't know if you're at a point in your life where you can give it a try again, but I would suggest going back to a weight specialist and seeing if you can try something else. If you're worried about potentially losing another job, you could tell the specialist about your experience and pay extra attention to potential side effects of any drugs they might prescribe.

          3 votes
          1. [3]
            demifiend
            Link Parent
            Not right now. I've got a solid job, but my wife is fighting breast cancer and I need to focus on her.

            I don't know if you're at a point in your life where you can give it a try again, but I would suggest going back to a weight specialist and seeing if you can try something else.

            Not right now. I've got a solid job, but my wife is fighting breast cancer and I need to focus on her.

            1 vote
            1. [2]
              Gaywallet
              Link Parent
              Could your luck get any worse? I'm sorry to hear this, and wish her (and you!) the best.

              Could your luck get any worse? I'm sorry to hear this, and wish her (and you!) the best.

              1 vote
              1. demifiend
                Link Parent
                Of course it can. I could also have cancer, it could be advanced and inoperable, and I could be unemployed, uninsured, and broke. Compared to a lot of people I've got it pretty fucking easy. My...

                Could your luck get any worse? I'm sorry to hear this, and wish her (and you!) the best.

                Of course it can. I could also have cancer, it could be advanced and inoperable, and I could be unemployed, uninsured, and broke.

                Compared to a lot of people I've got it pretty fucking easy. My wife is in her early, early 40s. We found a lump, promptly got it checked out, and learned it was a Stage I tumor. The doctors are confident they got everything out in the mastectomy, and everything they're doing to her now is to reduce the risk of recurrence.

                I'm sorry to hear this, and wish her (and you!) the best.

                Thanks.

                1 vote
        2. [2]
          Comment deleted by author
          Link Parent
          1. demifiend
            Link Parent
            Thanks, but I had bad experiences with Ritalin as a kid. The public school system insisted I had ADHD and that I needed to be on Ritalin, but it only made me worse.

            Thanks, but I had bad experiences with Ritalin as a kid. The public school system insisted I had ADHD and that I needed to be on Ritalin, but it only made me worse.

    4. [2]
      luffy
      Link Parent
      That's sad to hear, is it possible for you to find psychological help from someone who would accept a no-medication approach?

      That's sad to hear, is it possible for you to find psychological help from someone who would accept a no-medication approach?

      1. demifiend
        Link Parent
        You think there's psychological help for... Being a straight man? Being working-class in a capitalist society? Loathing what one does for a living yet being afraid to quit because it pays too well...

        You think there's psychological help for...

        • Being a straight man?
        • Being working-class in a capitalist society?
        • Loathing what one does for a living yet being afraid to quit because it pays too well and other work might be just as shitty?
        • Having no meaningful ties to a non-internet community?
        • Having no friends beside one's spouse and no inclination to reach out to other people outside the internet?

        I have a pretty good handle on what's wrong with me.

        2 votes
  3. [2]
    Pilgrim
    Link
    I have the opposite view as some of the other posters and value forthrightness from doctors. It's not a doctor's job to change anyone's lifestyle; just to inform us of the risks of our choices....

    I have the opposite view as some of the other posters and value forthrightness from doctors. It's not a doctor's job to change anyone's lifestyle; just to inform us of the risks of our choices.

    EDIT: That said, doctor's should explore all reasonable causes of an issue and not just point to weight as the root cause when it may be just a contributing factor. That this lady died without anyone checking deeper is sad. The healthcare system in the US it terribly broken and her story reminds me of every encounter I've had with a doctor over the last 10 years in the U.S., not because of any weight issues, but because doctors rarely seem to take patients into account at all, it's just x symptom = common treatment.

    9 votes
    1. Catt
      Link Parent
      The part about doctors rarely taking patients into account is too true, and is unfortunately not unique to this case.

      The healthcare system in the US it terribly broken and her story reminds me of every encounter I've had with a doctor over the last 10 years in the U.S., not because of any weight issues, but because doctors rarely seem to take patients into account at all, it's just x symptom = common treatment.

      The part about doctors rarely taking patients into account is too true, and is unfortunately not unique to this case.

      3 votes
  4. [2]
    GoingMerry
    Link
    I think one of the underlying issues is how doctors are compensated in this country. Most family and clinic doctors are incentivized to get people out the door as fast as possible, and therefore...

    I think one of the underlying issues is how doctors are compensated in this country. Most family and clinic doctors are incentivized to get people out the door as fast as possible, and therefore usually want to give you the next fastest step in the process without really listening to your history. Add to that the stretch of health care resources due to an aging population, and you get sub-optimal outcomes in lots of situations, not just for obese patients.

    The study linked to in the article recommends more training for doctors dealing with obese patients. It makes sense given the prevalence of obesity, but I wonder if it's missing the larger issue.

    6 votes
    1. Gaywallet
      Link Parent
      While this is absolutely true, weight loss science is still in its infancy. We know that eating less calories than you expend is how you lose weight, but we don't have good protocols on how to get...

      While this is absolutely true, weight loss science is still in its infancy. We know that eating less calories than you expend is how you lose weight, but we don't have good protocols on how to get a particular person to actually do this and to not relapse.

      I'm not sure that spending more time with the patient to hear them simply state "I can't stick to a diet" is going to help, if we don't have a protocol that will get them to stick to a diet. Our best bet right now is to keep prescribing them different diets until we find one that works (if it ever does) or send them to a psych to work on behavior modification via CBT or another method. These are poor solutions to a complex problem.

      2 votes
  5. [2]
    vegetablesupercargo
    Link
    What I'd be curious to see is numbers on whether doctors misdiagnose obese patients more often than a control sample. The articles links to a study that says doctors spend less time with obese...

    What I'd be curious to see is numbers on whether doctors misdiagnose obese patients more often than a control sample.

    The articles links to a study that says doctors spend less time with obese patients and run screening tests less often. On the other side, presumably, is that obese patients are more likely to have their weight be a causal factor in their health problems, as compared to the general population. But how much more likely? Without numbers, it's hard to say how it shakes out on balance.

    I agree with @GoingMerry that I think this is a bigger health administration issue. The doctor's not there to be your friend or even, sadly, to make you healthy, necessarily. From a public administration issue, the doctor's there to be efficient and save the province resources. On-call hours are resources, and screening tests are resources.

    1 vote
    1. Catt
      Link Parent
      I am always interesting in solid numbers too. Wasn't able to really find any though :(

      I am always interesting in solid numbers too. Wasn't able to really find any though :(