Doctors who don’t discriminate against obese patients

Written by Lauren Sauser
KHN

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, given what kind of pain he was feeling. But it wasn’t strange coming from this doctor. Every time he went, he’d talk about diet and exercise,” said Boughton, the 34-year-old who lives in Durham, North Carolina.

On this occasion, three years ago, a doctor told Boughton that losing weight might solve pelvic pain. Bring up the topic at least two more times during the date. He said he would order an ultrasound to calm her down.

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

“I hate that doctor for the way she treated me, like my pain wasn’t a big deal,” Boughton said. “He seems to be making a decision about me based on a very sneaky look.”

Melissa Boughton says her gynecologist told her to exercise and diet at least three times during an appointment and acted as if her ovarian tumor diagnosis was “the most normal thing in the world.”

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

Obesity, when a body mass index (BMI) is 30 or more, is prevalent in the South and Midwest, according to the 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 that is linked to a long list of health risks, including type 2 diabetes, heart disease, and some types of cancer. Although obesity is common, it carries a unique stigma.

Physicians often approach the practice of medicine with an anti-lipid bias and do not find it easy to communicate with patients whose weight is above 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 standards for diversity, equity and inclusion in June aimed at educating clinicians, among other things, about treating people diagnosed as overweight or obese with respect.

This doesn’t happen for many patients, said Dr. Scott Butch, MD, director of obesity medicine at the Cleveland Clinic Institute of Metabolism and Obesity. “It’s almost like bad practice… Stereotypes and misconceptions about this disease only seep into clinical practice.”

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

In 2013, the American Medical Association voted to recognize obesity as a disease. But Butch said doctors often approach it on a one-size-fits-all scale. He said “Eat less, move more” doesn’t work for everyone.

“There are many different forms of obesity, but we treat it as if we were giving the same chemotherapy for all cancers,” Butch said.

All but four of 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.

However, research indicates that many physicians around the world are not adequately trained to treat weight problems. A survey conducted by leaders of 40 US medical schools showed that only 10% felt their students were “very prepared” to deal with obese patients. In a 2020 article about the survey, they wrote that expanding education in this area is not a priority.

Butch wants Congress to pass a resolution insisting that medical schools incorporate substantive training in nutrition, diet and obesity.

Many topics should be covered more fully in medical school, said Dr. David Cole, president of the Medical University of South Carolina. “There’s a huge folder, it’s that big,” Cole said, raising his hand up high. “The point is: Things I didn’t learn in medical school.”

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

First, he developed a career readiness test for aspiring medical students, called PREview, which is designed to assess applicants’ cultural competence, listening and social skills, and their ability to analyze situations at hand. It 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 Hawley, 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 scores in PREview along with their entrance exam scores.

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

After discovering the source of Melissa Boughton’s pelvic pain, the same doctor acted as if the tumor was “not a big deal.”

Boughton sought a second opinion from a physician who declared his practice “healthy for all sizes.” This doctor referred her to a surgical oncologist, who removed the tumor, her left ovary, and part of her fallopian tube. The tumor was large but not cancerous. While surgery to remove it was deemed successful, Boughton has since had trouble conceiving and undergoing fertility treatment.

“It’s an emotional rollercoaster,” he said. “I feel too young at 34 to go through this.”

Boughton, who describes herself as “not fit in the BMI box,” said the experience taught her to choose her doctors differently. If the doctor asks if you diet and exercise, I just “start looking for another”.

KHN (Kaiser Health News) is the editorial room of the KFF (Kaiser Family Foundation), which produces in-depth health journalism. It is one of three major programs of the KFF, a non-profit organization that analyzes public health and health issues in the country.

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