Fat Prejudice and Obesity
Is obesity stigma preventing you from getting the care you need?
June 2012 — How do you see your doctor? Do you see a person interested and involved in your care? And how does your doctor see you? Does your doctor see you as a person with type 2 diabetes, or as an overweight or obese individual? If he or she does see you as overweight or obese, how does that viewpoint affect your care?
A provocative new article by Sharon Begley discusses the stigmatization of fat in our society. The article outlines a new study that demonstrates how patients' and doctors' views of one another can create problems in care for obese or overweight people with type 2 diabetes.
According to the article, physicians "often spend less time with an obese patient, and do not counsel them about a healthy lifestyle, perhaps believing it would fall on deaf ears." These negative attitudes from doctors and nurses can prevent obese patients from seeking treatment for diabetes, according to a study led by Elizabeth Teixeira of Drexel University College of Nursing and Health Professions.
"Patients are afraid of hearing, 'you're fat,' or 'just lose weight,' as if it were that easy," said Teixeira, a nurse practitioner specializing in diabetes. "I've had patients tell me they delay seeking care, even having their blood pressure or glucose checked, because they don't want to be lectured."
As if that isn't bad enough, the article also cites a 2010 study from Johns Hopkins University that found that the more overweight a patient, the more likely a doctor is to assume he or she is not taking medications as prescribed. Other studies have shown that this assumption may keep physicians from prescribing the necessary medications to these patients.
Clearly, this is a state of affairs that must be changed.
The first step may be to work on the widespread stigmatization of people who are overweight. Society focuses on individual responsibility for weight gain, making obesity seem like a result of laziness or a lack of discipline. In fact, contrary to the belief that losing weight is simply a matter of eating less and moving more, the prestigious Institute of Medicine has recently reported that the best way to stop the obesity epidemic is to change the eating environment. One way to fight obesity may be to limit the availability and marketing of calorie-dense food. We could also make lower calorie foods more generally available and provide more opportunities for exercise in schools and the community at large.
The second step is to start working to fight our society's prejudice against the obese. Studies have shown that children as young as three are already making assumptions about why people are fat and the "character flaws" that lead to weight gain. This means we need a concentrated re-education plan to make fat stigmatization as unacceptable as other types of prejudices.
The third step is to take responsibility as patients at an individual level. This means knowing that these prejudices exist, but refusing to take second-class care. Insist that your doctor evaluate you as carefully as other patients, and don't avoid getting needed tests. Denial only works until it doesn't.
The bottom line of this issue is simple: No matter what a person's size, they deserve equal respect. Medical professionals, who, frankly, should know better, should particularly observe this dictum.
It's past time to look at every patient as someone who deserves equal consideration and equal care. The very health of our nation depends upon it.
dLife's Viewpoints columnists are not all medical experts, but everyday people living with diabetes and sharing their personal experiences, most often at a set point in time. While their method of diabetes management may work for them, everyone is different. Please consult with your diabetes care team before acting on anything you read here to find out what will work best for you.
1 – Begley, Sharon. 2012. Insight: America's hatred of fat hurts obesity fight. Reuters. http://www.reuters.com/article/2012/05/11/us-obesity-stigma-idUSBRE84A0PA20120511 (Accessed 6/2012).
2 – Teixeira, Elizabeth. 2011. The effectiveness of community-based programs for obesity prevention and control. Patient Intelligence 3:63-72.
Whole Wheat Citrus Biscuits Mustard-Carrot Salad Garlic Spinach Pumpkin Splendor (Spread) Broccoli & Cauliflower Stir-Fry Cold Corn Salad Pork Olé Salad with Roasted Pumpkin Seed Dressing Lemon Angel Food Cake Bars Asian Vegetable Salad Fruit Kabobs
As I mentioned in an earlier post, one of the benefits that made it cost-effective for me to go with the real healthcare (HSA) plan rather than the phony (HRA) plan is that my company is now covering "preventative" medicines at $0 copay. The formulary for these, as stated by CVS/Caremark (my pharmacy benefits provider), covers all test strips, lancets, and control solutions. I dutifully get my doctor to write up prescriptions for all of my testing needs, submit...