Healthcare For Overweight Patients: Is It The Same?
Is healthcare for overweight patients the same as everyone else? Join us as our guest contributor, Doctor Jeffrey D. Breckenridge, answers this very important question.
“Hello? Dr. Breckenridge? This is the emergency room… I have an admission for the resident’s floor… blah…blah…blah. On physical exam this guy’s a “Land Whale…”
I remember this conversation with a new ER Physician because this was the first time I had ever heard a patient called “a Land Whale”. What I remember even more vividly was the doctor’s expression when I stepped into the ER to admit the patient. Dr. Breckenridge, Chief Resident and “Fellow Land Whale” striding into the ER at 425 lbs., in my 6XL scrubs!
Some providers and nurses view overweight patients as being unintelligent, lazy, sloppy, weak-willed or even unclean. A study at Yale University showed that, 24 percent of nurses said they are “repulsed by obese persons” (Puhl & Brownell, 2001). Overweight people are made fun of in almost every branch of society; and the field of medicine is not immune to disparaging attitudes towards overweight patients. Being an overweight doctor has in some ways shielded me from some of the venomous remarks made about patients, but regrettably not all. Here are some of the terms used to describe overweight patients:
- Land Whale – Obese patient
- Yellow Submarine – Obese patient with Jaundice from Liver Disease
- “Whopper” with Cheese – Obese woman with a vaginal yeast infection
- “Big Mac” with Ketchup – Obese woman with bloody vaginal discharge
- Patient has the “4 Fs” –Female, Fat, 40 & Fertile (Patient with Gall bladder disease risk factors)
All these are jokingly used throughout medical education in the US. I hear the United Kingdom has their version of reproachful terminology. However, no matter where in the world you are, these terms are indefensible, offensive and rude.
The American Healthcare System needs a “wake-up” call. This is about the plain simple issue of human decency and caring for our fellow man. Currently two-thirds of all American adults are either overweight or obese (Colditz, & Lin, 2015); and to be perfectly upfront, the current healthcare system is not ready for “Fat America.” Between ill-proportioned lobby chairs and wheel chairs; inadequate scales; tiny gowns that won’t cover your ass; CT, MRI and operating tables with maximum weights of 350 pounds; along with wall-mounted toilets that only hold 300 pounds – obese patients definitely do not feel welcome or comfortable.
Obese patients not only feel uncomfortable physically when the equipment is not fitted for them, but they also feel emotionally uncomfortable when they are harassed about their weight. Patients are more likely to postpone appointments and examinations if they feel they will be derided about their weight. Patients have indicated to me that previous providers would address their weight even at acute visits for respiratory infections or other non-obese related issues. They felt picked on and even embarrassed with the same discussion at every appointment.
The level of discomfort to patients is nowhere more prevalent than in Women’s Healthcare to Overweight & Obese Women. Studies from Yale University show overweight women visit the doctor’s office more frequently than “non-obese” women. However, the higher their Body Mass Index (BMI), the more likely they were to be delayed for breast exams, gynecological exams and pap smears (Puhl & Brownell, 2001). Yet, their being overweight did not correlate with delayed mammograms. Why? The examinations where a provider was required to do a personal assessment were delayed either by the provider or by the patient. However, the radiographic test that patients schedule themselves through the hospital was not negatively associated with the patient’s BMI.
Hospitals are facing cost and frustration for remodeling and upgrades to make their facilities service ready, but let’s face it, it’s not because they love us it is because of money. They should be dedicated to providing safe, comfortable, state of the art healthcare to all Americans, not just the skinny ones. It first starts with changing of the attitude; including the language, the name-calling and the provisions for treatment.
What has been your experience? please share in the comment section.
Article was written by Jeffrey D. Breckenridge, MD. Please contact Dr. Breckenridge at firstname.lastname@example.org
Colditz, G.A. & Lin, y. (2015). Prevalence of overweight, obesity in the United States, 2007-2012. Journal of American Medical Association, 175(8), 1412-1413. doi: 10.1001/jamainternmed.2015.2405
Peart, K.N. (2001). Obese people suffer bias from a variety of social sources, including their own physicians. Office of Public Affairs at Yale University.
Puhl, R., & Brownell, K.D. (2001). Bias, discrimination, and obesity. Obesity Research, 788-805.