Wednesday, August 20, 2014

Obesity Stigma in Health Care Education

I'm sure I sound like a broken record.

Even though I'm not a physician, I regularly get emails about continuing medical education and "diagnosis of the week" challenges. This one was brought to my attention by a colleague, however.

Here's the email:

It's perfectly acceptable to present an accurate image, even if we don't like it, in medical education. However, there are multiple images available of the rash, including the arm. The image of the large stomach, cropped to ensure the breast is hanging over is the one chosen.

Most correctly identified the diagnosis--erythema ab igne. However, they are then presented with a menu of options for the underlying cause of the diagnosis:

Of course obesity is one of the options. It's an obvious physical characteristic of the patient, even though the patient is otherwise healthy.

But here are the responses by the community (green is correct): 

Most of the doctors respond that obesity is the underlying cause of a relatively uncommon condition that many could identify. Obesity is NOT the correct answer.

This kind of subtle (or overt, depending on your perspective) discrimination against people who are obese is what those people have long claimed to experience in health care. Nearly half of doctors would have told this young man to go lose weight, completely ignoring the real cause of his problem.

Many people with obesity deal with this regularly. While many health complaints may be related to obesity, few, if any, are directly caused only by obesity and nothing else. Obesity may contribute to the severity of some conditions, but many health problems of people with obesity are completely unrelated.

I've often heard people say that the perception of stigmatization in health care is just a perception secondary to a sensitivity towards being judged. But the kind of evidence above, where obesity is blamed when it shouldn't be, tells me that this bias is real. When in doubt, it's easy for doctors to fall back on the most obvious "problem" to fix. This is certainly not the case for all doctors--I know many who work hard to specifically NOT allow such bias to creep into their work.

I hope more doctors will start to realize the danger of blaming obesity for too many health ills. Obesity is incredibly difficult to change, especially without substantial resources unavailable to many. Focusing on health improvement will yield far more successful results.