Tag: medical care

fat · fitness · health · stereotypes · weight stigma

Medical Decisions Still are Sometimes More Art Than Science

Diane Harper2 Comments

This is an anecdote, not a study result so take it for what it’s worth to you.

I needed some prescriptions refilled so I went to my doctor to get the annual testing done to confirm I still had the correct dose. He sent me a message saying that he recommended doubling my cholesterol medication because I am pre-diabetic (I am not) and have a history of heart disease.

I pushed back, pointing out that similar testing had been done at the heart institute three months prior, and the results were well within normal ranges for fasting blood tests. While my non-fasting results at the clinic were a little higher, they were still normal. This led to some back-and-forth about risk factors as a heart patient.

I wasn’t happy with what I was hearing so booked another appointment to discuss in person. I am “lucky” enough to have results of a recent CT scan on my femoral arteries, an angiogram, and a carotid ultrasound. All showed that my arteries are very clear. My heart disease is a mechanical thing that will be fixed with surgery. He admitted he doesn’t normally have access to that level of information so started to shift his approach.

He moved on to lifestyle and how I was possibly still high risk. Eating patterns: near-vegetarian who pays close attention to fibre intake. Exercise: at least 5 hours of moderate to intense movement each week. Weight: yup, it’s heavier than BMI recommendations, but it’s also mostly solid muscle (see previous note on exercise) and it has remained unchanged for over 30 years.

Diane in one of her favourite fat athlete photos. She is wearing a colourful bikini and blue cap. She is holding her orange float for open water swims and posing in the Ottawa River on a grey and cloudy day.

In short, I am a case study on why medical professionals should not rely on weight to judge overall health.

In the end, he agreed that my risk assessment should drop from high to low. My medication will not be changing.

Thanks fellow bloggers, especially Sam and Catherine, for writing so often about this issue and giving me the courage to speak up.

6 things Sam hates about seeing doctors, as a larger person
health · stereotypes · weight loss · weight stigma

6 things Sam hates about seeing doctors, as a larger person

Sam B

None of this is true about my current set of health practitioners. But they took awhile to find. Right now I’m halfway between jobs and cities and I’m looking for a new family doctor to start. It’s tough. And here’s why!

1. They believe ridiculous things about me. See this article about doctors and bias against larger patient. “Much research has shown that clinicians have biases related to overweight and obesity, conditions that affect more than two-thirds of U.S. adults, Dr. Gudzune said. “[With] the magnitude of the effect of obesity in our country, a substantial number of people are experiencing health care disparities as a result,” she said. Studies have consistently shown that physicians associate obesity with such negative attributes as poor hygiene, nonadherence, hostility, and dishonesty, Dr. Gudzune said. “These types of attitudes are pervasive. It’s not just in the U.S. … [but] physicians across the world as well: Australian, Israeli, European physicians. … These attitudes have been documented as far back as 1969, and they continue to persist up until today,” she said. In surveys of primary care physicians, more than 50% view patients with obesity as awkward, unattractive, and ugly, Dr. Gudzune said. “They have less respect for patients with obesity. They also believe that heavier patients are less likely to follow medical advice, benefit from counseling, or adhere to medications, which are some of the things that are really critical in thinking about managing obesity,” she said. She added that these attitudes may extend to other health professionals, such as medical students, nurses, and nutritionists.” Not fun.

2. They prescribe weight loss for everything. The evidence bar is very low. If there’s even a small chance that weight makes a difference, they mention it.

3. They don’t believe my attempts at trying to lose weight. I just haven’t tried hard enough apparently. It’s as if once a have a serious medical reason, like putting off knee replacement surgery, I’ll snap to it, get down to business, and the pounds will just melt away.

4. They don’t have anything useful to say about how to lose weight. See this post on unwanted weight loss advice. “Why do doctors weigh patients and offer weight loss advice? Other than “eat less and move more” which is kind of like the weight loss equivalent of “buy low and sell high,” what recommendations do they make and why?”

5. But they recommend diets anyway even though the most likely outcome is that the patient weighs more at the end. In this post I wonder if doctors would do that with any other “likely to fail spectacularly” treatment. See Well intentioned lies, doctors, and the diet industry: If weight loss is impossible, ctors-and-the-diet-industry-if-weight-loss-impossible-then-what/

6. They never believe my blood pressure readings or my cholesterol levels. I’ve had a complete work up with a endocrinologist who gave me a clean bill of fat health but still, it’s an uphill battle being seen. See this post and this one.

I know Catherine and Nat have blogged here about issues with doctors. I often think, hey we’re all strong feminists with serious amounts of post secondary education and some good attitudes, we’re white, English speaking, able bodied, if we have problems with doctors what’s it like for other women who don’t share our bundle of privileges? If you’re a larger person, what’s the medical world like for you. We want to know.