Handling medical/doctor visits

La di Da at the Fat-o-matic blog has a good post about going to the doctor for her "pre-employment physical." She includes a link to a letter by Hanne Blank (author of Big Big Love) that inspired her to write her own version to hand to the doctor, have placed in her file, etc.

Read the Fat-o-matic post here, and Hanne Blank's letter here.

Blank's letter is posted on Stef Jones's website along with her Fat Friendly Health Professionals list and Tips on Obtaining Good Health Care, both great resources as well.

Why are these useful? Sadly, many fat women have felt shamed and humiliated by encounters with medical professionals in which their health problems were ignored or appropriate assessment or treatment refused until they lost weight.

Lynn McAfee of the Council on Size & Weight Discrimination wrote in a guest editorial in Healthy Weight Journal that

We are given a diet as a first line of treatment. We are told not to come back until we lose weight, although we all know that weight loss and maintenance is a nearly unattainable task. If we can't lose weight, we are viewed as weak-willed or, worse, defiant. This is the kind of attitude that makes the 80-year-old woman afraid to see her doctor when her hypertension worsens. It causes a woman to die from uterine cancer because her doctor told her he wouldn't operate on her 225-pound body until she lost weight. Serious complaints, sometimes indicative of potential cancers, are dismissed under the mistaken impression that every fat woman should have menstrual problems. Important testing is not done. Supersized women are particularly victimized by this treatment.

A study by C. Olsen et al. in a 1994 issue of the Archives of Family Medicine indicated that 32% of female health care workers with a BMI over 27 delayed or canceled physician appointments because they knew they would be weighed.  (Gosh, do you think that percentage has gotten larger or smaller since the "war on obesity" has heated up?)

Surprised that health care workers might delay exams because of their weight? Maybe they have firsthand knowledge of how fat people (women in particular) are treated -- or not treated -- by physicians and other health professionals.

A study in the 1998 Archives of Family Medicine found that the higher the weight of women, the less likely they were than thinner women to have had either a clinical breast exam, a gynecologic exam, or a Pap smear in the previous three years, even though they had as many or more doctor contacts. (The only cancer screening performed regularly on larger women was mammography.)

In Women Afraid to Eat, Francine Berg reports that a study of 1,316 physicians showed they were more reluctant to perform pelvic exams on very fat patients. Higher weights of female patients was related to negative physician attitudes about patients' appearance, which in turn was related to lower frequency of pelvic exams. She noted that researchers warned that the lower level of preventive care large women are getting may account for some of the increased health risks found with "obesity."

By the way, a 2003  Obesity Research article by M. Schwartz et al also reported that health professionals specializing in "obesity" displayed significant anti-fat bias, endorsing stereotypes of fat people as "lazy, stupid and worthless." [Hmmm, is the moral here that if you're a fat person wanting good health care -- and personal respect -- don't go to an "obesity" specialist?] The researchers noted that

If patients are uncomfortable in health care settings, it would not be surprising if they avoided care.

Pat Lyons, R.N., M.A. and WomanCare Plus of Oakland, CA have developed a handy dandy "Big Woman's Passport to Best Health," which I talked about on the July 3, 2006 Health At Every Size show and blogged about here.

I also recommend the Health At Every Size resources available at Linda Bacon, Ph.D.'s website. She has a "Health At Every Size Manifesto" that can be downloaded and/or printed out and handed to health professionals (or others whom you would like to educate), along with a cover letter that can be included for physicians. (You have to scroll down in the text box on Dr. Bacon's Health At Every Size page to see the link to the cover letter.)

Bacon is a professor, researcher and writer who collaborated on a study indicating the weight-neutral Health At Every Size approach to well-being was much better for fat middle-aged women's physical and emotional health than a traditional weight-loss diet. The research was published in the Journal of the American Dietetic Association in 2005; you can request a PDF of the article by going here.

Comments

[Stef]

Thanks for linking to the Fat Friendly Health Professionals site along with those other resources.