Geschatte leestijd: 3 minuten“Sizeism,” discrimination based on weight. A review of recent studies shows that it is common in the medical sector and thereby jeopardizes the quality of care.
Fat shaming
The increasing prevalence of “fat shaming” with the rise of social media and the increasing number of people with overweight may not be surprising. Nor might it be surprising that it can have a negative effect on physical and mental health. However, it was personally unknown to me that weight-based discrimination could influence the quality of care.
I am not referring to medical procedures that cannot be performed due to overweight. That is a medical assessment that the overweight would increase the risks of complications during the procedure, making it irresponsible. Here, it concerns prejudices of doctors and other medical professionals leading to incorrect diagnoses and/or incorrect (dosages of) medication. Doctors often automatically attribute certain symptoms to overweight and therefore do not look for other possible causes. It also happens that dosages for people with overweight are too low.
These are the findings of researchers from Washington University on healthcare providers in American hospitals [1]. They conducted a review of recent studies and presented their work last week at the annual convention of the American Psychological Association. They did this review to provide an overview of the various consequences of fat shaming in the medical sector.
“First, lose weight”
One of the studies they included in the review examined 300 autopsy reports. It turned out that overweight patients were 1.65 times more likely to have a medical condition for which no diagnosis had been made.
“Fat is seen as a disease and weight loss is the remedy.” That would be the medical mindset according to the researchers at Washington University. Coupled with the assumption that weight is within the control of the patient and is caused by poor eating habits. Starting to lose weight would improve health.
This could lead to the right tests not being performed and incorrect diagnoses being made. The researchers consider these different treatments for patients with the same symptoms unethical and a form of medical misconduct. Their findings indicate that doctors often advise weight loss instead of recommending a CAT scan, blood tests, or physiotherapy.
Incorrect Dosages
In many studies on the effectiveness, safety, and correct dosages of medication, people with overweight are often excluded as subjects (they would not be representative). As a result, it is common for patients with overweight to be prescribed a too low dosage of medication. You can imagine the implications in cases of, for example, antibiotics and chemotherapy.
In one of the studies, the admissions to the emergency department and the administration of an initial dose of antibiotics were examined. 1,910 initial doses for three different antibiotics were compared with the guidelines. In all three cases, the dosage matched the guidelines in less than 10 percent of the cases in people with overweight (in the study, heavier than 100 kilos combined with a BMI higher than 40).
“Doctor Bully”
The researchers also warn of the deterrent effect of “medical fat shaming” on people with overweight. This can cause them to consciously avoid or delay contact with healthcare providers for fear of being treated disrespectfully.
They point to studies showing that even the implicit disapproval by healthcare providers can cause the necessary stress in patients. A disapproving nod while noting the weight as a “form of micro-aggression,” for example. Fat shaming, however, would not work as motivation. According to the studies, it would harm mental and therefore physical health.
He said, she said
The irony is that the image I chose for this article was found in a rather different article. An article following a study showing that people with overweight often do not link their weight to their health [2]. A study from 2011 in which just over half of the obese patients surveyed did not consider weight to be a problem for health. Only a third would have been pointed out by the doctor about overweight and possible risks. So, overweight would receive insufficient attention.
So, too much attention to overweight by the doctor or too little? I think possibly the wrong attention at the wrong time. Discussing overweight is fine, of course, when overweight is actually the subject at hand.
References
- apa.org/news/press/releases/2017/08/fat-shaming.aspx
