The Weight Conscious Doctor: Why Sensitivity Matters

April 27, 2018
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As a field, healthcare professionals have been talking about the “obesity epidemic” for years, but few among us have stopped to consider whether or not these constant warnings are actually benefitting patients. When we recommend patients lose weight, what are we really saying? Though we often assume we’re just acting in the patient’s best interest, many of those same patients experience this constant barrage of weight loss advice as discriminatory, leading to a lower standard of care.

It’s time for medical professionals to reconsider how and why we talk about weight; instead, focusing on the factors that contribute to ill health beyond calorie intake. By demonstrating a greater understanding of how socioeconomic factors influence health, as well as the concept of “health at every size” (HAES), doctors can treat every patient with the respect they deserve.

Factoring in Food Insecurity

The elephant in the room when talking about weight isn’t fat or calories – it’s food insecurity. Research shows that low-income individuals suffer from an unusual combination – both under- and over-nutrition. What does that mean? In essence, because impoverished individuals have less money to spend on food and are more likely to live in food deserts, they get too few quality nutrients and too many calories overall. This is why obesity and poverty are closely correlated.

Especially when dealing with low-income patients, then, doctors need to shift their focus from weight to nutritional deficiency, which are easier to remedy than a complex problem like food insecurity. Encourage your staff to look for indicators such as hair loss, tingling in the feet, and poor wound healing that may suggest specific vitamin and mineral deficiencies. Though these can also occur in those following fad diets or with specific food allergies and intolerances, they are especially common in low-income patients.

Be Data Driven

Healthcare is a science, so doctors should focus on data when assessing patient health. Unfortunately, many overweight patients find that once doctors see that single number, the rest get tossed aside. Just look at the story of Rebecca Hiles. Doctors assumed her weight and lack of activity was responsible for her breathing problems and persistent cough. After six ears of coughing and worsening symptoms – and only cursory examinations – a new doctor finally looked more closely at her nutrition and activity levels. Soon after she was diagnosed with cancer, resulting in her losing a lung.

This is what happens when doctors don’t look at all the data, which is why you might want to consider a more old-school approach – the nutritional history. A process popularized in the late 1990s, nutritional histories can offer a clear sense of not just what patients eat, but the conditions under which they eat – do they cook at home or eat prepared foods? It’s also a good way to assess macro and micro nutrient intake and to put numbers like weight and blood pressure into a larger context.

Doctors also need to remember that BMI, like most other health metrics, is not an absolute. Many athletes, for example, have BMIs that place them in the “obese” category, while almost all studies indicate that being slightly underweight is more dangerous than being even 75 pounds overweight. Just like some people have naturally low blood pressure or run a higher or lower than normal temperature, some people are naturally heavier than others. Health comes in all shapes and sizes and it’s important to consider the individual patient, not just the numbers.

Find Your Supports

If your hospital wants to use nutrition as a means of improving patient health – and it’s a valuable tool – then you need to move beyond the “lose weight” messaging and provide community supports. For example, many clinics working with low-income patients provide social worker support to get clients signed up for SNAP, offer mental-health services to help patients manage cycles of stress and anxiety that can cause obesity-related hormonal changes, or even have on-site food pantry programs.

While weight-related advice can be helpful, it needs to reflect the patient’s cultural understanding of weight and nutrition practices and include tangible goals – and it should never include shame. Overweight patients are more likely to avoid healthcare, including preventative care and immunizations, due to past shaming by doctors. When healthcare providers assume all problems are weight related, this avoidance is only reinforced.

Remember: most overweight patients have spent their lives on yoyo diets and other crash “health” plans that only leave them worse off than before. Instead of pushing a weight loss agenda, then, doctors should look for the gaps. We can help patients improve their health without taking a narrow view of what health looks like.