Nearly 35 percent of U.S. adults are considered obese, each with individual health-care needs. But if you’re among them, it might feel like you can’t get through a single medical encounter without being urged to lose weight — even if you just came in for a flu shot. And you’re tired of sitting on a too-narrow exam table in a too-small gown waiting for someone to find a blood pressure cuff that fits. You can ask for safe, accommodating health care that goes beyond your BMI.
I’m Overweight — I Get It
Before potential new health care providers ask Peggy Howell, 67, of Las Vegas about her medical history, she interviews them on their attitude toward and how they treat patients of “large body size.” Howell isn’t your average patient. As vice chairman of the National Association to Advance Fat Acceptance, she’s learned to speak up for right-size medical equipment and respectful care.
Studies have found weight bias among health care providers and others suggest that obese people may be more likely to postpone health care visits and delay screenings such as mammograms, colon cancer tests and Pap tests.
In Howell’s sit-downs with doctors, she lays down the ground rules: “I’m going to try to eat healthy and do what I can to improve my health — without the focus being on weight loss,” she says. “Then we can have a relationship. But if every time I see you, you seem to be telling me that I have to go on a diet and lose more weight — that won’t work.”
[Read: Managing the Power Dynamic Between Doctors and Patients .]
Less Bias, More Comfort
Medical suppliers are gearing more products toward plus-size patients, but some patients still find a lack of accommodation: flimsy exam tables that can tip up from the floor, blood-drawing needles that are too short, blood pressure cuffs that pop off their arms — and if you’re a woman, an OB-GYN speculum that doesn’t fit properly.
To address these concerns, NAAFA developed brochures like Guidelines for Healthcare Providers Who Treat Fat Patients, which you can hand out to doctors, nurses and receptionists. It reminds providers to “perform the same diagnostic tests on your fat patients you would on any other patients for a suspected condition.” And it warns them not to assume that weight is the cause of all symptoms.
The brochure addresses medical procedure safety and equipment accessibility and size, noting that too-small cuffs can cause false blood pressure readings. It calls for wide examination tables that are bolted to the floor or walls, and sturdy stools for patients to step up on, as well as “literature and wall décor that provide a body-positive and weight-neutral atmosphere.” And waiting rooms should offer armless chairs or benches and firm sofas, as well as inclusive information that “reflects size diversity.”
[ Read: America Tops List of 10 Most Obese Countries.]
Finding a Balance
Pounding in a weight-loss message doesn’t work, says David Katz, founding director of Yale University’s Prevention Research Center. But that’s what can happen to obese patients who have arthritis, high blood pressure or other potentially weight-related conditions, he says. Every time they go in for treatment, they get the talk. Eventually, he says, some patients “are so disgusted that essentially everything that’s ever wrong with them is pinned on their obesity, [so] they just stop going to doctors.”
His own grandmother was a case in point, Katz says, and she died in her 50s as a consequence. From what he’s since learned, she thought something was wrong early on but each time she went to the doctor she was told to lose weight. “Every time she left the office she felt about an inch tall,” he says. She had advanced breast cancer but she didn’t know it — she didn’t get screenings or return for care because she was ashamed of her weight. When she was forced to finally seek medical care, it was too late.
Doctors can’t ignore the topic of obesity, Katz says, because it carries too many health risks. The question is how to address the issue compassionately and constructively. “I think we raise it in this context,” he says: “‘This weight may be adversely affecting your health, and addressing that is my job. How can we talk about that? How can I be helpful to you?'”
Katz, who is president of the American College of Lifestyle Medicine, says if patients are being told to lose weight, they need quality methods to do so, and there’s not always a best, obvious choice.
[Read: Study: Americans 24 Pounds Fatter Than in 1960 .]
Just Another Vital Sign
Brian Wood, a family practitioner with Primary Medicine Associates in Auburn, Alabama, takes a subtle approach with his patients. Together, they discuss conditions such as high blood pressure, joint pain and diabetes and how they’re impacted by lifestyle, rather than zooming in on weight. “We talk about those issues and how [patients] can change — how they can eat in a more healthy way, how they can increase their activity — that kind of thing.”
His office routinely weighs patients, but there’s no pressure if somebody says no to the scale. When patients bring it up, he explains that weight is just another vital sign, like blood pressure, that’s tracked over time to show trends. When it comes to weight-based drug dosages — particularly anesthesia or chemotherapy, or children’s medicine — then it’s vital to know what the patient weighs.
Wood says he feels for patients who’ve been the brunt of abrupt or callous-seeming remarks. Whether it’s disrespect from a staff member, or something about that equipment that bothers you, “say something,” he advises. “And don’t be afraid to ask questions. Voice concerns. I think it’s important to realize that the doctor is there to try to help you.”
[Read: When You Learn You Have High Blood Pressure .]
Hopeful Attitude
Julie Rosa, a family medicine doctor in Hiawatha, Kansas, says it’s important to take a positive approach when discussing weight with patients. “You never scold; you never shame — because those things don’t work,” she says. “And frankly, they’ll never come back to see you again.”
Rosa says that with onset of surgical interventions such as lap bands and gastric sleeves, practices like hers have become more aggressive in treating severe obesity, and she feels more encouraged about weight-loss success.
With patients, she says her role is to encourage and problem-solve. “The ability to lose weight and successfully keep it off for the long term is absolutely a possibility but it takes a really dedicated lifestyle change,” she says. “So my job is for them to be hopeful about their chances.”
Shifting Focus
Howell isn’t looking to lose weight, but to be as healthy as she can with the body she has. She says she has white coat hypertension — her blood pressure rises every time she’s at the doctor’s office — and she’s come to realize she’s treating those results like a test she’s failed. “I have to get to the position where I accept it’s not my obligation to be the ‘healthy fatty,'” she says. “I am who I am, and I’m doing the best I can, and these are just results to let me know how I’m doing.”
In Clark County, Nevada, her group has started a Size Savvy project that rates health care practices (and business owners) on how welcoming they are to people of all sizes.
Howell’s final advice for health care providers: “How about seeing me as a patient who happens to be fat, instead of a fat patient?”
[See: 10 Lessons From Empowered Patients .]
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