Recognizing and eliminating bias in those with elevated body mass index in women's health care

Inklings

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Volume 109, Issue 5, Pages 775–776

Authors:

Steven R. Lindheim, M.D., M.M.M., Tanya L. Glenn, M.D., Leah D. Whigham, Ph.D.

Abstract:

My worst healthcare experience was with a new OB/GYN at my appointment to confirm my first pregnancy. I was elated and couldn't wait to have the doctor congratulate me, but instead she told me that I was a detriment to my unborn child because I was going to be an overweight mother, and that my baby deserved better. I left the office crushed and heartbroken. If I hadn't needed to seek medical treatment to ensure a healthy pregnancy, I would have never returned. I requested a new doctor and filed a complaint with the hospital, but I never heard anything back from them.

– Rudd Center, personal communication


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3 Comments

Go to the profile of Alexander Quaas
Alexander Quaas 6 days ago

This inklings piece addresses the increasingly important topic of obesity and the way we as health care providers deal with it. Importantly the authors point out that obesity is a disease, and not a character flaw or similar. Because obesity is immediately manifest when we meet a patient, and because it is an external feature that is viewed as undesirable by society (which idealizes slim models and fit / athletic celebrities), it is hard to talk about it objectively and without negative emotions. Providers often feel awkward when talking to patients about obesity, and patients may be defensive about the topic because they have had negative experiences talking about the topic with other providers. Every healthcare provider should develop good communication skills when dealing with obesity, because avoidance of addressing this disease epidemic would be fatal.
Having worked in the Midwest of the United States where I sometimes went through whole afternoon clinics without seeing a single patient that was not morbidly obese, I developed certain phrases and expressions that addressed the topic without offending patients, and in a positive, caring and helpful manner. Providers should examine their use of language and maybe even get feedback from patients how they viewed the interaction.

To put this topic in the greater context, I would add that there are many other diseases that are handled similarly poorly by health care providers (arguably worse!) and approached with an even greater deal of stigma and bias: cigarette smoking, alcoholism, narcotic addiction and mental illness, to name just a few.  If US health care is biased and hostile towards obese patients, I would argue that bias and hostility are even more pronounced towards these perceived self-inflicted "weaknesses". Patients with these conditions face an even larger amount of bias and stigma in  a society that is actually much more  accepting of obesity than others (such as European societies where cigarette smoking is more tolerated, but obesity even more stigmatized than in the US).

Go to the profile of Steven R. Lindheim, MD, MMM

I would agree whole heartedly.  We need to be mindful of the whole person and recognize it is easy to stigmatize.  Perception is reality.  Well articulated and well communicated!

Go to the profile of Alexander Quaas
Alexander Quaas 6 days ago

Thank you! I completely agree that it is important to always consider the whole person, with as little bias as possible...

Appreciate you bringing this issue to the attention of F+S readers.