Obesity: Pain and Prejudice

Barbara M. Maxwell, RN, PhD

Disclosures

During a bariatric surgery support group, a middle-aged gentleman shared his story. He said he was a physician and surgeon. He also shared how incredibly humiliating it had been for him to have to put up with the "friendly teasing" of his peers throughout medical school, internship, and residency. He was variously told such helpful pieces of advice as "You just need to try harder!" and "If you really put your mind to it you could do it," and, when he had finally made the decision to undergo gastric bypass surgery, he had to endure criticism and comments such as "You're taking the easy way out" and "You are just plain lazy." The group was silent; absorbing this kind of information from a physician, an authority figure, was amazing to them. He then said, "I guess I was just lazy in medical school, and internship, and residency!" The group members laughed but they appreciated the depth of his sharing. It helped them to know that even obese medical professionals who undergo bariatric surgery are exposed to the same kind of social and professional prejudice to which they have been exposed all their lives.[1]

Over the past 4.5 years, as Psychologist for the Bridges Surgical Weight Loss Program at St. Luke's Medical Center in Phoenix, Arizona, I have been privileged to personally interview more than 2000 patients seeking bariatric surgery. This experience has obliged me to reflect on the treatment that many have received at the hands of the very people who these vulnerable individuals contact for help with this traumatic condition. It is not a secret that the base rate of abuse (physical, emotional, and sexual) in the obese population is higher than in the nonobese population.[2] The stories that have been shared with me about how these people have been treated by friends, family members, and yes, even medical professionals have revealed the cruel and inhumane conduct to which the obese patient is regularly exposed.[3,4] Why those trained under the principle of primum non nocere would engage in emotionally harming those who have come to them for help is a mystery and speaks more to the issues of the professional than to the physical status of the patient.

It behooves us, as medical professionals, to examine and work through our own feelings about obesity and the personality characteristics that we have knowingly, or unknowingly, attached to the obese person -- without even being acquainted with the person. There are numerous social psychology studies demonstrating that people shown pictures of obese people, and then pictures of nonobese people, consistently rate the obese person as less attractive, less intelligent, lazy, weak-willed, gluttonous, and less likely to succeed.[5,6,7,8] Is it any wonder that the obese person usually works out of the public eye, accepts abuse and discrimination in the workplace that you or I would not tolerate, and stays in that job for fear of having to go out and find another? This pattern is also true in personal relationships, from friendship to intimacy.

I would like to urge all healthcare professionals to educate themselves and their office and hospital staff personnel to be sensitive to the plight of the obese person. Don't be like the doctor who told his patient that she would have to be weighed "at the zoo." Monitor your language and facial expression: Avoid adding to the pain your patient already feels. Don't tolerate disparaging remarks by staff. Make yourself a power for positive change in a subset of the population that is already punished by society and by their own bodies, and certainly by themselves. These people need your medical expertise and they need to know that you care about and accept them.[6] Many patients avoid going to the doctor because of the humiliation they have suffered in the past. Don't be part of that; provide those few kindnesses that will mean so much to the obese patient. A few wide chairs in the waiting room and a scale that goes over 350 lb would be nice! These are but a few of the ways in which you can tell the obese patient, "You are welcome in my practice."

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