The Obese Patient in the Healthcare Environment

Rebecca M. Puhl, PhD

Disclosures

September 13, 2011

In This Article

Case Presentation

Cheryl is 47 years old and weighs 357 pounds. She arrives at the office, and after checking in with the receptionist, Cheryl looks for a place to sit in the waiting room. She notices that all of the chairs in the office are narrow and have armrests. Her knees ache and she cannot continue to stand, so she awkwardly squeezes herself into the nearest chair.

When the nurse calls her name, Cheryl is led to a scale in the hallway and asked to step on it. Cheryl hesitates -- she is ashamed of her weight and does not feel comfortable being weighed where others might observe her. Not wanting to draw attention to herself, she reluctantly steps on the scale. To her humiliation, the scale only weighs up to 350 pounds. The nurse shakes her head and writes "350+ lbs." on Cheryl's chart.

The nurse leads Cheryl into a small examination room, where she struggles to take a seat on the narrow table. The nurse reaches for the blood pressure cuff, then realizes her mistake and says, "One moment; I have to go get the big cuff."

When she returns and takes Cheryl's blood pressure, it is 160/90 mm Hg. The nurse comments, "Your blood pressure is high. You're going to have to do something about that."

By the time the healthcare provider arrives to see her, Cheryl is feeling anxious and frustrated, wishing she were somewhere else. She tells the provider the reason for her visit -- she is experiencing worsening knee and back pain. The provider begins to discuss a plan for addressing her pain and elevated blood pressure, but begins the conversation by saying, "We need to talk about how obese you are, and how this is affecting your health." But Cheryl does not want to listen. She asks for a prescription and leaves the office as quickly as possible.

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