Care for Obese Women Should Be Nonjudgmental, ACOG Says

Norra MacReady

May 22, 2014

Obese women deserve compassionate, respectful care that takes their individual circumstances into account, the American College of Obstetricians and Gynecologists Committee on Ethics states in a new committee opinion. The opinion includes recommendations and conclusions for physicians to keep in mind when treating these patients.

Obesity rates in the United States have doubled between 1980 and 2004. At this time, 36% of American women are obese, and rates of obesity have surged past 20% in all 50 states and the District of Columbia. "Given these statistics, obstetrician–gynecologists will inevitably encounter obese patients in their practices," the authors write. Among their recommendations is that physicians "be prepared to care for obese patients in a nonjudgmental manner, being cognizant of the medical, social, and ethical implications of obesity."

Classifying obesity as a medical condition should help reduce bias and change the physician's approach "from one of blame to one of caring," they write in the opinion, published in the June issue of Obstetrics & Gynecology.

Physicians should include calculation of body mass index (BMI) and assessment for both obesity and eating disorders in well-woman and prenatal examinations for all women, the committee writes. Anyone with a BMI of 30 kg/m2 or more is considered obese.

"It is the responsibility of the physician to recognize the medical risks that are associated with obesity and to counsel the patient regarding these risks in an unbiased manner, respecting her autonomy and maintaining her dignity," the opinion states. "The physician should avoid blaming the patient for her increased weight and integrate weight loss conversations into medical recommendations."

When counseling obese patients, clinicians should keep in mind the unique barriers to care these patients often face, including social and economic deterrents; blame from friends, relatives, and other healthcare providers; and stigmatization in a society that equates slimness with health and beauty. Classifying obesity as a medical condition is something of a double-edged sword: it may counteract some of that stigma, but it may also encourage patients and clinicians alike to accept the condition and conclude that little can be done to reverse it.

"As physicians, we must serve as advocates for our patients who are affected by obesity, while providing them with the resources necessary to deliver the best possible care," Sigal Klipstein, MD, chair of the College's Committee on Ethics, said in a college press release. Clinicians should seek consultation or referral when necessary, but if the patient's needs fall within the scope of the physician's practice, it is unethical to refuse to care for her simply because she is obese. The authors suggest that physicians view obese patients as they would any other high-risk patient, such as someone who is elderly or who has multiple comorbidities.

Physicians should conduct weight-loss counseling based on medical need. "An understanding that weight loss entails more than simply counseling a woman to eat less and exercise more and a willingness to learn about the particular causes of a patient's obesity will assist physicians and other health care professionals working with them in providing effective care," the committee states. For example, lower-income patients may have fewer opportunities to shop in stores that sell fresh produce, and their environments may not be conducive to safe exercise.

Physicians might also examine their own biases toward the obese. The committee sites evidence that healthcare professionals often harbor negative attitudes toward their larger patients, which can place the physician–patient relationship at risk. In contrast, clinicians who are struggling with weight issues themselves may feel uncomfortable counseling patients who are overweight. "Physicians should work to avoid bias in counseling regardless of their own BMI status."

The committee urges that more education on the "specific medical, cultural, and social issues of the obese woman" be incorporated into the training of all healthcare providers.

"It is our responsibility as ob-gyns to recognize the medical risks associated with obesity and to counsel patients affected by obesity in an unbiased manner, while avoiding blame and maintaining their dignity," Dr. Klipstein said in the press release. "We must recognize and remember that obesity is a medical condition, much like hypertension. This will allow us as physicians to objectively counsel and care for our patients in the manner that they deserve."

The authors have disclosed no relevant financial relationships.

Obstet Gynecol. 2014;123:1388-1393. Full text


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