Fat Chance for Healthcare Access

Health is not an obligation, a barometer of worthiness, a guarantee, or entirely within our control.  One of the major variables is access. Access includes a number of things.  (I’m going to use HCP to mean Health Care Provider, including whatever health care someone might choose –  doctors , nurses, hospitals, acupuncturists, chiropractors, homeopaths etc.)

Ability to get to the HCP

This would include proximity, transportation, ability to get time off work, to go, or ability to visit before or after work, being able to meet the requirements that your insurance has for you to see the appropriate HCP, being able to get an appointment with the HCP you desire to see.

Ability to afford the HCP

Can you get insurance? (Before the affordable care act, I wasn’t able to get insurance because companies were allowed to exclude me because of my size).  Can you afford the insurance?  If not can you afford the cost of care without it?  If yes, does your insurance cover your health issues?  Can you afford the co-payment?  Can you afford any medicines prescribed? Can you afford follow up care, physical therapy etc. Can you afford to take off work if necessary for the treatment?

Ability to get good care from the HCP

Doctors ability to give good care can be hampered by their own stereotypes, preconceived notions and prejudices.  It can also be hampered by what they can afford in their facility.  This is where we fat people can have some serious issues.  Rebecca Puhl,  a researcher at Yale University, does a great deal of  around obesity and discrimination.  In one of her studies 24% of nurses said that they are “repulsed” by obese persons. Also more than half of the 620 primary care doctors questioned described obese patients as “awkward, unattractive, ugly, and unlikely to comply with treatment.”

I have personally had doctors try to put me on blood pressure medication before taking my blood pressure (it was 117/70), and look at me and mis-diagnose me with Type 2 diabetes without doing any testing.  I’ve overheard my doctor tell my nurse that she should use the large blood pressure cuff instead of the extra large because “if we use the right cuff her blood pressure is normal.  A too-small cuff will show high blood pressure and maybe that will scare her into losing weight”.  I’ve had doctors prescribe weight loss for a broken toe, separated shoulder, and strep throat.  I hear stories all the time from people who have been diagnosed as “fat” by their doctors when they have real health issues that could easily be treated.

In order to truly have access to healthcare fat people must first be willing to go to our HCP –  if that HCP is a doctor then we have to be able to go in knowing that there is a more than 50% chance that the person we are coming to for health care will think that we are “awkward, unattractive, ugly, and unlikely to comply with treatment”, and an almost 25% chance that the nurse we see will be “repulsed” by us.  Even if they are not part of that group, there’s a good chance that no matter what we go in for, we are getting a lecture about our weight, and if we practice Health at Every Size, we are probably going to have our research and choices dismissed as ridiculous by someone who is recommending a solution that almost never works.

If we can get over that, we have to find a doctor who won’t let his/her personal weight bias get in the way of actually treating us for what is medically wrong. Based on my own experience, my fat friends’ experiences and the stories that I’m reading all over the blog-o-sphere that is much easier said than done.

I wonder how many of the incidences of major health problems in obese people are due to the fact that going to the doctor is such a stressful, humiliating, and ultimately useless experience for us that we don’t go until our minor medical problem has become something major?  How many people miss out on early diagnosis and early cure of issues because they couldn’t bear to be humiliated and lectured at their annual annual physical, or they don’t get a proper examination because the doctor is convinced that weight loss is some sort of snake oil cure-all.  How many people don’t go get follow up x-rays because they  just can’t bare to put themselves through the process of being naked in front of someone who is repulsed by them.  How many people gave up on doctors because no matter how healthy our habits were, we were called  liars if we claimed to be anything other than sedentary over-eaters.

One of the lines in a widely used version of the hippocratic oath is:

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.

I cannot find a version of the oath that includes “unless I find that patient ugly, unattractive, and awkward”.  So no matter what his/her personal weight bias may be, doctors appear to have agreed to treat us with warmth, sympathy and understanding.  I think it’s time that starts happening.

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Published in: on January 20, 2011 at 7:21 am  Comments (22)  

22 CommentsLeave a comment

  1. Just wanted to let you know that as a student nurse, I’ve learnt a lot from your blog and will be sure to be a better health care provider because of it, so thanks for that! Best to catch them early, right?

    • Thank you so much for being open to new ideas. A lot of my friends are nurses and it is a profession for which I have a lot of admiration and appreciation. Thanks!

      ~Ragen

  2. If there were any way to improve this situation, it would be beyond fantastic. Reading your post and even THINKING about going to the doctor has left me crying and on the verge of hyperventilating. And yes, I fall into that camp of people who’ve had really serious (ended up needing surgery, serious) health problems that I’ve put off until crisis-point, because I could not trust any doctor anywhere to take me seriously and treat me with respect. When they say that fat people are using up all the damn health care, I want to laugh my ass off. You have to *drag* me kicking and screaming to the doctor. Last time I went in for an OB-GYN visit, the nurse took my vitals and did her exam, pronounced me a “very healthy lady” and asked me if I had considered a lap-band. :-/

    • I find it amazing how thinner people believe that lap banding is just this easy day surgery/magic bullet solution.

  3. I am so blessed to have a group of doctors who are wonderful! My internist is concerned about my weight, but not to the point that she won’t treat other ailments. I have an autoimmine disease and luckily I am treated for it and not lectured about my weight.

    I would love to add my wonderful doctors to any list of good doctors being compiled!

    xo Susie

  4. I think this is a really good idea Ragen, especially the list of fat-friendly and un-friendly doctors!

  5. PLEASE give me a list of where i can go without being told OMG yoy are going to DIIEEEEEE.

  6. I’m sure there’s just as much bias against fat people amongst HCPs here in Canada as there is in the States. But I can’t help feeling utter horror and incomprehension when I see you calmly state that you can’t get health insurance simply because of your weight. To me, not providing all citizens of a country with at least a minimum level of health care (i.e. universal health care) is absolutely incomprehensible, unfathomable and frankly, barbaric.

    I think the idea of creating a list of fat-friendly HCPs is great, but I urge all Americans to fight for health care for all. Everything else is, pardon the pun, just a band-aid solution.

  7. Another blog I subscribe to is ‘First Do No Harm’ which is similar to this campaign I think. Some of the stories shared can be heartbreaking because they are usually of the ‘and she left it too late because she was terrified of being fat shamed’ or ‘and the doctor refused to do anything other than say ‘you’re fat, you need to lose weight”.
    http://fathealth.wordpress.com/
    While looking up the address of that (I RSS everything) I stumbled across https://www.msu.edu/user/burkejoy/ which doesn’t seem to be a HAES site but also doesn’t seem quite as ‘OMG DEATHFAT SHAME THEM!! SHAAAAAAAME THEM!’ as a lot of other sites when I skimmed through it. Worth engaging with?

    • Those are great resources, thank you so much, and I agree some of the stories are absolutely heartbreaking.

      ~Ragen

  8. I’m lucky in that access to health care has never been a problem (not being a US citizen!). But let me tell you what happened to me nevertheless…

    As I said in my blog comment yesterday, I have gastric reflux disease, which has impacted me quite badly and, given my family history, could become a precancerous condition without treatment. Ever since it was diagnosed, I have been told over and over to lose weight to cure it.

    I’ve never been clinically obese, though in the last couple of years I’ve come close. But being overweight was enough to have the condition put into the “diseases that come with being fat” basket.

    Early last year, the gastric reflux suddenly got a whole lot worse, to the point that I stopped eating. My partner was horrified and kept telling me to go to the doctor, but I wouldn’t, because I “knew” it was my weight that was causing it. I decided to try and lose the weight and do whatever it took to make it better.

    Success! The weight started to drop off me. Really drop off me. But the problem didn’t go away.

    By the time I sought medical help, I had extensive Stage IV cancer, that was exacerbating the pre-existing condition. I want to be clear that no doctor turned me away and, given my symptoms, they would have treated me seriously. But in my head, I heard “this is because you’re fat” and so I avoided the doctor to the point that I put my life on the line. I’m very lucky to be alive today.

    By the way, I’m not fat anymore. I’m rake thin. Yet the gastric disease is still there.

    My story should serve as an awful, awful warning to doctors who think they are helping their patients by “shaming” them about their fat, as though those of us who carry extra kilos around don’t already know it.

  9. I love the idea of taking positive action and creating a HAES Doctor Registry sounds like a wonderful project.
    I’d love to help.

    (PS: Thank you!)

  10. I got my allegedly fat-friendly doctor from this list:

    http://www.cat-and-dragon.com/stef/fat/usa/us_ca.html

    • That’s awesome, I will definitely pass it along. Thanks!

      ~Ragen

  11. I’m lucky in that I can do a crapload of exercise (it makes me happy to be a distance runner.)

    Every time I see a new health care professional, I just happen to be wearing a marathon finishers shirt. Every time I get asked “And what do you do for exercise?”, I tell them “I run marathons.”

    I’ve had a doctor not ask the question, and start in on “I want you to walk for thirty minutes, five times a week”. I told him I’d be happy to cut back, but I was accustomed to running 50km a week.

    I’ve had a physio react in shock when he asked how I thought I’d pulled a muscle. “Running a marathon”. Not the answer he expected a fat chick to give, I think.

    I’m intelligent,speak medical jargon, and I still get treated like crap by health care professionals because I’m fat. I think the list is a wonderful idea. Please do it.

  12. On the nose…again…nailed it Ragen. I think compiling a list of non-sizeist docs. is a great idea!
    I finally trained my physician’s assistant to not take me to the scale every time I show up for an appt. I just say, “NO I will not get weighed unless there is a rational justifiable reason to get my weight.” Maybe we can find a student that is doing research for a Masters or Doctorate degree to create a survey as part of their research and distribute it and compile a list that way?

  13. My bmi is 35, first level obese. I’m not particularly strong, but apparently I don’t “look fat”. I’ve had doctors say this to me. My cholesterol is off the charts, I eat a lot of processed food, and I rarely exercise. But because I don’t “look fat”, I get treated very carefully by doctors. “You look so good now, think how you’d look if you were a healthy weight!” They focus on how I look rather than my habits or indicators, and give me back-handed compliments.

    Why should two people with the same health indicators be given different care because of how they look?

  14. I think a list is a great idea. Someone told me about ASDAH the other day but it turned out not to be a great resource for fat-friendly doctors, just HAES experts. http://www.sizediversityandhealth.org/index.asp

    I’m also surprised that NAAFA doesn’t have something like this, but a quick look didn’t turn anything up. So the long answer to your question is: yes please! It’s time to start this list! How can I help?

    On a personal note, although I am not technically considered overweight or obese right now, I have been in the past, and as a person now committed to not dieting, not seeing my weight on the scale is especially important to me right now. I have started to refuse the weigh ins at my doctor’s office, and most of the time the nurses have been fine with that. The other day, when I said “I don’t do the scale,” the nurse said “We need your weight for medical puposes.” I asked what those purposes were, and after sputtering gibberish for a few minutes, she came up with nothing. She had no idea. I told her it was more important for me to not see my weight right now. I don’t get any more shit because as I don’t look (very) fat, but I remember being 15 years old, stepping on the scale (in Canada) and my doctor telling me I needed to lose weight even though I was there for something else. And then began the compulsive eating for the next 8 years.

    I would be happy to support anything that would help someone avoid that experience and get REAL treatment for whatever they needed.

  15. I would be dead (no, I am honestly not being extreme here) if it were not for the incredible kindess, warmth, and understanding of Dr. Mark Akin. Every doctor I had gone to before him (WITHOUT ONE SINGLE TEST) declared my intense bleeding was because I was grossly overweight and that meant I was storing too much estrogen, which caused the bleeding. Um, no. I had a serious problem. The first time I met with him he asked me all the pertinent questions and asked me when my last sonogram was. I said I’d never had one. He was quiet for a very long moment. With a huge waiting room full of patients, with this procedure not being “scheduled,” he walked me across the hall and performed an ultrasound. This was not the only test performed to assess my situation. Long story short, if I had not had his care, I would have gone on blaming my situation on my weight. And I’d be dead.

    So rock on Ragen!!! Let’s get the word out about amazing doctors. Dr. Mark Akin certainly doesn’t need my advertising. He’s an incredibly well-respected doctor and surgeon. But I proudly offer the testimony of his and his entire staff’s gentleness and kindness, and beyond top-of-the-line care.

  16. For everyone who thinks that a government health care system is the answer, here is an announcement from the British NHS stating that they will no longer pay for joint replacements for overweight patients. EVEN IF THE PERSON IS IN SEVERE PAIN!

    The one who pays the piper calls the tune.

    http://www.news-medical.net/news/2005/11/24/14630.aspx

    • That’s just awful. So much is wrong with this I can’t even start right now. Thanks for letting me know about it, it seems pretty likely that I’ll be crafting a blog around it soon!

      ~Ragen

  17. As someone who has spent six years trying to get a diagnosis for what I KNEW was an autoimmune thyroid condition, I’m all for it and would even be willing to participate somehow.

    We need to do something about the inherent sizeism, sexism AND racism in the medical field.


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