The health care disadvantages of being obese

Abstract

People who are obese are disadvantaged socially-in public places, in employment, and in health care. 1-2 Many obese people are afraid of approaching health professionals and attending health facilities. Problems of access and lack of suitable facilities for obese people are a problem; however, the greatest impediment is the fear of encountering judgmental and discriminatory attitudes from health professionals about a patient's obesity. Because of an increased risk of medical illnesses such as type 2 diabetes mellitus, hypertension, cardiovascular disease, stroke, sleep apnoea, gallbladder disease, and osteoarthritis, 3 the need of obese people for medical care is great. However, the recommendation of weight loss as a primary therapy may compromise and delay the management of significant medical problems. This article describes the attitude of some health professionals towards obese patients, obese patients' views about health care, myths and realties about obesity, and suggests how health care for obese patients can be improved.

Weight bias and health care utilization: a scoping review

“…Patients indicated that health professionals often made assumptions about what it is like to live with obesity (Wadden et al, 2000;Pryor, 2002;Merrill and Grassley, 2008;Forhan et al, 2013;DeJoy et al, 2016;Ferrante et al, 2016). A participant in one study said:…”

“…They never asked me; they just said things like 'Don't drink soda,' which I don't, and 'Don't eat candy bars', which I don't. (DeJoy et al, 2016) These types of assumptions were often inaccurate, but health professionals did not listen when patients made efforts to correct them (Pryor, 2002;Merrill and Grassley, 2008;DeJoy et al, 2016). Wadden et al showed that over 60% of patients complained that their physicians did not truly understand how difficult it was to be overweight (Wadden et al, 2000).…”

“…Seven studies (Olson et al, 1994;Drury and Louis, 2002;Pryor, 2002;Amy et al, 2006;Forhan et al, 2013;Russell and Carryer, 2013;Ferrante et al, 2016) cited reasons for avoidance, delay, or cancellation of health care services observed with individuals with overweight or obesity. Barriers to health care utilization included unsolicited lecturing about weight loss (Olson et al, 1994;Wadden et al, 2000;Drury and Louis, 2002;Pryor, 2002;Amy et al, 2006;Ferrante et al, 2016); not wanting to get weighed (Olson et al, 1994;Drury and Louis, 2002); feeling embarrassed about their weight (Amy et al, 2006;Forhan et al, 2013); a fear of exposing their bodies (Russell and Carryer, 2013); undressing in health professionals' offices (Drury and Louis, 2002); and inadequate hospital equipment such as small gowns, examination tables, chairs, and blood pressure cuffs (Pryor, 2002;Kaminsky and Gadaleta, 2002;Amy et al, 2006;Merrill and Grassley, 2008). A female participant expressed having to wait half an hour for a nurse to find an appropriately sized blood pressure cuff (Merrill and Grassley, 2008).…”

“…Seven studies found that weight bias among health professionals was associated with patient avoidance or delay of preventive screening, maternity, and general practitioner healthcare services (Olson et al, 1994;Drury and Louis, 2002;Pryor, 2002;Amy et al, 2006;Russell and Carryer, 2013;Puhl et al, 2013;Hansson and Rasmussen, 2014). Olson et al reported that 32% of women with obesity and 55% of women with severe obesity reported delaying or canceling health care appointments because they knew they would have to be weighed during the appointment (Olson et al, 1994).…”

“…The results of this review indicate that patients with overweight and obesity delay or avoid health care services as a result of health professionals' weight bias. Receiving unsolicited lecturing about weight loss (Olson et al, 1994;Drury and Louis, 2002;Pryor, 2002;Amy et al, 2006;Ferrante et al, 2016), not wanting to get weighed (Olson et al, 1994;Drury and Louis, 2002), feeling embarrassed about their weight (Amy et al, 2006;Forhan et al, 2013), fear of exposing their bodies (Russell and Carryer, 2013), and inadequate hospital equipment such as small gowns, examination tables, chairs, and blood pressure cuffs (Pryor, 2002;Amy et al, 2006) were reported by participants as reasons for avoiding health care.…”