Better Treatment for Overweight Patients

[Guest guest]

> ok, here it is this time for real, lol!

>

> For Better Treatment,

> Overweight Folks Must Stand

> Up To Doctors

>

>

> August 1, 2000

>

> News Service

>

> Judi Dandy remembers her worst trip to the doctor.

> She went to see an internist because, in the course of a

> few hours, she lost all feeling in her left thigh.

>

> After poking pins into her legs through her pantyhose,

> he told her his professional opinion: She was fat. His

> prescription: She should lose weight. Then he charged

> her $75 for the visit.

>

> She left, still numb - now mentally, as well as physically.

> There is a fairly common condition, " meralgia

> paresthetic, " in which the thigh can lose feeling because

> of excess weight. But Dandy was angry that the doctor

> didn't explain the diagnosis, examine her or order any

> other test to see whether the cause might be linked to a

> more serious problem.

>

> Her left side did return to normal within a few weeks,

> but the incident left her wary of the health-care system.

> Now, she screens doctors to try to make sure she's

> going to get the care she needs, not just a lecture about

> something she's already painfully aware of.

>

> " Too often, (obese) people cannot go to a doctor

> without having them tell us that everything, everything, is

> related to our weight, " says Dandy, a 57-year-old

> Roswell, Ga., resident who is about 100 pounds

> overweight.

>

> Such experiences, medical professionals say, are

> keeping many overweight patients from doctors' offices

> and making them forgo preventive services in order to

> avoid ridicule.

>

> " Even though every doctor's office now has obese and

> overweight patients, we still find there is a problem of

> some people really being treated with disrespect, " says

> Yanovski, director of the Obesity and Eating

> Disorders Program at the National Institutes of Health.

>

> Few studies have examined how many obese people

> may avoid medical treatment, out of embarrassment or

> because of doctors' insensitivity. But with half of

> Americans now considered overweight and one in five

> classified as obese, according to a recent study by the

> Atlanta-based Centers for Disease Control and

> Prevention, it's an issue that's getting a second look by

> public health agencies.

>

> It's not a minor concern: Obese men and women have

> significantly higher rates of heart disease, diabetes and

> some cancers, numerous studies have shown.

> Consequently, it's in the best interest of both doctors

> and patients with weight problems to see one another in

> a consistent, scheduled manner.

>

> And yet doctors must, in some ways, be like

> neighborhood cops. They should be friendly enough to

> foster trust and communication with those at risk. But at

> some point, they also have a responsibility to point out -

> and try to stop - dangerous behavior.

>

> Occasionally, it's difficult to find that balance. And

> sometimes, doctors bring prejudices about weight to

> the office, which can make a patient's visit a gantlet of

> humiliation and shame.

>

> Lynn McAfee, director of the Council on Size &

> Weight Discrimination, a New York-based advocacy

> group for the overweight, has collected several such

> incidents of disrespect, such as:

>

> A woman sprained her ankle but was initially

> unable to convince her doctor that she needed

> treatment. Finally he agreed to prescribe

> anti-inflammatory medicine, telling her, " Take this

> with food, which shouldn't be a problem for

> you. "

> Another woman, who wanted to get pregnant,

> was told by her doctor that if she succeeded, he

> would recommend abortion.

> A grandmother, berated by her doctor about her

> weight, confessed that she started fasting and

> drinking a bottle of laxatives before stepping on

> the scale at the doctor's office. A heart patient,

> she did this every other week.

>

> Forty-two percent of obese patients say that a

> health care worker has suggested that they lose

> weight, with the most likely candidates for such

> advice being middle-aged women with higher

> education, according to a study published in

> October in The Journal of the American Medical

> Association.

>

> But too often, the advice is to diet, even though

> studies indicate that less than 5 percent of dieters

> keep off the weight they've lost for more than

> five years. Miriam Berg, the weight

> discrimination council's president, for example,

> has lost more than 300 pounds through the years

> on diets, and she's gained every pound back.

> Dandy has been on more than two dozen diets.

>

> " I think if I told patients I had a cancer cure, but

> it had less than a 10 percent success rate and it

> was going to cost a bundle of money, I'd be

> laughed right out of the office, " said Dr.

> King, a California endocrinologist who has been

> working with diabetic patients, many of them

> obese, for almost three decades. " And yet, we

> keep trying to sell this to overweight patients,

> and they're supposed to take it seriously. "

>

> Instead, experts say, doctors and patients should

> discuss more lasting lifestyle changes - to move

> more, eat less - that go beyond fad diets and

> short-term solutions. Such discussions remove

> the stigma of obesity and instead center on

> advice everyone should follow, regardless of

> what the scale says.

>

> For example, federal guidelines say that people

> should eat five servings of fruits and vegetables a

> day, along with two servings of animal protein

> and two to three servings of low-fat dairy

> products. And everyone should exercise for a

> minimum of 30 minutes three times a week.

>

> Yet, according to a new poll conducted by The

> Atlanta Journal-Constitution, three out of every

> 10 Southerners say they never exercise, and

> another two of every 10 exercise only one or

> two days a week. One-third of the Southerners

> polled said they eat no fruit or vegetables on an

> average day or consume one serving at best.

>

> " Health is not always necessarily a size issue, "

> said Dee Hakala, who weighs 220 pounds and is

> a winner of the Nike Fitness Innovation Award

> and runs aerobics classes for the overweight.

> " It's a movement issue. ... it's a healthy-lifestyle

> issue. "

>

> And doctors can create a more hospitable

> environment for obese people just by making a

> few changes in their offices, experts say. Instead

> of tiny chairs with armrests, they could include

> love seats or larger chairs without armrests. They

> could offer gowns and blood pressure cuffs that

> actually fit.

>

> " You need to keep saying, " I may be bigger, but

> I deserve equal treatment, " ' Hakala says. " You

> cannot let them bully you around. "

>

> GETTING RESPECT Overweight people can

> get better medical treatment if they're willing to

> become more assertive about their needs.

> Experts recommend:

>

> Call a new doctor before a scheduled

> appointment and simply ask whether he or she is

> comfortable with heavier people. The doctor

> may not tell the truth, but a patient might be able

> to sense any significant discomfort.

> Acknowledge that weight might be playing a role

> in an illness or injury, but remind the doctor to

> check other factors as well. It is not acceptable

> to get a diet speech when you need treatment for

> the flu.

> Don't be combative. Instead, patients should

> work with their doctors to try to find a way to

> improve their health that feels comfortable to

> both.

>

> Copyright 2000 News Service. All rights

> reserved.

>

>

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