THE ARTICLE
Discrimination against obese people is not just a societal problem but also a medical one, as recent studies have shown. American women who are overweight tend to have more difficulty finding health insurance and/or end up paying higher premiums, they are more likely to be misdiagnosed and receive inaccurate drug dosages, they are less likely to receive fertility treatment when requested, and are at greater risk for undiagnosed cancer and to receive ineffective treatment for the cancer.
With society still viewing obesity as a personal failure rather than as a failure of society's food production, delivery, and promotion system, overweight individuals face significant hurdles in the doctor's office. There is a significant tendency, according to some doctors, in attributing physical ailments immediately to the weight of the patient.
"Doctors make mistakes in diagnosing 10 to 15 percent of all patients, and in half of those cases it causes real harm," says Dr. Jerome Groopman, M.D., author of "How Doctors Think." "If doctors have negative feelings toward patients, they're more dismissive, they're less patient, and it can cloud their judgment, making them prone to diagnostic errors."
With many hospitals concerned about how their insurance companies view and rate them, many of their surgeons feel uneasy about performing surgery on obese patients due to the increased difficulty and chance for complications. Since surgical-complication rates are often determined without taking in account the elevated risk of overweight patients, hospitals are often better off denying the procedure to their overweight patients.
But even when doctors are aware of their tendency to let weight issues cloud their diagnosis, excessive body fat can cause real difficulties in detecting and treating various illnesses such as cancer and heart disease. It becomes harder for doctors to hear the heart and lung functions through the fat and when trying to palpitate for masses, the fat tends to hide growths. This is especially true for pelvic exams where the vaginal walls can become lax and collapse thus obscuring the cervix.
One of the major difficulties in diagnosing people who suffer from obesity is that much of the diagnostic equipment, such as MRIs and CT scanners, are not designed to accommodate large individuals. X-rays and ultrasounds, even though they may be used on any size individual, are also sometimes ineffective in diagnosis. According to Dr. Raul N. Uppot, M.D., radiologist in the Division of Abdominal Imaging and Intervention at Massachusetts General Hospital in Boston, "ultrasound is the approach that's the most limited by body fat, because the beams can't penetrate the tissue if you have more than 8 centimetres of subcutaneous fat."
Since women often need ultrasound tests in order for uterine tumors and ovarian cysts to be properly diagnosed, this presents a significant problem for obese women. This is also of particular concern for obese women who are pregnant since the primary method for determining the health of the mother and baby is through ultrasound. Researchers at the University of Texas Southwestern Medical Center in Dallas found a 20 percent decrease in the effectiveness of ultrasound in detecting problems with the fetus in obese women.
CT scans, while less affected by levels of body fat, still require significantly more radiation in order to get a clear image from a heavier patient than from a lighter one. This can be a risk proposition especially if several CT scans are necessary in order to get a clear idea of the medical situation.
All of this can lead to situations where doctors have little or no information to work with other than the symptoms they are able to observe and their own intuition.
Even if the problem is detected early and treatment is started promptly, often the treatment is insufficiently tailored for overweight patients. Chemotherapy dosage levels are determined by trials on average women and because of the toxicity of chemotherapy, most doctors are very reluctant to up the dosage for heavier patients. Unfortunately, this underdosing can be the difference between a successful treatment and an ineffective one.
Although it has been known for some time that women who are obese have a higher mortality rate for ovarian and breast cancer, they are just as likely to survive the cancer as thinner patients are as long as the chemotherapy doses are based on the woman's actual weight.
The health risks and stigma facing America's burgeoning population of overweight and obese citizens continues to erode their ability to get proper health care and effective solutions for their conditions. A shift away from blaming the patient for their condition and towards mutual respect, openness, and comfort is necessary if real progress is to made in the fight against obesity.
YOUR FEEDBACK
Have you got any comments about this article? In an effort to provide an unbiased site for our visitors, we ask that you provide your opinion!
