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CLINICIANS need to “straighten themselves out” and address the real issues important to their fat patients, says a leading Australian expert in obesity.
Professor John Dixon, senior research fellow at the Baker IDI Heart and Diabetes Institute in Melbourne, told MJA InSight many GPs were focusing on the wrong things when treating their obese patients.
“I speak regularly to GPs about obesity, and they very much need to understand the disease better”, Professor Dixon said.
“They express such a degree of frustration and that’s because they are focused so much on the perception of weight.”
Professor Dixon was commenting on US research which found that weight discrimination was associated with becoming obese. (1)
The study involved 6157 people aged 50 years and older using data from the US Health and Retirement Study. (2)
Using a 2006 questionnaire about discrimination experiences as the baseline, the researchers found in a 2010 follow-up that participants who were not obese in 2006 but who had reported weight discrimination were about 2.5 times more likely to be obese than those who did not report weight discrimination.
They said the association between experiencing weight discrimination and becoming obese was similar when the sample was limited to participants who reported being overweight at baseline but was much greater for participants who reported normal weight at baseline.
For participants who were already obese at baseline, experiencing weight discrimination was associated with a more than threefold risk of remaining obese at follow-up, compared with those who did not experience such discrimination.
“In addition to poorer mental health outcomes, weight discrimination has implications for obesity”, the researchers wrote. “Rather than motivating individuals to lose weight, weight discrimination increases risk for obesity.”
Professor Dixon told MJA InSight that there was discrimination from doctors towards obese patients, including assumptions that fat people were lazy and non-compliant and had brought their condition upon themselves.
Outcomes that were important to patients were quality of life issues, such as functionality, psychosocial factors, and whether they could do the things they wanted to do.
“We have to straighten ourselves out and see what we can do to improve those things for our obese patients rather than focusing so much on the weight”, he said.
Professor Dixon said his own research found older obese patients actually perceived less discrimination than younger patients. (3)
“We’ve found that older women are actually quite tolerant and accepting of fat discrimination they may experience”, he said. “In a sense they’ve become used to it.”
He said that, generally, older obese women did not experience the same educational, medical or employment discrimination as obese women under 30 years of age.
“There is no doubt that obese people suffer from lower self-esteem, depression, and they are often [self-critical] …. They put themselves down and they find other people then follow suit. It becomes a self-fulfilling prophesy.”
Professor Dixon said self-sabotage was particularly an issue with obese women who felt threatened by the prospect of weight loss, perhaps because they were using the weight to hide from past traumas or other issues.
“They want to lose weight, but are afraid to lose weight and so they self-sabotage and it becomes this awful, vicious cycle”, he said.
“It’s a very complex issue”, he said, emphasising that GPs and other clinicians needed to do more than reduce everything to the numbers on the scale.
Professor Deborah Lupton, professor of sociology and social policy at the University of Sydney, agreed, saying discrimination in a medical setting was leading to obese patients avoiding their doctors, leading to increased health problems down the track.
“Doctors need to think carefully about how they interact with their fat patients”, Professor Lupton told MJA InSight.
“They’re in a tricky position, but they need to be positive, and they need to think very carefully about the words they use.”
1. PLOS One 2013; Online 24 July
2. University of Michigan 2013; Health and Retirement Study: A longitudinal study of health, retirement and aging
3. Obesity Facts 2010; 3: 7-14
Are there any helpful hints about how not to be assessed as discriminatory by a “sufferer of obesity”? Is there any POSSIBILITY that such people, who really are overweight are perhaps too sensitive or am I expecting too much that we ALL need to accept “how it is”? I accept the need to be tactful, but perceptions are just that, as seen from one’s own perspective.
Overweight has some adverse health consequences often, so is that not something to own if one is overweight? How can it be well discussed otherwise?
Does this correspond with the thought of socially contagious obesity. You’re only overweight if you have disease related to obesity or if your friends are not as fat as you.
To answer your question on weight discrimmination; many people in their healthy weight range are told that they are fat; through various media, esp magazines. The usual pattern is then an increase in fad dieting resulting in less micro nutrition. This in turn affects various hormone levels that then alter the way in which calories are utilised in the body. It is not as simple as ‘eat less’.
For example; if I have reduced sleep for more than a few days in a row, increased stress, less time to prepare healthy food for a family and less time for daily exercise, then my weight balloons. Once I reverse these events the weight drops off ‘without trying’.
If anything, what is needed is a rethink of our curent lifestyle that leaves less time in each day for self care.
In the study quoted – how would the group who were of NORMAL WEIGHT at baseline have been subjected to “weight discrimination”. Surely one needs to be overweight to be subjected to weight discrimination.
Is it not time that we stopped making excuses for obesity. After all in most cases the equation is simple – if you eat more calories than you use you WILL put on weight and if this continues for long enough you will be obese.
The flip side is that if you use more calories than you eat you will loose weight so for those with obesity start exercising and eat less!