Size Prejudice Is Alive and Well, Part 2

Last time I talked about how size-based discrimination in the workplace is still a big problem in this country--as discussed in The New York Times essay For Obese People, Prejudice in Plain Sight.

This time I'll focus on the other area the essay highlights where fat people face prejudice: the doctor's office. Yes, you read that right. The doctor's office.

Source: istockphoto.com

Saying, "Some of the most blatant fat discrimination comes from medical professionals," the essay uses the following examples:

• Over half of doctors in one study "described obese patients as 'awkward, unattractive, ugly, and unlikely to comply with treatment.'"
• "Despite the abundance of research showing that most people are unable to make significant long-term changes in their weight, it’s clear that doctors tend to view obesity as a matter of personal responsibility. Perhaps they see shame and stigma as a health care strategy."
• Another study found that "the higher a patient’s body mass, the less respect doctors express for that patient." 

And doctors can be pretty open about their bias:

• "Dr. Delos M. Cosgrove, a cardiac surgeon and chief executive of the prestigious Cleveland Clinic, told a columnist for The New York Times that if he could get away with it legally, he would refuse to hire anyone who is obese. He probably could get away with it, actually, because no federal legislation protects the civil rights of fat workers, and only one state, Michigan, bans discrimination on the basis of weight."
• Dr. Rebecca Puhl, who conducted the first study linked above, said, "If I was trying to study gender or racial bias, I couldn’t use the assessment tools I’m using, because people wouldn’t be truthful...They’d want to be more politically correct."

In response to all of this I was all set to write, "Doesn't the Hippocratic oath say, 'First, do no harm'?" (for, in ways we will see shortly, bias certainly does harm). But when I went to find the Oath online so I could link to it, I discovered that neither the classical version nor a commonly-used modern one have that phrase. But the modern one I'm linking to here does include this:

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.

So how does doctors' fat bias effect their patients? The essay gives these examples:

• Many fat people will just avoid going to the doctor, for routine or sometimes even serious stuff. Of course this can potentially put the patient in grave danger.
• "'Stigma and prejudice are intensely stressful,' he [Dr. Peter A. Muennig, an assistant professor of health policy at Columbia] explained. 'Stress puts the body on full alert, which gets the blood pressure up, the sugar up, everything you need to fight or flee the predator.'"
• "Over time, such chronic stress can lead to high blood pressure, diabetes and other medical ills, many of them (surprise!) associated with obesity." So it becomes a maddening cycle.
• "[T]he less respect a doctor has for a patient, says Dr. Mary Huizinga,...assistant professor at Johns Hopkins School of Medicine, the less time the doctor spends with the patient and the less information he or she offers."
• "[D]octors who think patients won’t follow their instructions treat and prescribe for them differently."

The bottom line is this: Like all other people, fat people deserve respectful treatment by doctors and other medical professionals. And doctors of all people should strive to provide it.

If you are a doctor or other medical professional and see yourself in any of this, I have one message for you: It's time to do better. Remember that inside the body of every one in your care is a person who deserves to be treated with the same amount of respect and caring as you would hope to receive.

Your patients--and potential patients--can no longer afford your bias.