Obesity etiquette The medical perils of a large person can include a doctor’s disdain

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At one doctor’s visit, Todd Turner was told an X-ray could not penetrate his girth. At another, an exam table collapsed beneath his weight. But the worst experience came when he sought relief from horrible back pain.

“Oh my God,” blurted the chiropractor when he saw Turner, of Akron, Ohio, in an exam room. “I’ve never seen anyone that fat in my life.”

For people who are exceedingly and permanently large, a trip to the doctor can be a nightmare of degradation. The torture starts in the waiting room, where chairs are too narrow for wide behinds. Nurses often insist that fat patients be weighed, even if there’s little point. Many doctors deliver tired lectures on the health risks of being fat.

But activists say embarrassment isn’t the only risk. Doctors frequently blame excess fat for health problems unrelated to weight.

“I went to the doctor and I said that my back was hurting,” said Sherry Collins-Eckert, of Affton, Mo. “He said, “Fat people’s backs hurt.’ Four weeks later I went back because my feet were swelling. He said, “All fat people swell up.’ Eventually I ended up in the emergency room with bladder hemorrhages. (The doctor) had the nerve to come into the hospital and say, “How did it get this bad?’ It turned out I had a bladder infection probably for a year.”

According to a recent federal estimate, about 5 percent of U.S. adults are “morbidly obese.” That means 10 million American men and women are 50 percent to 100 percent – or 100 pounds – above their ideal body weight.

People who are overweight or obese are at increased risk for heart disease, high blood pressure, high cholesterol, type-2 diabetes, stroke and other problems, federal experts say.

Very overweight people say they understand the potential impacts of their size. But they say doctors – part of a society obsessed with slenderness and alarmed by the perils of obesity – often view them as simply fat, lazy and unwilling to tackle their problem.

Significantly overweight patients say they are chastised for not sticking to a diet, not exercising enough, refusing medication or ruling out stomach surgery.

“There is a tendency to blame the patients for their conditions,” said Paul Ernsberger, an associate professor of nutrition at Case Western Reserve University in Cleveland. “And there is a real moral quality to it: They brought it on themselves. It’s all their fault. If they would just stop eating constantly, they would lose weight.”

But this approach discounts realities of excessive obesity and the complexities that make each patient different from the next, activists say. For one thing, some people are just destined to be fat; their metabolisms predispose them to adding weight.

In addition, studies have shown diets can be counterproductive over the long term. Very large people may lose weight, but chances are good they will eventually regain the fat – and often become heavier than when they began.

“Average people, when they go into the doctor, the goal is to either prevent or treat a problem,” said Lynn Meletiche, a New York City resident who said she’s been prescribed amphetamines, diuretics and other treatment that failed. “When fat people go to the doctor, the goal is, how do we make this person thin or conform to our prescription of health?”

Some doctors also assume fat people don’t care about health. But many overweight people work hard to be active and eat healthy foods, activists say. Meletiche, 62, said healthier eating recently helped her drop 40 pounds. She’s under 400 pounds for the first time in her adult life. But she has no delusions about reaching “normal” weight.

“I am a self-accepting fat person,” Meletiche said. “This is who I am. It’s not like I blew up one day and said, “Oh, I must get back to normal.’ I feel good that I’m eating in a more healthy way. … But I don’t think I’m going to lose more.”

Authors of a July 2005 study in the International Journal of Obesity concluded that bad experiences in doctors’ offices discouraged women from getting gynecological cancer screenings.

The study drew on surveys of 498 women, many of whom described negative experiences – disrespectful treatment, negative attitudes among office staff, embarrassment at being weighed, unsolicited advice to lose weight, and medical equipment that was too small.

Sixty of the studied women had body-mass indices of at least 55 – 350 pounds for a woman 5 feet 7 inches tall. The larger the women, the more likely they were to delay pelvic examinations, Pap tests and mammograms, the study concluded. The largest women had Pap smear rates of 68 percent in the last two years, far lower than the national average of about 85 percent. Frequent dieters were also more likely to delay care.

Study authors said cancer screening rates among large women were low even though 90 percent had health insurance. Many of the 129 doctors and nurses surveyed in the study reported they had little education regarding the care of obese women, and that examining and caring for large patients was more difficult than for other patients.

“I knew a woman who had headaches,” said Pat Lyons, an Oakland, Calif., public health nurse and one of the study authors. “She was told they were related to high blood pressure, and that if she were to lose weight, that would bring her blood pressure down and stop the headaches. This went on for more than a year. She had a brain tumor.”

Lyons is a member of the National Association to Advance Fat Acceptance. The anti-discrimination group offers this advice to doctors dealing with overweight patients:

• Treat fat people with gentleness and tact. Many have had run-ins with doctors, and some have been given inappropriate treatment.

• Weigh patients for compelling reasons only. The weighing should occur in private and the weight should be recorded silently.

• Use the same tests on fat people as with average-sized people. Do not assume extra weight is the cause of a medical problem.

• Take care in prescribing drug dosages. Some fat patients react sensitively to small dosages while others require higher amounts due to weight.

• Equip offices with appropriate furniture and gear – sturdy and armless chairs, large blood pressure cuffs, super-large gowns and long needles to draw blood. A sturdy stool helps patients get onto exam tables. Exam tables should be wide and bolted to the floor to avoid tipping.

Seeman can be contacted at bruce.seeman@newhouse.com

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