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Dealing with Obese Patients: A Required Behavioral Shift

Submitted by on February 2, 2013 – 2:08 PM

docs-underqualified-treating-obesity-articleMedical students often tend to stay away from obese patients while sharpening their examination skills in the hospital. This is understandable, granted the plethora of difficulties that the process requires. It is significantly harder to palpate various body organs and bony landmarks. Respiratory, cardiac, vascular and, needless to say, abdominal sounds are often muffled and difficult to hear.



It also takes a fair amount of practice to perform various clinical procedures on larger patients. House officers often find themselves struggling to find the right vein to pass a cannula. The blood pressure reading acquired from a sphygnomanometer could be less reliable. Even a skilled anaesthesiologist’s expression may rapidly turn dark at a request to anaesthetize an obese gentleman.



Ethics require us to not strip a patient down to a walking and talking set of signs and symptoms. It is imperative to preserve his or her dignity by seeing him/her foremost as an actual person, and not merely a diseased body. Ethics, furthermore, require us to have a non-judgmental attitude towards our patients.



A smoker who may have brought his emphysema upon himself is no less deserving of our medical attention than a man who developed lung cancer by sheer misfortune. It’s the same for an alcoholic with liver cirrhosis, a sexually active female with an STD, or a drug addict with a perforated nasal septum. A hospital is not a school of morality, merely a place of healing.



There is, unfortunately, far less little stress given on treating obese patients without being condescending, judgmental or, in extreme circumstances, even negligent. Doctors, like the general public, are likely to succumb to a stereotypical perspective of fat people as incompetent, comical or even unintelligent individuals.



According to a study by John Hopkins researchers, doctors tend to be noticeably less respectful towards obese patients than they are towards those with normal weight. This attitude is usually reinforced by the increased difficulty faced by the medical staff in caring for obese persons. I’m not entirely sure if a similar study exists specifically for Pakistan, but it’s axiomatic that in our country where terms like “fat prejudice” are uncommonly used, and where behavioral science is a relatively new addition to the medical curriculum, the situation may not be markedly different.



It ought to be recognized that while maintaining a healthy weight is largely dependent on a person’s own life choices, there are many genetic, epigenetic, hormonal, environmental and pharmacological factors beyond an individual’s control that could complicate the process of losing weight. While overweight patients must, for their own sake, be advised and motivated to lose weight, doctors must also recognize that it is not equally easy for everybody to achieve this.



A patient on tricyclic antidepressants, for instance, may have a harder time dropping the same amount of weight as a person not receiving such medication. Hypothyroidism and hypercortisolism have similar effects. While often ignored, several genes have been identified that significantly influence a person’s eating habits. Psychological disorders, particularly those causing anxiety, could cause a person to eat compulsively.



Of course, none of this is meant to relieve obese patients from all responsibility towards their weight problem. Ultimately, the importance of making healthy food choices and exercising regularly cannot be over-emphasized. But it would behoove us to be more empathic towards an obese patient, and acknowledge that he or she requires no less respect and attention than any other person arriving at the hospital.




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