Empathy is the cornerstone of quality patient care. It is no surprise that the fundamental moral code that has facilitated human kindness for thousands of years is what drives physicians to commit to their oath today:

Treat others as you would have yourself treated

When it comes to the disease that is obesity, I can empathize. I’ve struggled with obesity for as long a time as I can remember.

There are many factors that cause obesity and it is rarely, solely, the fault of the individual that they are obese. There is generally some mixture of genetic metabolism, knowledge, resources, eating habits, and activity level. For me, specifically, though, it’s overeating. I can’t claim knowledge is a barrier as I work in healthcare. I know what is healthy to eat and what is not. I practice emergency medicine in community hospitals throughout West Virginia (one of our most obese states). I know the dangers of obesity as I see patients in my ED suffering daily. I just eat too much. I’ve never been able to help myself. Either I stress eat when I shouldn’t be eating or I continue to eat after I’m full. I know I can lose weight. I’ve lost it before; I lost 40 pounds in college, 115 pounds in medical school, and 80 pounds in residency. The weight just always comes back when the diet ends. For all of my, and every other physician’s, preaching about a “lifestyle change”, I can’t do it. If I don’t actively count every single thing that I consume, then I will inevitably consume too much and end up back where I started.

 

The challenges of being addicted to food

I’m an addict. My obesity is a disease like drug addiction is to another patient. Don’t get me wrong. Drug addiction is horrible. There are particular interpersonal and legal consequences associated with illicit mind altered substances that I can’t fathom relating to, but there are 5 challenges of being addicted to food that people tend to overlook:

1. I never had a choice of trying unhealthy food for the first time. I can’t remember a time as a child when I wasn’t eating. I CAN remember turning down cigarettes and drugs as a teenager (with at least SOME sound mind and body to make my own decisions).

2. I have to eat something to survive. Every time I eat, I’m forced to deal with my addiction head on by eating healthy and/or eating a measured amount.

3. Food is everywhere (the Emergency Department, on the street, in my house, at a social event, etc.). I can’t escape the temptation by a change in scenario or friend pool.

4. I can’t hide my problem. Other addicts are great at hiding their addictions. I can’t hide mine. As someone who’s been to the mecca that is thin privileged and returned, trust me, obese people are treated differently by society.

5. It will kill me. That’s right. My current BMI is 37.5, which is class 2 obesity (teetering just below morbid obesity). Throw in my family history of heart disease at a young age, and I’ve likely got up to 10-15 more years left if nothing changes.

As of this year, my obesity and long-term health now directly affect more than just me. I recently got married. Every new path in life adds new challenges to weight management. Marriage is no different. Before, it was hard for me to keep the weight off. Now, I’m having difficulty losing it in the first place. Marriage means you have increased your social pool. It means more birthdays, more weddings, more tailgates, more dinners/parties, more group vacations, more holiday celebrations, etc. Food, as I mentioned before, is everywhere. It’s ingrained in every social event in American life and makes things harder for anyone who engages in social activities.

 

The blame game

I’m not alone in my struggle. Thirty-two percent of healthcare and social assistance workers are obese. The number dips to 22% when narrowed to practitioners. Though we certainly shouldn’t act as if we’re above it, we still do. We are nowhere close to being immune to the obesity epidemic, yet we are just as much, if not more, judgmental than society at large. Physicians often assume an obese patient’s symptoms are just a result of them being fat without exploring other pathologies for their symptoms (often pathologies that the patient is sometimes obviously at risk for). Sometimes, when we do diagnose ailments, we blame the patients for their disease, which impedes on empathy. Frankly, we are giving these people (my people, our people) worse care because of said biases. There’s data to prove this.

If you learn anything from my experience and perspective, then I’d want it to be this: We obese people didn’t choose to be obese. Obesity is complex. Let’s not think, “Oh, they did it to themselves…so whatever.” The disease is not that simple. Despite the “body positive” trends in social media, we don’t want to be unhealthy. We don’t want to be looked at differently. We don’t want simple tasks, like sitting on an airplane and putting on the seatbelts, to be difficult. We don’t want to go home and cry with our spouses every few weeks. We don’t want our significant others to be judged. We don’t want to die early.

 

Resolutions for the New Year

This New Year, I’ll make, essentially, the same new year’s resolution I make for every year. I’ll try to address the bane of my existence and hope things work out. I’d like us, as physicians, to make a resolution, too:

We will empathize with the obese in 2017. We will accomplish this inside, and outside, of the patient encounters.

2 COMMENTS

  1. I can attest to the judgement of physicians based on bmi. I gained a lot of weight due to depression after miscarrying three pregnancies. The one that survived was during a time of high stress in my life. When I went to my appointments my ob was rude, and decided because I was fat, I must have diabetes. I had to take that disgusting sugar test THREE times! Then, because I was swelling with high blood pressure, he decided that I must have proteins in my urine, and I had to collect urine samples at work all day, because fat people get preclampsia… He put me on synthroid, because I was fat, and my thyroid must be what was causing me to be fat, even though my levels were within reasonable range. He went above and beyond blaming my weight for every symptom he saw including my miscarriages!

    Little did he know I was impoverished, living on the good graces of my in laws who only bought prepackaged foods, so my potassium was severely low. Then she enjoyed making my life difficult and upset me on a regular basis. Then I went to work, and my boss would scream at me, a parent of one of my students was bullying me, and I went home to more screaming…

    My blood pressure was environmental due to a past history of ptsd triggered by loud noises ie: all the screaming. My swelling was part my active job, part nutrition. My weight gain was depression. None of the symptoms he saw were caused by my weight, but he sure made me embaressed about it!

    My next pregnancy, my blood pressure began to rise so I eliminated stress, and it went right back down. I ate extremey well, and put 6 hours between me and my inlaws. I am the same size, but I have zero swelling, normal blood pressure, and no complications at all. If I swell at all, I eat 1 or 2 bananas and it goes completely away (I swear there is a relationship between third trimester swelling and an increased demand for potassium!). The miscarriages were from a septate uterus, and had nothing to do with my weight either.

    By dwelling on my weight, my doctor exasperated the symptoms he was trying to treat and was blinded to the true causes. He limited his own effectiveness.

    The other good news is the more children I have that live, the less depression I have, and the more I lose weight. Crazy right?

    I agree doctors should get on board with seeing more than the weight scale when examining their patients. If they did, I would not have had to figure out what was happening with my body all by myself.

  2. From my medical practice in France, I know well to coach people to lose weight. It needs different degrees of medical practice: 1/ psychology 2/ internal medicine 3/ nutrition then we must add biochemistry and cooking. Tulane Medical School is developing Culinary Medicine.
    People knows that I have coached people taking them from BMI over 35 to under 25, with the miracle that these patients kept their healthy weight after. When I set my website and my facebook page I was thinking to have clients knowing my expertise. I was surprised to have followers, most millennials, wanted to be healthy and asking for food and cooking advice to prevent diseases. They want a healthy life and they trust me about recipes, lifestyle and my followers are coming from the different part of the world.
    It looks to me that the medical doctors must address what is “the eating right”.
    The parent to be must learn to feed the children and teach them to eat healthy, with an open window on tasty delicious food. It looks as we have really to rethink American Nutrition.

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