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Doctor Posts Joke Video Demonstrating Stigma That Kills People. Where’s the Hippocratic Oath When You Need It?

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So apparently Dr. Terrible is getting a run for his money in my all time list of creeps.  Meet Dr. Irresponsible and Dr. Hatemonger.

So yesterday, a number of people told me about a video posted on Kevin MD that was horrible beyond the normal bonds of horrible.  (Sorry, no power on earth will compel me to link to that ish.  Some things deserve exactly zero clicks.)  And the first thought that came into my mind is, “This video is going to kill people.  Literally.  People are going to see this video and they are going to not go to the doctor and they are going to die.”

You see this video, created by Waqas Khan or (Who calls himself Dr. I Am Sorry) was one of the most nightmare cases of bigotry, prejudice and racism I have seen in a long time.  (Again, not willing to give clicks here.  Google it if you must.)  In this video (which is part of a series of videos of unrestrained bigotry by the way) we see Miss Fatty going to the doctor.  In this short video we get to see all of the following tropes played out:

  • Fat people are slow.
  • Fat people are pushy.
  • Fat people eat nothing but junk food.
  • Fat people are completely incapable of understanding what they are eating.
  • Fat people are lazy.
  • Fat people have done nothing to try to lose weight.
  • Fat people are stupid.
  • Fat women will never find a man.
  • Fat people believe that there is a magic pill that will make them thin.
  • Fat people are guaranteed to get diabetes.
  • Fat people understand nothing about their bodies or their health.
  • Fat people never exercise.
  • Fat people don’t do anything their doctors tell them to do.

Oh and by the way, did I mention that Ms. Fatty is African American?  So all those stereotypes, yup, you can apply them ALL to African American women while you’re at it.  And you can add:

  • African American Women are fat.
  • African American Women are bossy.

A lot of this is punctuated by soliloquies by Dr. I Am Sorry. (Or “Dr. You Should Be Sorry and I Predict Will Be Soon” as I call him) spouting anger and bile and vitriol and bigotry towards his imaginary non-compliant patients that make it clear he has nothing but disgust and hatred towards them.

Okay.  Now let’s get to the killing people part.

We know from several sources, including the Rudd Center for Food Policy and Obesity that weight stigma among American medical professionals is rampant.  In one study 24 percent of nurses reported being repulsed by obese patients and 12 percent preferred not to touch fat patients.  In another study, 48 percent of nurses reported being uncomfortable treating fat patients and 31 percent reported a preference for not having to care for obese patients at all.  Yet another study involving doctors found that two-thirds reported that their obese patients lacked self-control, and 39% stated that their obese patients were lazy.

Prejudice towards obese people in medical settings is well documented and you can bet that patients are aware of it.  Naturally for some fat people, this awareness makes them more fearful about going to the doctor.  In some cases it makes them delay going to the doctor or avoid going to the doctor altogether.  In one study, over 12 percent of women said they canceled or delayed doctor appointments due to concerns about how they would be treated regarding their weight.  In this same study, embarrassment over weight and concerns about how the doctor and staff would treat them was cited as the number one reason among women for cancelling or delaying appointments.  It is also well documented that when people delay or stop going to the doctor, they get sicker and they die sooner.

So we have a situation where:

  1. Doctors, nurses and medical students have a demonstrated bias against fat people.
  2. Fat people are aware of this bias.
  3. The awareness of this bias causes fat people to delay or avoid going to the doctor.
  4. The number one prescription of doctors for people is weight loss even though there is no medically proven (outside of amputation) method to achieve this for most patients–at least not long term, and the weight loss “cure” suggested by doctors is more likely to leave patients sicker, sadder and fatter than before.

And the solution suggested by these two “doctors”  is to create (Dr. Waqas Khan) and publicize (Dr. Kevin) a video that shows a fat African American woman actively demonstrating every stereotypical view that medical professionals typically hold about African American women and fat women while simultaneously demonstrating the medical profession’s hatred and disgust towards these very patients?  How is this not convincing even more people of size not to go to the doctor?  How is this not eventually killing people who have decided not to go to the doctor?  How is Hippocrates not jumping out of his grave to take away their medical licenses?

It’s time for doctors to realize that holding a lot of unsubstantiated and biased views about people of size is lazy, unethical, dangerous and deadly.  And it is way past time for doctors to realize that posting a pile of hate that pours lighter fluid on an already painful and problematic situation for a little click bait is beyond irresponsible–it can be fatal.

In short, shame on you doctors.  Shame. On. YOU.

Sincerely Yours,

Jeanette DePatie (AKA The Fat Chick)

Doctors Consult on Fat Profits from Medical Weight Loss Programs

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New profits from an old formula

A recent article in the New York Times got my blood boiling this morning.  The article cites a few medical professionals (and others) talking about how to fatten profits from offering weight loss products, potions, procedures and magic pills.  In particular Dr. Kaplan (touted as a “leader in the medical weight loss industry) talks about his Long Island Weight Loss Institute and the various products and services he offers people to help them lose weight.

In fact, Kaplan is so well known as an expert in the industry that he has started a consulting business to help other doctors.  Is he helping other doctors figure out what are the best evidence-based options for helping their clients actually lose weight.  Well no.  He’s helping doctors figure out how to increase their bottom line by teaching primary care doctors how to bill insurers for obesity treatments.

This is a very big business, at least in part, due to a provision in the federal health care law requiring insurers to pay for nutrition and obesity screening.  Marketdata Enterprises Research Director John La Rosa has studied the weight loss industry for more than 20 years.  In an interview cited in the Times, La Rosa estimates that medical weight loss programs currently bring in $1 Billion annually–a number he expects to grow 5 percent annually at least through 2019.  La Rosa calls the Federal health care provision a “game changer” and mentioned a seminar he recently sponsored advising entrepreneurs to take advantage of the insurance coverage by opening their own weight loss clinics.

While the profits appear to be new, the procedures being sold don’t seem to be new at all.  In fact many of the procedures, potions, chants, and magic pills offered have not been proven to be effective or have even been discredited as widely ineffective.  Kaplan’s own office offers very low calorie diets, meal replacements, B12 shots and vitamin supplements.  None of these techniques have been demonstrated effective for anything but very short term weight loss which typically begins to reverse very shortly after the treatment period (which can be as short as six weeks).  What’s more, many of these programs offer little medical supervision.  The patients are often actually seen by nurse practitioners or physician’s assistants with little specialized training in the fields of nutrition or bariatric care.  One company, Medi-Weightloss (with over 76 locations throughout the country) advertised for a medical director at its Connecticut facility stating that the hours are “not very demanding” stating that files could be reviewed remotely and “there are no set hours or emergency calls”.

Now don’t get me wrong.  I think most doctors work very hard in a system that is not very hospitable to good medicine.  And I am an entrepreneur.  I believe in the power of invention and good business practices.  But when you are holding seminars to teach guys in white coats the best way to get insurance companies to reimburse the same snake oil they have been trying to sell us for centuries, I get a bit miffed.  I think people are entitled to research-based medicine.  And by research-based, I mean medicine that is proven to be effective, not just turn an ever increasing profit.

In this country, not everyone has access to even basic, decent medical care.  Medicine is very expensive here.  And we are often taught that the reason that medical care is so expensive here is that the fatties are driving  up the costs.  So the idea that doctors are learning to fatten their profits at the expense of their fat patients has got me more than a little upset.  Lets give every BODY access to bias-free, evidence-based, reasonable healthcare.  And let’s put the fat-shaming, profit mongering medical weight loss industry on restriction.  That would seem to be the healthy thing to do for our bodies and for our economy.

Love,

Jeanette DePatie (AKA The Fat Chick)

P.S. Want me to come and speak about evidence-based medicine and wellness to your group?  Go here.  Or just email me at jeanette at thefatchick dot com for more info.

Powerful new Resource Helps Medical Professionals Understand HAES.

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I am very excited to tell you about an epic new article that has appeared in the Journal of Obesity.  This article called, “The Weight-Inclusive versus Weight-Normative Approach to Health: Evaluating the Evidence for Prioritizing Well-Being over Weight Loss” reviews much of the available literature on doctors and weight loss and comes to a very firm conclusion: our medical obsession with weight loss is not making us any healthier.  The article defines the difference between the Weight Inclusive and Weight Normative approaches this way:

In this paper, we review evidence that challenges the weight-normative approach for health promotion and offer evidence to support a weight-inclusive approach for health promotion. Instead of imagining that well-being is only possible at a specific weight, a weight-inclusive approach considers empirically supported practices that enhance people’s health in patient care and public health settings regardless of where they fall on the weight spectrum [1, 2, 22]. These approaches differ in the emphasis each one places on weight. While health care professionals using either approach may share some commonalities (e.g., recommending similar self-care practices), they contrast in the relative importance they place on body weight in the context of health and medical treatment, their perceptions of the malleability of weight, and how they respond to patients based on their weight.

The article is very long and rich and cites hundreds of sources.  But I thought I’d pull out

10 things you can learn about weight-focused healthcare in this article:

1.  Recommending weight loss is actually a less conservative approach than recommending HAES because there are negative consequences associated with weight loss attempts.  Thus prescribing weight loss can go against the edict to “first do no harm”.

2.  The data do not support the notion that higher BMI causes poor health outcomes.

3.  Prescribing weight loss supports the notion that permanent weight loss is largely under a person’s control, and that fat people cost society more money.  Neither of these notions are supported by the data.

4.  Weight bias not only exists, but is common in clinical environments.  This is a part of the general increase in weight stigma in the wider world, and weight stigma is dangerous to your health.

5.  Not only does weight loss not work on a permanent basis, but weight cycling (the common result of repeated weight loss attempts) is dangerous for your body.

6.  Obsession with weight loss has led to an increase in eating disorders.

7.  But there is another way.  The  weight inclusive approach focuses on weight as a simple data point in a much larger view on health and focuses on positive behaviors.

8.  The basic principles of the weight inclusive approach are these:

1)Do no harm.

(2)Appreciate that bodies naturally come in a variety of shapes and sizes, and ensure optimal health and well-being is provided to everyone, regardless of their weight.

(3)Given that health is multidimensional, maintain a holistic focus (i.e., examine a number of behavioral and modifiable health indices rather than a predominant focus on weight/weight loss).

(4)Encourage a process-focus (rather than end-goals) for day-to-day quality of life. For example, people can notice what makes their bodies rested and energetic today and incorporate that into future behavior, but also notice if it changes; they realize that well-being is dynamic rather than fixed. They keep adjusting what they know about their changing bodies.

(5)Critically evaluate the empirical evidence for weight loss treatments and incorporate sustainable, empirically supported practices into prevention and treatment efforts, calling for more research where the evidence is weak or absent.

(6)Create healthful, individualized practices and environments that are sustainable (e.g., regular pleasurable exercise, regular intake of foods high in nutrients, adequate sleep and rest, adequate hydration). Where possible, work with families, schools, and communities to provide safe physical activity resources and ways to improve access to nutrient-dense foods.

(7)Where possible, work to increase health access, autonomy, and social justice for all individuals along the entire weight spectrum. Trust that people move toward greater health when given access to stigma-free health care and opportunities (e.g., gyms with equipment for people of all sizes; trainers who focus on increments in strength, flexibility, V02 Max, and pleasure rather than weight and weight loss).

9.  Along with the data that shows the weight normalization (weight-loss focused) approach is ineffective and harmful, is significant data showing the weight inclusive (HAES-oriented) approach is more successful, and that it does not share the negative side effects of the weight normalization approach.

10.  With these thoughts in mind, it makes sense to move to a weight inclusive approach in both personal and public health and actively work to reduce stigma both within and outside of the world of medicine.

I urge you to take some time to work your way through this epic piece of work.  And I urge you to print a copy and bookmark this for sharing at a later date.  Maybe you could take this along to your next doctor appointment.  Maybe you have a friend that is struggling with health care that can use the data to his advantage.  In any case, I’m very, very excited about this and couldn’t wait to share it with you.

Love,

Jeanette DePatie (AKA The Fat Chick)

Protecting your Heart from new Weight Loss Drugs

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Well it’s that time of year again.  The time of year that we talk about cupids and Valentines and love and stuff.  And, as a good friend of mine on facebook pointed out, we’ve also reached the golden moment where post-Valentine’s day chocolate is 50% off.  It’s the time of year when we think about our hearts.

So in this spirit, I thought I’d write about a new controversy brewing over two new weight loss drugs/combinations that have recently been approved by the FDA.  In 2012, the Food and Drug Administration approved two new sets of magic beans, I mean “weight loss drugs” lolorcaserin hydrochloride (brand name Belviq, manufactured by Eisai Inc.) and phentermine-topiramate (brand name Qsymia, manufactured by Vivus, Inc.).

People have been pretty excited about these coming out, especially since a number of other “weight-loss” drugs have been taken off the market due to concerns over cardiac side-effects.  Now one might think, in light of the fact that we put thousands of people at risk with the previous round of “weight loss” drugs, that the FDA might be extra careful not to release a new round of weight loss drugs with the same problems.

Not so fast, say a pair of doctors in an editorial recently published in the February 10, edition of JAMA.  In this article, Steven Woloshin, MD, and Lisa M. Schwartz, MD, point out that these drugs were approved by the FDA despite an alarming number of side effects.   In the abstract for the piece the doctors state:

The drugs have been associated with serious harms: Both drugs’ labels include warnings about memory, attention, or language problems and depression; for lorcaserin, the label also warns of valvular heart disease and euphoria; and for phentermine-topiramate, the label warns of metabolic acidosis, increased heart rate, anxiety, insomnia, and elevated creatinine levels. Neither medication is marketed in Europe because of safety concerns.

And as I read these words, all I can think is, “Here we go again!”  The drugs were approved under the condition that the drug manufacturers would conduct studies looking into the drugs’ heart risks.   According to the FDA, waiting until such studies were completed to approve the drugs would “delay effective therapy” for obesity.  The post marketing trials that were required to begin 16 months ago, do not appear to have begun.  And even once those trials begin, those studies are not scheduled to be finished for another four or five years.  And in the meantime we’re prescribing drugs known to potentially cause memory, language, attention, mood and serious vascular and inflammatory problems because some trials have shown short-term weight loss improvements of 3 to 7 percent over placebo.  There are no studies indicating long-term weight loss improvements in those who take these medications.  Nor, as Doctors Woloshin and Schwartz point out, is there any proof that these medications prevent disease or help us live any longer.

In the meantime we play with people’s hearts both literally and figuratively.  In a culture and a society where many of us are taught that being overweight is the worst possible situation, doctors are peddling hope in the form of these pills.  And rather than rule out potential cardiac and other serious heart attacks before the drugs are prescribed, doctors prescribe these pills to hundreds of people and “expose a lot of people to it while sorting it out,” said Woloshin.

So we can hope that the “post marketing studies” will actually begin and show no serious, long-term side effects like the permanent heart-valve damage we’ve seen from similar drugs in the past.  We can hope that we won’t market these drugs as the next great hope for people hoping to escape the pain of weight stigma in our society just to have to pull them off the market a short time later.

But I fear this is yet another page in the weight-loss-fantasy playbook likely to leave a string of broken hearts.

Love, Jeanette (AKA The Fat Chick)

When doctors are wrong.

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drmistake

I recently watched this video–a TED talk–by Dr. Peter Attia. You may have seen it as it’s become quite a viral sensation over the last few weeks. But even if you have seen it, you might find it useful to watch again. So here it is:

While I don’t agree with absolutely everything Dr. Attia has to say, I do think he brings up a few important points.  One issue is that some doctors, scientists, and other medical professionals are really starting to question the causal nature of the link between obesity and diabetes.  I think this is an important area that will require a lot more study.  And I think it is our job to continue to push for this continued study.

But one issue that I want to particularly want to highlight here is how hard it seems to be for doctors to admit they are wrong.  Dr. Attia is clearly deeply moved.  He feels a tremendous sense of remorse for how he treated that poor woman with diabetes.  Once he realized the level to which he had allowed stigma to affect his treatment of this woman he was devastated.

Many of us would be quick to state, well he should be.  He may have deeply hurt this woman.  He may not have given her the best medical care.  Many of us don’t go to the doctor because we are so afraid of being hurt just this way at the doctor’s office or the hospital.  Some of us have died because of this.

To which I would respond, “Yes, that’s true.”

But I think it’s also important to see what this video has to teach us about doctors and what it might be like for them to understand that they were wrong about something.  We look to doctors to fix everything.  We ask them to make us well and to bring us back from the brink of death.  It takes a certain amount of arrogance to hold a person’s beating heart in your hand and endeavor to fix it.  And I imagine there is a certain amount of pain when you have to tell somebody or tell their family that you can’t fix it.  You can’t make it all better.  You are not god.  And I’m not sure that the pain ever goes away.

Please understand.  I am not making excuses for doctors who bully and stigmatize fat people.  It is wrong, and it needs to stop.  Now.  That is why I am working so closely with the Size Diversity Task Force and the Association for Size Diversity And Health on the Resolved project.  We need to share our stories.  We need doctors and the public to understand that weight stigma is extremely damaging to fat people in medical settings and is sometimes even fatal.  There was a period of years in my life when I was quite sick and might have died based on the assumptions that doctors had made about me.  So I get it.  This must change.

But I think, if we want our work to be effective, if we want things to change, we need to be perceptive and understand what it means to help doctors understand that they are wrong about this.  We need to understand this–not so we can let them off the hook–not so we can let them down easy– so we can find the best path towards an actual solution, so we can understand why many doctors are so resistant, and so we can better understand why this is taking so long.

The issue of weight stigma in medicine is complex and nuanced.  But I do know one thing.  It will only change if a lot of us continue to work together to bring about change.  I would love to hear your thoughts about this issue.  And I would love to have your continued support to make the Resolved project a success!  Click here for more information about how you can participate.

Love,

The Fat Chick

Like my posts?  You’ll love my stuff!

Buy my book: The Fat Chick Works Out! (Fitness that is Fun and Feasible for Folks of All Ages, Shapes Sizes and Abilities)–available in softcover and e-book versions

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Paging Doctor Good…

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Sometimes fat chicks have to shop a little harder to find a good doctor…

 

Well, yet another study has come out indicating that fat stigma is alive and well among medical students.  Even NPR (with it’s RWJ-fueled, anti-fat slant) released a story about this study conducted among medical students in South Carolina.  Over one third of the students tested, demonstrated moderate to strong bias against obese people.  What’s more two thirds of those students who demonstrated fat bias were even aware that they had any bias against overweight and obese subjects.  And while the study only checked bias among students in one school, it is clearly in line with other studies that demonstrate fat bias among doctors and med students.

None of this comes as much of a surprise to overweight and obese people seeking health care in this country.  Many of us have experienced not only a flat refusal to treat the illness or injury for which we are seeking care, but also outright and overt disdain from our doctors.  I have spoken extensively about my own story in the past.  And as I have reviewed the videos that have been submitted for the Resolved Project created by the Size Diversity Task Force and ASDAH, I’ve cataloged so many distressing stories.  We are compiling a veritable library of cases of little kids put on speed, doctors refusing care and medically supervised fat shaming.

It’s so hard to find a good doctor that will treat us with respect.  It can be a long and arduous search.  So it’s probably not a shock that another report was released last week that shows that overweight and obese patients are more likely to engage in “doctor shopping”.  If one in three doctors coming out of medical school are displaying recognized or unrecognized bias against people of size, it makes sense that we have to look a little harder.  What I find interesting about the study however is the way it connects doctor shopping with quality of care.  One of the lead doctors from the Johns Hopkins study, Dr. Kimberly A. Gudzune, stated:

“There’s something going wrong in these doctor-patient relationships that make these switches so frequent for this group of people… The real problem here is that the health of overweight and obese patients who doctor shop is being compromised. Because they do not remain with their doctors for very long, they are ending up in the emergency room, likely for things that could have been taken care of in a primary care office.”

I wonder, does this point to yet another reason why fat stigma may be causing health problems that are currently blamed on fat?  I’ve stated before, and I’ll state again, there is no proof that weight loss improves health.  (For one thing, we can’t get enough people to keep enough weight off for long enough to do a real test.)  We also know that people who engage in healthy behavior live longer, regardless of body size.  What would be very interesting to me would be to see what impact medical training to reduce weight stigma would have on the health of fat patients.  That’s the study I would like to see.

In the meantime, I guess we’ll just have to keep searching for Doctor Good…

Buy my book: The Fat Chick Works Out! (Fitness that is Fun and Feasible for Folks of All Ages, Shapes Sizes and Abilities)–available in softcover and e-book versions

Buy my DVD: The Fat Chick Works Out! (A Safe, Easy and Fun Workout for Klutzes, Wimps and Absolute Beginners!)

Buy a book or a DVD for a friend and save $5!  Just enter FRIENDBLFT in the discount code box!

Check out my Training Programs–both in person and via Skype (Starting at just $25!)

or

Book me to speak at your special event!

Right Now Show–Episode 003: Healthcare and YOU

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In episode 003 of the Right Now show, we explore the new initiative by the Association for Size Diversity And Health (ASDAH) called RESOLVED: addressing weight bias in health care.  Jeanette DePatie (AKA The Fat Chick) shares some stories about her journey in healthcare and shares details about the RESOLVED project with the viewers.

For more information about the RESOLVED project, go to the ASDAH website.  And to read another story about a truly frightening misdiagnosis of a fat person, click on THIS LINK.

And finally, if you’re enjoying the show, don’t forget to subscribe at: http://www.youtube.com/jeanettedepatie.

Thanks so much!

Love,
Jeanette
AKA The Fat Chick
http://www.thefatchick.com

P.S. This marks my 365th blog post!  (One whole YEAR of blog posts=YAY!)

Don’t forget to enter your miles in the Fit Fatties Across America page on the Fit Fatties Forum.  Let’s see if we can get out of Colorado and a little further down the road!

And if you’d like more information about how to pick a doctor that’s right for you, there’s a whole CHAPTER on that subject in my book The Fat Chick Works Out!  You can buy a hard copy or an e-book, whichever you like!