Tag Archives: fat bias

New Study Suggests Obesity Doesn’t Make Joint Surgery Less Safe

BadKnees

Another media appearance for the bad knees.

I recently came across a recently published study that was published in The Journal of Arthroplasty regarding overweight and obese patients and joint surgery.  In particular, the study evaluates data from 900 hip surgeries and over 1,500 knee surgeries.  The data was evaluated in terms of weight, BMI, how often blood transfusions were necessary, complications from infections, and time spent under the knife (how long the surgeries took).

The study results were “counterintuitive” to many–meaning it failed to confirm some of their deeply held biases about hip and knee surgery and people who are fat.  The concern was that surgery on fat people would take longer than surgery conducted on thin people, and thus would increase the probability that a blood transfusion would be required.  This is of deep concern to doctors because blood transfusions can cause serious complications–with as many as 1 in 5 causing some sort of negative effect.

However, this assumption was not borne out by the research.  In fact, overweight and obese patients were less likely to require a transfusion than their thinner counterparts.  During hip surgery, on average 35 percent of the “normal weight’ patients required a transfusion compared to 28 percent of the “overweight”  patients and 22 percent of the “obese” patients.  During knee surgery, 17 percent of the “normal weight” patients needed transfusions compared to 11 percent of the “overweight” patients and 8 percent of the “obese” patients.

Furthermore, the study indicates that their research turned up no evidence that overweight or obese patients spend any more time under the knife than their thinner counterparts.  However, a slight uptick in complications from infection was noted for those in the overweight and obese categories.

A recent article in HealthDay turns to a surgeon from Los Angeles for a quote.  Dr. Alex Miric, an orthopaedic surgeon with Kaiser Permanente in Los Angeles stated:

“I agree that the results are counterintuitive,” Miric said. But he also agreed that conclusions “would need to be replicated with more surgeons and a larger and more current patient population before such a finding would gain traction in the orthopaedic community.”

Hmmm.  While surgeries for fat people might not take longer or be more dangerous than those for thin people, it seems pretty clear that surgeon bias against fat people is alive and well.  I have read many anecdotal accounts from people denied surgery–especially hip or knee replacement surgery because they were too fat.  People with diminished mobility and often severe pain are sent home to “lose enough weight” to be a candidate.  Those fat people determined to receive surgical relief often find themselves wandering a desert of medical red tape looking for a surgeon willing to take on their case.  And they suffer needlessly while they do.

The question of whether the mobility and pain outcomes are as successful for fat people as thin people is a topic for another post.  But in the meantime, I wonder how many studies will have to be done and how many cases will need to be reviewed before the “counterinituitive” nature (read physician weight-based bias) will be reversed.  And how many fat people will have to suffer for how long while we wait for that to happen.

Fired up?  Want to fight stigma and bias?  I’d love to recommend that you join Ragen Chastain, a huge group of additional talented speakers and I for the Fat Activism Conference THIS WEEKEND.  We start on Friday night, so if you don’t want to miss it, I suggest you register now!

Love,

Jeanette DePatie

AKA The Fat Chick

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

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)

Teenage Boy “Diagnosed Fat”–Infection Missed

chart2How many times have we heard this same story?  A vibrant, active young man goes to the doctor, in this case, with knee pain.  The doctor does a routine test and doesn’t see a problem.  The doctor does see a young man who fits into an “undesirable” segment of the BMI chart.  The solution, the young man is diagnosed as fat, is told that his “extra weight” is probably causing the pain in his knee and sent home.  Now Kaleb is an active kid.  He plays rugby, and he loves to sail.  But once the doctor sees Kaleb’s place on the BMI scale, he just might think something like this: “Aha!  I don’t have to say that I don’t know what’s wrong with this kid’s knee.  I can write obesity in the kid’s chart and then we have a diagnosis!”

Unfortunately, in Kaleb’s case there was another diagnosis besides “fat” to be found.  A short while later, he was taken to the hospital via ambulance after he fell down some steps.  At that point, he was referred to a specialist that he saw two weeks later.  The specialist ordered an MRI and during the scan they found a serious bone infection.  Kaleb was scheduled for emergency surgery the same night.  He is recovering well.  So thankfully, the story has a happy ending.

But how much pain could have been avoided without the “fat diagnosis”? It appears that had this infection been detected earlier, it could have been treated with antibiotics rather than emergency surgery.  Now there’s no guarantee that had Kaleb been thin, they would have found the infection sooner.  They might have still sent him home and told him to take some aspirin and take it easy.  Thin people are misdiagnosed too.  But I’ve heard time and time again about people who are “diagnosed fat” and sent home.  Remember this guy who was diagnosed fat, and it turned out to be a brain tumor?  Remember his emergency surgery?  I wonder if doctors, frustrated by a lack of diagnosis and discouraged from ordering expensive tests don’t lean on the BMI chart as a way to have something to write in their diagnosis box.  I imagine in many cases, once patients are “diagnosed fat” and are shamed and blamed, they stop asking annoying questions.  They stop demanding that doctors figure out what is wrong with them.  In some cases, they stop going to the doctor altogether.  This is part of the collateral damage and opportunity costs in the “war on obesity”.  This is another example of the casualties that arise from singling out a body type as unacceptable and trying to eradicate it.

And we’re not just dealing with misdiagnosis here.  We’re dealing with fat people suffering and dying from the mutilation of otherwise healthy tissue via gastric bypass and banding surgeries.  We are seeing the development of more and more new strategies for trying to make fat people “healthy” by making their digestive systems mimic eating disorders and limited blood flow to the gut.  We are so focused on helping fat people get healthy by making them thin that we are willing to make them really, really sick to help them get there.  And sadly, in so many cases, the fat people who undergo these treatments end up fatter or sicker or less happy than they were in the first place.

There are weapons we can use in this war.  One of them is to ask the doctor if thin people also experience the same problem.  In Kaleb’s case, he or his mom might have asked, “Do thin people also have knee pain?  What tests might you do if I were thin.  Can we do those tests please?”

Another weapon is to help make doctors and other medical professionals more aware of the pain and repercussions of fat bias.  And it just so happens that we have some terrific tools to do that.  The Association for Size Diversity And Health (ASDAH) along with the Size Diversity Task Force are compiling videos about fat bias in healthcare.  The project is called RESOLVED.  Some folks at ASDAH have informed me that the deadlines are being extended.  You can hear more about the project and see my sample video HERE.  In addition, the Size Diversity Task Force has a unique opportunity through one of our members to help train medical advocates about fat bias in healthcare.  But in order for your video to be used in both places, you need to submit your video by March 18.  If you’re interested in participating in the project and/or have any questions or concerns, please leave me a note in the comments below.  Or send me an email at jeanette at thefatchick dot com.  I’d be glad to help.

Let’s do what we can to limit the number of casualties in the war on fat.  Let’s help kids like Kaleb get the attention and care they need at the first doctor’s appointment–not the third.  Let’s see what we can do to have “diagnosed as fat” be a thing of the past!

Love,

The Fat Chick