Tag Archives: misdiagnosis

Six Year Old Girl Dies–Diagnosed as Fat?

Sorry to start your week out with such a sad story, but I think it needs to be told. Late last week I became aware of the story of Claudialee, a six-year-old girl who passed away after being misdiagnosed with type 2 diabetes, when she actually had type 1 diabetes. There is a very detailed account of the story here.

I’m not going to go into every detail of this story, but I did want to point out a few things that stand out for me. One is that Claudialee has a family history of diabetes. Another is that the doctor diagnosed Claudialee as obese. It is clear that the doctor was deeply concerned about the young child’s weight–prescribing diet and exercise in an effort to get her to lose weight. It is also clear that the mother closely followed the doctor’s recommendations–carefully monitoring what Claudialee ate and making sure she got plenty of exercise.

What is not clear is why the doctor felt so strongly that this child had Type 2 Diabetes as opposed to Type 1. According to a source cited in the article (The National Institute of Health) at that age group, Type 1 Diabetes has an incidence of about 20 in every 100,000 kids, whereas Type 2 Diabetes has an incidence of .4 in every 100,000 kids or 1 in every 250,000 kids. What’s more, at that age, Type 1 Diabetes is a far more urgent problem than Type 2 Diabetes. So what led to the doctor’s misdiagnosis?

We may never know for sure. But it does invite one to speculate whether the child’s weight was a factor. Clearly, getting Claudialee’s weight down was a prime part of the prescription to the parent. And as the child’s weight went down, the doctor neglected to do some of the critical follow-up blood tests that would have indicated that something was drastically wrong.

The article states:

Because Mercado [the doctor] had locked in on type 2, she did not monitor her patient’s blood. She did not tell Irma [the child’s mother] to purchase a $20 blood sugar meter from the drugstore. She did not ask Irma about the frequency with which her daughter drank and urinated. And neither she nor Cabatic [another doctor] described to Irma the danger signs to look out for.

When asked in court, why the doctor seemed so certain that the child had type 2 diabetes when type 1 diabetes was so much more prevalent among children that age, she stood by her original diagnosis:

“How many type 2 infant diabetics have you treated?” a lawyer asked her.

“A lot,” she replied. “Maybe it’s geographical, because I work at Brooklyn as an assistant professor and also in wellness program where there are a lot of obese children, so we diagnose a lot of children with type 2 diabetes.”

Clearly there may have been other issues at play here. Claudialee was on Medicaid and doctors are paid significantly less for treating patients on Medicaid than they are for those with private insurance. The doctor was not board-certified, and the article points out that finding board certified physicians willing to work in clinics that take Medicaid can be difficult. And this is a single case where a single doctor has been convicted of malpractice. We will never know exactly what was in the doctor’s mind.

I but I personally found myself wondering if this doctor had ever previously considered that she may have a bias against fat patients–and maybe even fat children with low SES in particular. I wonder, had this doctor considered the potential for her own bias in this arena, would that child still be alive? Would Claudialee still be running around and playing today?

We certainly have plenty of evidence for a seeming “hysteria” around the issue of childhood Type 2 diabetes. A simple google search of “childhood diabetes epidemic” yields hundreds and hundreds of articles. This hysteria has spawned a number of shaming techniques aimed at children despite the fact that shame has been proven over and over again to be ineffective at treating obesity at any age, that shame is more likely to make kids engage in unhealthy behaviors, and that eating disorders are much, MUCH more prevalent among children than diabetes of any kind.

All I know for sure, is that stories like that of Claudialee get me even more fired up to fight against weight stigma in medicine. And that passion leads me to come to you with a plea. The Association for Size Diversity And Health and the Size Diversity Task force have embarked on a documentary film project to help doctors see and understand weight stigma and weight bias in medicine. This project is called the Resolved project. But this project needs a little bit of help from you. We are raising funds to finish the documentary on Go Fund Me here. Any help you can offer would be greatly appreciated. Even if you can only give a few dollars, that will help. And if you don’t have a few dollars to spend, would you consider sharing this with your friends and asking them to help? Let’s see if we can end weight stigma and weight bias in the healthcare industry for good. And maybe, just maybe we won’t have stories like Claudialee’s any more.

Love,

Jeanette (The Fat Chick)

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Why BMI stands for “Blatantly Meaningless Information”

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Yup, higher shoe size means higher BMI. Maybe we should re-institute foot binding for better health?

The LA Times has published another awesome article, this time taking aim at BMI. The article headline states “For nearly 1 in 5 Americans, BMI may tell the wrong story”. Although one of the main studies actually places the misdiagnosis statistic closer to 2 in 5 Americans, I have to give the LA Times credit for posting this story which goes on to detail something that many of us in the HAES (R) universe already know: BMI is not a good predictor of individual health. In short:

Having a high BMI does not mean you have poor metabolic health. Having a low BMI does not mean you have good metabolic health.

So why is this important? Well for a lot of reasons. First off, if your doctor is using BMI to determine whether or not you should get further screenings or tests, he or she is using an extremely unreliable metric to make this determination. This means as a fat person you may be exposed to a lot of tests you really don’t need. This means as a thin person, your doctor may miss some stuff that is really important or even life-threatening. I often wonder if a significant proportion of the medical costs associated with fat people are because we have so many more tests done. Or even if higher percentages of certain diagnoses among fat people are in part because we look so much harder for these diagnoses among fat people.

Another reason that BMI bias is such a big problem is that the workplace wellness gurus are using it to coerce or even force us into interventions that may be entirely inappropriate for us. For example, I’ve been talking a lot about this Michigan “walking program” for fatties. BMI was used as the sole determinant as to who had to participate. Those with higher BMIs were told they either had to wear a pedometer that reported their steps to the “home office” or they had to go to Weight Watchers. There was no initial fitness assessment done. There was no assessment of eating behaviors. The program simply assumes that people with higher BMIs don’t engage in fitness and eat very poorly. It’s entirely possible that people in the program had to reduce other, more strenuous and more enjoyable exercise programs in order to comply with the stupid walking rules. It’s entirely possible that people in the program with well-balanced healthy eating habits were encouraged towards more disordered eating habits after their new stint with Weight Watchers. It’s almost certain that people with low BMIs who are also sedentary and eat nothing but junk food were patted on the head and told to “keep up the good work”.

But we’ll never know because they never tested this stuff.

You know what? When company money and government money and my money gets spent on stupid health programs that are just as likely to make people less healthy than before, and nobody bothers to test the hypotheses because “fatties” I get pretty annoyed. In fact I’m crossing right over the line towards enraged.

It’s not like this research is all new. It’s not like the problems inherent in the BMI as a measurement of individual health haven’t been known for decades. But as long as entire industries are set on putting their fingers in their ears and chanting, “La, la, la, I can’t HEAR you!” I’m just gonna have to keep on saying the same things over and over and over. As long as people walk around with misdiagnosed brain injuries because doctors simply think they need to lose weight, as long as thin people miss out on important medical screenings because they are assumed well, and as long as some insurance programs think it’s okay to strap a piece of hardware to my a@@ to track whether I’m moving enough just because of my dress size, I’m gonna keep on talking.

You hear that universe? I’ll keep shaking my chubby fist and you and shouting that your BS. Measuring. Instrument. is not a valid way to understand anything about who I am.

Love,

The Fat Chick

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Teenage Boy “Diagnosed Fat”–Infection Missed

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How 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

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!)

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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!