Some S. Florida Gynos Refusing to Take Overweight Patients

…because they’re afraid of getting sued. No, really. Apparently the medical malpractice laws in Florida are so stringent that they are in effect making blanket pronouncements (and proscriptions against) ‘overweight’ women because they are deemed to be generally too ‘high-risk.’ There’s some blather and blah about not having the equipment to handle fat ladies, but that’s bunk because only a tiny percentage of fat ladies are large enough to need special equipment.

Report: Doctors Refusing to Treat Overweight Patients (CNSNews)

“People don’t realize the risk we’re taking by taking care of these patients,” the newspaper quoted Dr. Albert Triana of South Miami as saying. “There’s more risk of something going wrong and more risk of getting sued. Everything is more complicated with an obese patient in GYN surgeries and in [pregnancies],” he told the newspaper.

People don’t realize the RISK we’re taking by taking care of these patients, sobbed Dr. Someone about those horrible fat people. Don’t you realize they’re ticking time bombs? And I don’t have the insurance money to cover cleaning all that adipose tissue off my exam room walls, you dig?

I dig, brother. Thankfully, the article doesn’t go on to shame and blame fat people, and ends on a reasonably reflective note:

It is not illegal for doctors to refuse overweight patients, but it has medical ethicists worried. So far, the weight cutoffs have been enacted only by South Florida ob-gyns, who have long complained about high numbers of lawsuits after difficult births and high rates for medical-malpractice insurance.

And I don’t even have to be a medical ethicist to be concerned about the ethical implications of suggesting that people be turned away from medical care for a characteristic that is 77% hereditary.

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No Empathy for the Fat in Healthcare

I saw this Scientific American article in my Google Reader this morning, and it struck me right away that this — THIS — is what’s missing from the average fat person’s healthcare, compared to the average thinner person.

Empathy.

Missing But Crucial to Successful Healthcare: Empathy

Sure, empathy is in short supply in many doctor’s offices and bigger institutions, with the growing shortage of healthcare professionals in proportion to those who seek care. But many of the horror stories from First, Do No Harm are about a very particular lack of empathy for fat people from those same professionals, whether they be doctors, nurses, surgeons, nutritionists, and so on down the line.

Underlying the lack of empathy is the appalling prevalence of bias against fat people in the medical community, which often starts in medical school.

Many medical researchers also seem to lack empathy for fat people, as they twist themselves into statistical knots trying to make their conclusions fit the anti-obesity paradigm, making recommendations that are tantamount to the eradication of a whole population of people or children without so much as thinking about fat people as individual humans. They never blink an eye at talking about ‘eradicating obesity.’ But there is no such thing as ‘obesity,’ there are only obese people.

Perhaps if doctors had a little empathy, they wouldn’t start in on the weight discussion when their patient just needs antibiotics for a sinus infection. Perhaps if they had a little empathy, they wouldn’t recommend a course of treatment with such a huge failure rate. Perhaps if they had a little empathy, they would help their patient get that kidney transplant/knee replacement/IVF without demanding they first physically uncover the thin person within as some kind of marker of worthiness; that is, they would help their patient find an anaesthesiologist who can handle a person of their size.  Perhaps if they had a little empathy, they’d think about how to make their patient feel better rather than using Ailment X as yet another ‘teachable moment’ about their patient’s weight.

Empathy is crucial to good health care, as mentioned by the article in Scientific American. And for fat people it is, sadly, in particularly short supply.

The Fat Balancing Act

This is a post initiated by Raznay’s “Some Studies Show Fat Is Bad… Mmmkay?” on the never-ending oodles of studies trying in every which way to investigate just why “fat people are so disgusting.” It discusses the implications of the mindset which is generated by assumptions made in these studies — that is, how fat people are commanded to strike an impossible, delicate balancing act in order to be granted the respect and dignity accorded axiomatically to their non-fat peers.

Like Raznay points out, this is often to the detriment of more deserving topics, like cancer research. Then again, many obesity researchers (not all — hi, Dr. Samantha! 🙂 ) I’ve run across in real life, in comments on blogs, and on their own blogs/articles, are convinced that fat cells and hormones are absolutely causing or triggering fat-related diseases in the predisposed.

But I think two major factors are never accounted for in most of these “fat is bad go mutilate yourself/starve your body/feel like a drain on society” studies: dieting history, and current dieting status of participants.

See, lots of fat people diet. In fact, we make up the larger proportion of dieters. (My ‘normal’ -sized stepdaughter would say, “Ew, diet! Why would I ever want to go on one of those? They sound awful.” — but that’s nurture as well as nature, there.)

And those of us who’ve dieted for any length of time know:

  1. Dieting makes brain fuzzy. Huh? What about the food I can’t eat now? Oh you were actually asking a math question? Mmm, math. (Homer drool)
  2. Dieting is very stressful. So is living in a fat-hating world. Researchers are finding out more and more about the deleterious effects of stress on physical health. What they find might account for some the more specious claims correlating cognitive decline and fatness — that is, it might be about anxiety, at bottom.

There are a great many novelists, scientists, and all-around smart people who are big. Some of my most beloved writers are big people. One of my favorite politicians puts Taft to shame. They’re all extremely smart. And they’re not outliers — in fact, I’m willing to wager that intelligent, capable people, correcting for the stress and side effects of a life time of dieting and social stigma, are present in fat populations to the same degree they are present in non-fat populations. If I could commission a study, I would.

Here’s one tweet from the #thingsfatpeoplearetold hashtag which rings particularly true with my own experience of being fat and mingling with ‘intelligentisia.’ —

“Fat people are stupid. If they weren’t, they wouldn’t be so fat.”

I’ve especially gotten this impression from intelligentsia who are/were themselves fat and take it upon themselves to expound on their diet/reduction techniques:

“Oh, it’s easy, I just bag up smaller portions and do all my meetings on the treadmill. I rigged a laptop stand and I can just exercise all day if I want to!”

Of course, they’re smart, but they nevertheless don’t seem to make the connection between their twig-like human garbage disposal of a colleague who hasn’t seen a treadmill in forever, and metabolism and predisposition. If all it takes is living on an exercise machine and having bags of carrots and grain around, whose kind of lifestyle are you living? Your thin colleague’s — who is “better” because he is thin — or a horse’s?

And why the hell should fat people have to live like livestock in order to get the most basic kind of respect freely granted to the naturally-thin? (no insult intended to horses or livestock, of course)

Many fat people who’ve played this game long enough know that we’re expected to conduct a very delicate balancing act every day, seven days a week, until we die. We are supposed to “have it all” — aspire to the high-powered position, parenthood, hobbies, and community involvement — while still paying 15+ hours/week of penance on a treadmill, powered by a handful of carrots, oats, and apples. And advertising, of course, since fat isn’t okay unless you’re ‘doing’ something about it. Then you’re a go-getter! But not if you stay fat for too long!

Sound familiar? It’s chasing the dollar on a string. The dollar is basic human respect and dignity; the string is a tool of oppression, that with which we’re controlled and kept in our place. The man working on his treadmill, surrounded by plastic baggies of veg — is he free? And what is he chasing after? Is it thinness, or is it basic human dignity and respect, despite the fact that he is otherwise an example of success? Perhaps he runs to deserve his success in some intangible way unavailable to a person of his size unless human sacrifice is made? And is this the Puritan work ethic rearing its ugly head yet again, or is it something else?

Being seen as a successful, respectable fat person is a delicate balance, one which I’m not sure most people can strike. But should we have to? When do we get to step off of our treadmills, abandon our baggies of ‘good’ treats, and enjoy the world? When do we get to start being more than second class citizens? Isn’t this world — love, drama, beauty, art, travel, science, family, pleasure — isn’t it our world, too?

First Lady Releases Child Obesity Recommendations

…largely blames mothers for child’s obesity.

cue shock and surprise

Link to the AP article

Some particular gems (note throughout these that the child omgbesity is referred to, without challenge, as “the problem”):

Mrs. Obama has said she wants to help solve the problem in a generation so babies born today will come of age at a healthy weight. The report says that could happen if childhood obesity rates dropped to 5 percent by 2030.

Read: Non-experts who don’t apparently know anything about statistics, genetics, and the science of size can now control billions of dollars and influence countless lives as long as they’re somehow connected to an influential politician (this is not new, of course, but it can’t be reiterated too many times in my opinion).

Or: Welcome to the moral panic. Check your deviant status—and your children—at the door.

Or: The report says that one can solve the problem in a generation if rates drop to very low in a generation—i.e., one can solve the problem if one solves the problem—i.e., the utter BS non-speak tautologies presented as some kind of ‘revelation’ in order to push an agenda fueled by bias and the politics of crisotunity rather than facts and reasonable outcomes.

The report says a woman’s weight before she becomes pregnant and her weight gain during pregnancy are two of the most important factors that determine, before a child is born, whether he or she will become obese. [bold mine]

Read: Fat women have a higher likelihood of giving birth to fat children. Before driving in the Duh! Truck, realize that they’re not implying here that fat is genetic. In fact there isn’t the single, slightest nod paid to the overwhelming (77%) role genetics plays in the determination of weight. The report is written on the assumption that weight—for a mother before pregnancy, during pregnancy, and then the weight of the child—are completely controllable. Of course, instead of just assuming fat children would become thin children with the ‘proper’ diet, it attempts to correlate some hoo-doo about the physiology of fat mothers and future fat children. If this seems convoluted to you, then you’re on the right track. Instead of talking about genetics or talking about what fuels significant weight gain in pregnancy (someone more expert correct me if I’m wrong, but I was under the impression that large pregnancy weight gains in general are most strongly correlated with a concurrent cessation of a calorie-restricted diet), they couch everything in dubious ‘risk factor’ and correlative language.

(As an aside, if anyone has a copy of this actual report, I’d like to read it. I have a feeling it’s just a data dredge survey of some kind)

Something also very interesting to note, for those who have a nose for these public policy scienterrific press releases: the selective use of numbers. Note that the statistical correlations between fat moms (before pregnancy), weight gain (during pregnancy) are just reported as existent, while the correlation between breast-fed and reduction of obesity likelihood is stated outright (apparently 22%, but remember this is an odds ratio, so what that really means is that if the average bottle-fed child has a 15% chance of becoming obese, if they are breast fed then this goes down by 22% of 15% — that is, by 3%. So if the average bottle-fed child has a 15% chance of becoming obese, the average breast-fed child apparently has a 12% chance. The numbers are a bit less scary, no? That’s why they’re reported as odds ratios instead of real probabilities — to inflate their significance).

Do you avoid going to the doctor?

There’s a great post over at Fat and Sassy, linking a study which concludes fat people of a certain age are hospitalized far more than their thinner peers. A quote from the study:

Appropriate primary care could have prevented these hospitalizations, Ferraro said. However, those who are overweight or obese may not have sought regular care because of embarrassment or other issues related to their weight.

I was raised in a household where you always went to the doctor if something was even mildly wrong. Throat hurts, persistent dizziness, weird skin thing, etc, you let it go for a few days but no longer than two weeks, and then you go to the doctor.

When I was in elementary school, I was brought to the pediatrician a lot. I don’t really remember all the times I went, but I do remember one particular time: that’s right, it was the time that my doctor made me cry because he suggested I wasn’t getting any exercise and eating tons of junk because I was a chubby kid. The reality was, of course, that my mom didn’t even allow junk food in the house, and nearly every afternoon and evening I would either be riding my bike or playing games with the neighborhood kids (after dark we used to play a great hide and seek game called ‘Bloody Murder.’ Gruesome title that had nothing really to do with the game except that if you got caught, you had to lay down ‘dead’ while your capturer got to scream “Bloody murder!” and run off).

After I passed through middle school, I started actively starving myself, and then my doctor’s visits increased because my ailments increased. However, no longer was I a target for my weight, though once in a while I was still harangued about being ‘overweight’ by the BMI charts. Of course, I told them I was ‘on a diet’ and ‘working on it,’ and they shut up pretty quick. They never dreamed that the ‘diet’ had anything to do with the fact that my blood pressure was always abnormally low, and that I was usually dizzy and pale whenever I was there. They would ask me if I’d had anything to eat that day, and I’d say, “Oh, you know, some carrots. I’m trying to watch my weight,” and that would shut them up. Diet of carrots for the fat girl? Guess that’s okay, though all her indicators show she is STARVING, DEHYDRATED, and in a CONSTANT FOG. But that’s okay. Fat girls don’t deserve to have the ability to use their brains and feel well, right?

I used to visit the doctor perhaps twice or three times a year, for various things. In the past four years, I’ve been once, for some chronic dry skin at the corners of my mouth (that still hasn’t go away, gar). All I needed was a prescription for something stronger than I could get over the counter (nothing was working). I sat in the doctor’s office for 40 minutes before I got seen—no one else was there—and then the nurse briskly led me over to the scale. “Oh, I’m not getting weighed today, I came in for a skin issue,” I explained. She looked at me like I had two heads. “But we need a baseline for your weight, we don’t have one, you’re a new patient.” I smiled at her, and repeated pleasantly. “No, I’m not going to get weighed today. But thanks.”

She made no attempt to hide the disgust on her face as she then led me into the examination room. She angrily started getting the blood pressure equipment together, and I asked, “Do you have an extra-large cuff? I have large upper arms, and the reading won’t be correct unless you have an extra large cuff.” She again looked at me as if I had two heads, or rather, how dare I, the patient, a fat patient no less, make suggestions? She pretended to look for a different-sized cuff, and then without a word as to whether she found one or not, retrieved the original cuff she’d been going for before I said anything (so obviously not a larger cuff). She strapped it around my arm and pumped furiously, breaking several blood vessels on my arm and causing extraordinary pain. Note: I also have painful fat syndrome due to lipedemic fat on my arms, legs, and other areas. So it was doubly painful.

This might sound horrific. But my weight wasn’t mentioned after that, not by the nurse or doctor. I came away from that visit as if it were a win of all things. Though my upper arm was tender the rest of the day. And the prescription my doctor gave me didn’t ultimately work for anything except to temporarily abate the symptoms. Of course, I’m afraid to go back in order to seek a referral to a dermatologist.

I’ve had this likely easily curable skin condition for over a year now. And it’s probably not going to be enough to land me in the hospital for any reason. But how many of us sit on other more serious symptoms, because of the fear of going through humiliation and sometimes real pain and torture because of our fat?

Send Away the Fat Kids

Shudder-worthy article today: Task force: Screen kids, obesity treatment works

An influential advisory panel says school-aged youngsters and teens should be screened for obesity and sent to intensive behavior treatment if they need to lose weight — a move that could transform how doctors deal with overweight children.

Needless to say, sanity watchers points required when reading the entire article.

Ugh, this kind of thing makes me sick…such blatant ‘othering,’ such a huge expense, for: “…intensive treatment can help children lose several pounds — enough for obese kids to drop into the “overweight” category, making them less prone to diabetes and other health problems.”

Several pounds? Twice a week appointments, group ‘therapy’ meant to brainwash children that feeding themselves and/or not having a cookie-cutter body type is a sign of being broken and bad?

Ugh, ugh, ugh. What are your thoughts?

Quick Hit: Americans Are Just as Fat Now as 1999-2000

…you know, just after the BMI categories for overweight and obese were revised downwards several points, in effect making millions of Americans overweight or obese overnight.

One-Third of American Adults Are Obese, but Rate Slows

Figures from the National Center for Health Statistics showed 34% of American adults age 20 and older were obese in 2007-08 while 68% were considered overweight or obese. In children ages 2 through 19, 17% were considered obese while 32% were considered overweight. Broadly, the figures are similar to rates seen in 1999-2000.

But don’t worry, just in case you were starting to get the idea that the obesity epi-panic’s drama was largely constructed to profit a wide variety fear/hate-mongering groups and body-hate industries, the next paragraph in the piece reminds you that once again that if you’re fat, ur gonna die.

“Obesity remains high and is a significant public-health problem in the U.S.,” said Cynthia Ogden, one of the main researchers involved in tabulating the data and an epidemiologist with the Centers for Disease Control and Prevention’s health-statistics unit.

And then, a little later on, a funny kind of quote:

“I see this as relatively good news,” said William Dietz, the director of CDC’s division of nutrition, physical activity and obesity. “It suggests we’ve halted the progression of the epidemic.”

And how is it that you’ve “halted the progression of the epidemic”? Because I certainly don’t remember all those anti-fat vaccines being offered in schools and the workplace. And I don’t remember dieting suddenly starting to work. And WLS not only doesn’t work in the majority of cases but also makes people sicker (and hence more costly from a public policy perspective). So, right. All that — stuff — we did, that uh, didn’t have any effect, well it sure has slowed/stopped the epidemic!

How about this: There was never any obesity epidemic. But there was panic. And there is still panic. So don’t think this is going to stop us from hating you and wanting to eliminate you, fattie. Because you’re still a threat.