Health Care for the Obese

A new study published today reports that overweight and obese patients get the same or better quality of health care than "normal" weight patients.

Researchers at the University of Pennsylvania say they looked at quality of care across eight performance measures among Medicare and VA patients, and found no difference in the kinds of treatments doctors prescribed for obese and non-obese patients.

According to a s tory on MedPage Today, "Performance measures included diabetes care management (such as lipid and HbA1c monitoring and eye tests), pneumococcal vaccination, influenza vaccination, screening mammography, colorectal cancer screening, and cervical cancer screening." The story goes on to quote one of the researchers commenting that while doctors do "harbor negative attitudes" toward heavier patients, that prejudice doesn't affect the quality of care delivered.

I think this is a pretty grandiose conclusion to draw from such a limited study, and the researchers themselves cautioned against extrapolating these results too broadly. To me, the study raises some interesting questions: Are doctors more tolerant of overweight vets and/or poorer patients? Is "quality of care" strictly a function of which treatments are recommended?

I don't think so. I wonder what the patients would have to say about the quality of care they received--not just the treatment recommendations (which are of course important) but the relationship they had with their docs, and how it affects their long-term care. I wonder whether these two populations typically have long-term relationships with the same doctor, or whether they often see a revolving cast of medical providers, and whether that might make doctors react differently to them than to patients they see regularly.

Thoughts?

Fat-friendly doctors

I'm writing a magazine piece right now on "women's diseases"-the disorders (often autoimmune) that have historically been pooh-poohed by doctors. I'm talking about diseases like chronic fatigue syndrome, lupus, MS, fibromyalgia, and PCOS. As part of my research, I've talked to many women with these diseases, especially PCOS, or polycystic ovarian syndrome. One of the telltale characteristics of a woman with PCOS is having very high levels of insulin, which wreaks all sorts of havoc on the body. And which, oh yes, makes you gain weight.

One of the women I interviewed talked about gaining 125 pounds in less than a year, without changing her diet or exercise habits--and then being told by a doctor that she had to "get your eating under control!"

Of course, you don't have to have PCOS or another illness to have had a run-in with fatphobic doctors. Many of the stories here speak to the same issues.

So for anyone who's ever had to deal with a doctor who just doesn't get it, here's a link to a fabulous list of fat-friendly health professionals around the world.

The site is maintained by one Stef Maruch. Thanks, Stef. You're doing us all a big favor.