Tag Archives: physicians

Physicians Won’t be the Ones to Help You Lose Weight

Surprise! Your doctor may not be the best person to get you to lose weight – and it seems that it’s largely because they are averse to talking about it at all. A recent article from NPR breaks down some of the troubling reasons behind why this relationship isn’t making real significant strides in this public health fight.

78 million Americans are obese. There are 164,000 primary care doctors that are able to treat them. That’s a daunting division as it is, but when you think about the average amount of time a physician sees a patient – maybe 20 minutes, it seems impossible to achieve the task of vastly reducing the prevalence of obesity. The kind of personalized information that is needed for each patient would take longer than 20 minutes to gather, and creating a personalized subsequent behavior change and nutrition plan takes even longer. Interestingly, the NPR pieces cites the American Association of Family Physicians in reporting that not even 50% of primary care providers calculate a patient’s BMI (there are a lot of problems with BMI as a measure, and they’ve been widely discussed – how they don’t take into account muscle mass, for example – but for some obese patients, they can be a reasonable crude measure of where the individual is in terms of major health risks and how to initiate a weight loss program). But physicians who know the history of a patient and have tracked their health for years are in the best position in terms of knowing how risky an individual’s weight is.

Of course that’s not all that needs to be considered – I actually don’t think it’s even the most pressing or pertinent issue as to why physicians aren’t able to tackle the obesity epidemic. As the NPR article says, the psychologist in charge of the University of South Carolina’s weight management center calls the topic of weight loss and obesity a “mine field.” There can be resistance in going to the doctor for any number of reasons – shame or embarrassment, frustration, avoidance or denial, and even the very real fear of what a physician might tell them. And, importantly, deep concern and worry about not having the means – financially, mentally, community or family-wise, to tackle what seems like insurmountable changes in lifestyle. On the other side, doctors claim that some patients react defensively if they suggest that weight loss needs to be in their future.

This is a complicated dance, and I can’t help but draw parallels in these kinds of responses to the relationship between eating disorder patients and their physicians, psychologists, and nutritionists. Weight is so inextricably tied to identity, personally and culturally, for so many people, that the mere suggestion of a necessary change – either gaining or losing weight – can feel like an assault on the person’s actual self. How do we best navigate this? These conversations, first of all, can’t be brief. They just can’t. They require a meaningful relationship between those negotiating solutions, and for the individual who is in a precarious health position – whether it be due to restricting and bingeing and purging, or due to inactivity and unbalanced diets and genetic factors – it requires the sense that the person ostensibly helping them knows them personally, what their fears and concerns are, is patient, and most of all, is able to be consistently present and supportive through the successes and inevitable failures of the journey. And those relationships can be mighty hard to come by.

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Filed under Disordered Eating, Health Education, Public Health

I’m Rarely Speechless.

But I was reminded of an instance this past fall when I was. You know what’s one of my least favorite things to witness? People in positions of power, authority or supposed trust mocking those who come to them for help, advice, guidance, or wisdom. Last year, there was a pretty striking example of this in Spain, which got a fair amount of attention abroad but received minimal coverage here in the States. It was brought to my attention by Stephanie, and I’d shelved it for a few months since I had a lineup of things to chat about, but it most definitely deserves attention. I will say that this is old news, and I usually try to only post about current events – but it’s only old news in the world of Internet, as it happened a few months ago (September-October 2011). I think the issues it brings up are obviously still relevant and the fact remains that it never should have occurred to begin with.

The Spanish Society of Obstetricians and Gynecologists published a comic strip in their newsletter depicting images of physicians mocking patients – the physicians are always male gynecologists, and the patients are always female, and always drawn as unattractive with exaggerated features and shown with enlargement of their reproductive organs and functions. The comics mock women for uterine prolapses, for being informed about the birth process, for wanting to following non-interventionist labor procedures, imply that sexual interest is behind a doctor pap-smearing a patient every three months, mock elderly women and portray women with questions as insufferable. The link to the images is here (you will have to select that you want to see the pdf in the upper right corner of the page) – but I want to give warning that the images are graphic and can be extremely insulting. The words are in Spanish, but even if you don’t have elementary skills in the language the images do a pretty sufficient job of getting the message across.

There was obvious outcry, and petitions passed by many, to denounce the comics and ask them to be removed. But I remain absolutely flabbergasted that these were ever drawn at all, much less published by an organization that ostensibly commits itself to women’s and maternal health. Communicating with one’s physician is difficult enough for many people (men and women alike), and by publishing this, the SSOG has confirmed what are the worst fears of many – that their doctor doesn’t respect them, thinks they are foolish, thinks that their reproductive health needs are disgusting or gross, assumes sexual activity equals promiscuity, dismisses them if they have questions or are informed, that their doctor finds alternative therapies laughable and unsound, and that they as patients do not deserve to be treated with dignity – not to mention reinforcing the age-old stereotype of male gynecologists being driven by sexual interest instead of scientific, medicinal inquiry (and in this instance, the woman on the receiving end of a doctor’s inappropriate pursuits lauds HPV as a virus community comprised of an elite ‘club’ of women who are sexually active). It is particularly trying that the implications of the  gender binary here was so clear – the males were the physicians, in charge, in the know, firmly in the power position, and the females were weak, uninformed, unaware, and their reproductive health was repellent and the stuff of slapstick humor. It’s just an egregious example of an abusive power dyad.

This kind of impression can completely shut down any channels of communication, limiting the physician-patient relationship in its ability to be a health education opportunity, an encouraging behavior change environment, and most importantly, a place of trust and confidence. I wanted to highlight this issue mainly because of these points – that the physician-patient relationship has always had real promise, but that it cannot be effective if it isn’t mutually respectful and the patients aren’t seen as worthy of having dignity. That this was published in 2011 is to me a devastating indication of how in some areas, this seems very far off.

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Filed under Defining Gender, Feminism, Gender Stereotyping, International, Public Health, Sexism