Do Obese People Get Poorer Health Care?
Wednesday, May 19, 2010
I have previously blogged about the problem of weight bias amongst health professionals and how this can possibly lead to poorer health care for people with excess weight.
A new study by Virginia Chang and colleagues from the University of Pennsylvania, just published in the Journal of the American Medical Association (JAMA) suggests that the quality of health care may not necessarily be worse for obese people compared to normal weight folks.
The reserachers examined eight different performance measures in two US national-level patient populations: (1) Medicare beneficiaries (n = 36 122) and (2) recipients of care from the Veterans Health Administration (VHA) (n = 33 550).
The performance measures included diabetes care (eye examination, glycated hemoglobin [HbA(1c)] testing, and lipid screening), pneumococcal vaccination, influenza vaccination, screening mammography, colorectal cancer screening, and cervical cancer screening.
Based on these data, the researchers found no evidence that obese or overweight patients were less likely to receive recommended care relative to normal-weight patients.
In fact, comparing obese vs normal-weight patients with diabetes, obese patients were more likely to receive recommended care on lipid screening (72% vs 65%) and HbA(1c) testing (74% vs 62%).
Obese patients were also more likely to receive pneumococcal vaccinations (53% vs. 49%).
In fact, there was no measure in which obese people were less likely to receive care compared to people with normal weight.
Of course, this study says nothing about attitudes or bias amongst health care professionals, which continues to be a concern, and it should perhaps be noted that the patients in both of these data bases tend to be older.
While the authors interpret these findings as evidence that perhaps more attention is now being paid to health in people presenting with excess weight, they also suggest that previous reports on poorer care for obesity may in part be due to self-reported recall biases in retrospective studies.
I wonder what my readers think about this issue: any personal stories or anecdotes are most welcome.
AMS
Edmonton, Alberta
p.s. Join my new Facebook page for more posts and links on obesity prevention and management
Chang VW, Asch DA, & Werner RM (2010). Quality of care among obese patients. JAMA : the journal of the American Medical Association, 303 (13), 1274-81 PMID: 20371786
Wednesday, May 19, 2010
I have certainly found that my family physician is very careful to take my health issues related to obesity very seriously. Cholesterol, blood sugar, blood pressure, these are all addressed as soon as they are even slightly irregular. What I have also found, however, is a tendency to attribute everything to the obesity. Painful knees or hips? Must be the obesity, the only solution is to lose weight. Chronic Plantar Faascitis? Caused by the obesity, the only thing that can be done is to lose weight. Constant dry cough? Likely related to the obesity. I think there’s a tendency when treating obese people to assume the most likely cause and never look past it. Much of the time this will be correct, but at times obese people will have the same problems that healthy-weight people get, and it might be worth a second look before making an assumption.
Wednesday, May 19, 2010
How about in getting a referral to a rheumatologist, who can’t be seen without said referral?
Despite years of symptoms, a diagnosis of psoriasis and a family history heavy on a number of autoimmune diseases, all the GPs I saw would do was test for lupus, which I test negative for and tell me I should lose some weight. I finally convinced a GP to refer me anyway when I was divorcing. The rheumatologist was astounded that I had trouble getting a referral given my symptoms and family history. Rheumatologist examines me agrees that there’s something going on and notices an enlarged thyroid.
Tests show I have autoimmune thyroid problems – contributing to my weight issues. The joint issues may be realated to that, or may be psoriatic arthritis, or maybe a combination – the symptoms are there but don’t line up neatly with one particular form of arthritis. GIven a family history that includes diagnosed rheumatoid arthritis, lupus, psoriasis and ankylosing spondylitis, who knows what the ultimate cause may be.
Yeah, I’d say that the GPs who knew my history but who wouldn’t refer me were convinced that I was just overweight – never mind the problems started before I was overweight.
Wednesday, May 19, 2010
Despite years of symptoms, a diagnosis of psoriasis and a family history heavy on a number of autoimmune diseases, all the GPs I saw would do was test for lupus, which I test negative for and tell me I should lose some weight. I finally convinced a GP to refer me anyway when I was divorcing. The rheumatologist was astounded that I had trouble getting a referral given my symptoms and family history. Rheumatologist examines me agrees that there’s something going on and notices an enlarged thyroid.
+1
Wednesday, May 19, 2010
We know that people with higher BMIs are less likely to get routine preventive care, and I do think that the bias they encounter has to do with this.
It’s important for larger people to know that the quality of the care they receive is not different from the care that thinner people get, but if the experience of going to see a health care provider (something most people don’t like to do, anyhow) is one that makes one feel bad about oneself, it’s more likely to be avoided.
I’ve had several excellent doctors who have figured out how to communicate with me in a way that doesn’t make me feel blamed about my weight, even when weight is playing a role in what I’m experiencing with regard to my health. They haven’t “sugar-coated” anything, but treated me with humanity and compassion.
I feel lucky, as I have certainly had some very bad experiences, too, to now have such great providers. It’s possible providers as a whole have gotten better at communicating with patients (or some providers have, at least) but it may take some time for the cumulative experiences of larger patients to catch up.
Medical and nursing schools are hopefully addressing this as new doctors and nurses are “born.”