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When Doctors Judge Their Obese Patients

I met a woman who had been driven from any and all benefits that modern medicine might offer her by the cold and denigrating judgment offered her by almost every modern medical practitioner she had met.
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I saw a patient in my clinic last week who came to me for ... never mind. I am now her doctor; she is now my patient. What happens between us is private and privileged, and none of your business.

But in one regard, this patient was a prototype of countless others, and that can, and perhaps should, be everybody's business. She was heavy. She was very, very heavy.

She, of course, knew she was heavy. She also knew that I knew she was heavy. And she knew that I knew that she knew that she was heavy.

She had, in fact, been heavy her whole life. Dealing with it was the struggle that defined her life, and the merits or demerits of any given day. But this patient's weight is not the point of our story.

This woman came to see me seeking attention for some new medical concerns that had cropped up in her life. I quickly ascertained that seeing a doctor was quite a novelty for her. She avoided us ... like the plague.

How ironic, that expression, for professionals bequeathed the proud legacy of predecessors who risked their own lives to treat such antique scourges as plague!

She avoided our kind like the plague because we had been that virulent in her life. Across an expanse of medical encounters for an array of reasons across a span of years, a whole battalion of us had abused her. We had treated her not as a patient, but as a fat patient.

She couldn't quite bring herself to tell me the specific words of insult and injury she had encountered, again and again. She came close -- she told me I wouldn't believe the harsh words (although, alas, I'm sure I would) -- then squared her shoulders and wiped incipient tears not quite escaping the brim of her lower lids. She managed in a combination of few words and silence to convey very eloquently the vile, venal, vituperative reception we had given her, again and again.

Whatever her reason for seeking our care, whatever her acute need -- we apparently never missed an opportunity to remind her that she was fat. And we made it plain: she was to blame.

That was what was sown in my patient's medical history. What did we reap?

I met a woman who should have received medical attention for a variety of remediable issues, but who had not. I met a woman who should have had cancer screening tests, but had not. I met a woman who should have had screening tests for cardiac risk, and received select immunizations -- who had not.

I met a woman who had been driven from any and all benefits that modern medicine might offer her by the cold and denigrating judgment offered her by almost every modern medical practitioner she had met.

In this public forum, I say to my new patient and all others like her: I am sorry. I am sorry for the sins of ignorant brutality originating in a profession that espouses to "first, do no harm." I am saddened. I am ashamed. And I am profoundly sorry.

To my professional counterparts who have perpetrated this abuse, I say in no uncertain terms: shame on you! Have you looked around? Have you noticed that two-thirds of American adults and a rapidly rising proportion of the global population are overweight or obese? Has it not occurred to you that something larger than the will power or motivation of an individual might be in play?

To any of you who espouses the view that this is all about personal responsibility, I invite you to consider the implications. Given the relatively recent advent of pandemic obesity, this worldview suggests that the current generation of Homo sapiens, across an array of cultural bounds is, ipso facto, fundamentally less endowed with personal responsibility than every prior generation.

If you espouse this view, I have just two words for you: prove it.

There is, of course a need to address weight control among other medical priorities; obesity can conspire mightily against health. And there is, of course, a role for personal responsibility in addressing the challenge of weight control. But sharing in responsibility for the solution says nothing whatever about being to blame for the problem.

And since we are quick to accept that with 'great power comes great responsibility,' we should pause to consider the obvious corollary: in order to take responsibility, one must be empowered.

The modern environment is profoundly, rampantly, unprecedentedly obesigenic. To one degree or another, it disempowers legions of us endeavoring to lose weight, and find health. It can be overcome, but most lack the skill set to do it.

They will never get it if the health care professionals positioned to help impart it are more interested in misguided recriminations.

The prime directive of the medical profession is "first, do no harm." In deriding patients for their struggle with weight, we are doing harm. In denying patients the compassion that was the hallmark of our profession long before the cutting edge of biomedical advance was quite so finely honed, we are doing harm. In driving patients away from the very services we are charged to provide them, we are doing harm -- and violating our professional oath.

To react to the largely unmet challenge of weight control in the modern world with judgment and blame helps no one; harms many; and redounds to our profession's shame.

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