Too Overweight for Medical Care?

More than 60 percent of American women are considered overweight. That's a lot of people to exclude from medical treatment.
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Recently, the South Florida Sun Sentinel reported that several area ob-gyn doctors are refusing to accept overweight women who are otherwise healthy as their patients. In defending their decision, the doctors cite concerns about potential complications in care, risk of malpractice suits and medical equipment that is not designed to deal with excess weight. Wow. More than 60 percent of American women are considered overweight. That's a lot of people to exclude from medical treatment.

Let's take a moment to think about the absurdity of this situation -- and the headlines we might read if other specialty health care providers followed suit:

"Oncologist Declines to Treat Woman's Breast Cancer Due to Excess Weight"

"Cardiologists Determine Obese Men are Beyond Help, Decline to Perform Surgeries or Prescribe High Blood Pressure Medications"

Of course, it's highly unlikely that these scenarios would ever come to pass. And it's not because breast cancer or cardiology patients are not at high risk. They are. But medical professionals don't turn away cancer and cardiac patients because of their high-risk disease; it's precisely why they treat them.

Across the country, we have many specialists who handle complex conditions and high-risk patients but we have few specialists who are trained to manage obesity -- and even fewer general physicians who are trained to help their overweight or obese patients improve their health.

In recent surveys, we found that nearly 90 percent of those with obesity have tried to lose weight and more than 50 percent are currently involved in a weight loss effort. At the same time, almost three-quarters of primary care physicians -- 72 percent -- say that neither they nor anyone else in their office has received training regarding weight issues.

It seems to us that those who are overweight or obese know they have a problem. Many are seeking help and they continue to seek help -- even when they are discouraged by previous efforts. The irony is that what would seem to be a key resource for help -- a primary care doctor -- really has no relevant expertise.

Add to this another study, which found that more than half of primary care physicians view those with obesity as awkward, unattractive, ugly and non-compliant. Apparently those South Florida ob-gyns are in good company.

We cannot think of any other health condition where there are so many affected and trying to improve, while large components of our health care delivery system seem completely unable, or unwilling, to help.

There are many laudable independent efforts underway at both the state and federal level to address issues in our environment that are contributing to this epidemic, but as a nation we have yet to think how we can comprehensively approach this issue. Some have suggested that screening and education efforts are necessary. The more important question, however, is, "What happens next?!"

Our health care system is already facing the impact of the obesity epidemic -- costs are increasing exponentially and lives are being lost. We need to stop and face the reality that we are doing very little in our health care system to help until other serious conditions -- like diabetes, heart disease and cancer -- kick in. It's time to change.

Christine C. Ferguson, J.D. is a professor at The George Washington University School of Public Health and Health Services as well as the Director of STOP Obesity Alliance. Scott Kahan, M.D., M.P.H. is a Clinical Advisor for STOP Obesity Alliance.

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