A study of discrimination within the medical community as viewed by obese patients

Abstract

Background: Although prejudice may not be verbal in nature, the lack of response from professional and non-professional medical personnel regarding the obese patients' needs (medical equipment, comfortable surroundings, properly fitting attire, etc.), leads one to assume that obese patients continue to be a target of unfavorable opinion. Methods: 200 patients from four busy east coast bariatric practices received detailed surveys requesting information regarding experiences incurred during the entire peri-operative period. The responses were blinded as to patient or site of surgery. Patients were questioned about attitudes of primary care and consulting physicians and staff, all hospital and outpatient departments, and patient care areas within the hospital. The appropriateness of equipment was also questioned. Results: There were 40 respondents aged 44.7 years (range 21-61 years); 34 were women. Average preoperative weight was 145 kg (range 101.8-231.8 kg). Average weight loss at time of survey was 42.8 kg; average time after surgery was 9.5 months. Responses concerning physician attitudes were similar through all patient groups. There was no difference in degree of discrimination felt by the lightest or the heaviest of the morbidly obese. 7 patients (17%) changed primary care physicians due to a perceived indifference, lack of concern, or negative attitude toward bariatric surgery. The procedure-oriented physicians (orthopedic surgeons and gastroenterologists) were most supportive, while social workers and psychologists scored lowest. Most hospital departments treated patients well, except those with equipment that may be affected by increased patient weight (e.g. treadmills and x-ray tables). Conclusion: Patients undergoing bariatric surgery continue to feel misunderstood and mistreated by medical and non-medical personnel involved in the treatment of their obesity. Like other forms of prejudice, this most likely is due to a lack of understanding of the disease of morbid obesity, the root causes and the medical consequences if untreated. Despite laws designed to prevent discrimination based on appearance, unfavorable attitudes and practices persist. A plan for continued education of the medical and non-medical communities is essential to breakdown the barriers in place due to ignorance and indifference. Patient support groups continue to play an important role in the ongoing battle to correct the negative effect of these attitudes on the morbidly obese patient.