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Open apologies from a doctor to those struggling with overweight and obesity
Doctors have told overweight people to exercise more and eat less, when in fact their overweight may be due to genetic factors or other factors that exercise will not change. UConn Rudd Center for Food Policy and Obesity, CC BY-SAObesity has emerged as a significant risk factor for poor outcomes in patients infected with COVID-19. Based on how doctors and other health care professionals have treated patients with obesity or overweight in the past, I guess many will respond by saying, “Well, it’s their own fault. Overweight! In the spirit of recognizing that people struggling with weight loss include our family and friends, let me offer a different sentiment. To those we have shamed for having excess body weight and / or a poor diet: “You were right, and we are sorry. After giving you unachievable tasks, we ridiculed you. When you tried to tell us, we called you weak and crazy. Because we didn’t understand what you were going through, we looked down on you. We had never felt it ourselves. We did not know. And for that, we apologize. A nutritionist speaks with a patient at an obesity clinic in Mulhouse, France. BSIP / Universal Images Group via Getty Images “Fat shaming” doesn’t work This is just a version of the apologies we owe our fellow human beings who have been told to lose weight through diet and exercise. Then, when that didn’t work, we blamed them for the failures of our treatment plan and stifled their comments with prejudice and persecution. As a doctor and researcher, I have been working in this field for many years. I have witnessed first-hand the life-changing power of pre-existing ideas, judgments and stereotypes. I have seen how negative and unfounded ideas are woven into virtually every interaction that those struggling with weight loss go through when they seek help. And there are tens of millions of them. The Centers for Disease Control and Prevention classifies over 70% of American adults as overweight and over 40% as obese. These numbers continue to climb, and even when some do manage to lose weight, they almost always regain it over time. Rash Judgments To illustrate, imagine that I am your doctor. You have a rash (which represents the condition of being overweight or obese) and you make an appointment with me to discuss a treatment plan. During your visit, the staff in my office use stigmatizing language and non-verbal cues that make it clear that we are annoyed at the idea of dealing with another reckless person. We invoke a set of assumptions that dictate the tone of our relationship, including notions that you are lazy or ignorant or both. You will feel my disgust, which will make you uncomfortable. Unfortunately, healthcare providers typically treat patients struggling with weight loss by attributing to them stereotypes, snap judgments, and ingrained negative attributes, including laziness, disrespect, weakness, and dishonesty. After this uncomfortable exchange, I will prescribe a treatment program for your rash and explain that it is quite simple and easy to use. I am going to point you to several resources with photos of smiling people with beautiful skin who have never had a rash to highlight how wonderful your result will be. “It’s just a matter of sticking to it,” I will say. When you get home, you can’t wait to start treatment. However, we quickly realize that putting on cream is unbearable. It burns; your arms and legs feel like they are on fire soon after you apply the treatment. You shower and wash off the cream. A dismal conversation After a few days you try again. Same result. Your body will not accept the cream without intolerable burning and itching. You return to my office and we have the following conversation: You: Doctor, I can’t stick to this plan. My body can’t stand the cream. Me: That’s exactly why doctors don’t want to deal with reckless people. I’m giving you the treatment and you won’t stick to it. I put on the cream every morning without a problem. You: But you don’t have a rash! Applying this cream when you have a rash is different from applying it on fair skin. I want to get rid of my rash, but I cannot tolerate this cream. Me: If you don’t want to go through the treatment, it’s up to you. But it is not the cream that needs to be changed. It’s your attitude to stick to it. This exchange illustrates prejudicial behavior, biases, and a disconnect between a provider’s perceptions and a patient’s experience. New approaches are needed for those trying to lose weight. Jamie Grill / JGI via Getty Images Bias and Bias For someone who wants to lose weight, the experience of a diet and exercise prescription is not the same as a skinny person on the same program . To perceive another person’s experience as your own when circumstances are different fuels prejudice and prejudice. That night, however, you can’t help but wonder, “Is something wrong with me?” Maybe my genes or my thyroid or something? The cream looks so fun and easy on everyone. At this point, the blame falls unduly on the patient. Despite an undeniable explosion of this rash and appalling treatment adherence rates as we tout the cream, we stubbornly maintain that it works. If the rash gets bigger and hundreds of millions of people fail treatment or relapse every day, well, it’s their fault! Over time, you feel more and more discouraged and depressed because of this untenable situation. Frustration wears off your sense of optimism and erupts in your happy times. You have this rash and you can’t tolerate the treatment plan, but no one believes you. They judge you and say that you choose not to use the cream because you lack willpower and determination. You hear their conversations: “It’s his fault,” they say. “If this was me, I would just use d # $% cream.” This is the very definition of prejudice: an opinion, often negative, directed towards someone and related to something that the individual does not control. Although the causes of overweight and obesity have been widely shown to be multifactorial, the myth that it is the patient’s fault is still widely accepted. This perception of controllability leads to the attribution of a derogatory stigma. A setup for failure That night you sit alone. You think that there is not a single person on the planet who thinks that your body will not tolerate this treatment. The company thinks that you have imposed this on yourself to begin with; there does not seem to be a way out. We have driven overweight and obese people to this place far too many times. We put them in place to take responsibility for our failed treatment approaches. When they came to us with the truth about tolerance, we strongly discredited them and said that they were mentally weak, non-compliant, or lazy. [Deep knowledge, daily. Sign up for The Conversation’s newsletter.] So where do we go from here? If we agree to stop stigmatizing, stereotyping and blaming patients for our treatment failures, and accept that our current non-surgical paradigm is ineffective – what takes its place? To start with, we need a new approach, based on the respect and dignity of patients. A new lens of acceptance and a suspended judgment will allow us to focus on treatments for the body, rather than “mind rather than matter,” which is a concept we don’t use for any other medical condition. . A perspective based on objectivity and equality will allow caregivers to escape the archaic approach to blame and perceive overweight or obese people in the same way as those who suffer from other illnesses. Only then will we finally change the paradigm. This article is republished from The Conversation, a nonprofit news site dedicated to sharing ideas from academic experts. It was written by: J. David Prologo, Emory University. Read More: Here’s Why We Crave Food Even When We’re Not Hungry Vegetarian and Vegan Diet: Five Things to Consider for People Over 65 When Switching to a Plant-Based Diet 8 Simple Strategies For fueling your body during a pandemic J. David Prologo does not make it work for, consult with, own stock or receive funding from any business or organization that would benefit from this article, and has not disclosed any relevant affiliation beyond their academic appointment.