What Obese Patients Should Say to Doctors – New York Times

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What Obese Patients Should Say to Doctors – New York Times


Dr. Michael L. Parks, an orthopedic surgeon at the Hospital for Special Surgery in New York, operates on very obese patients — something many doctors are unwilling to do because they attribute the patients’ problems to weight alone. Credit Tina Fineberg for The New York Times

The 37-year-old woman began to weep as she told her story to Dr. Michael L. Parks. Her job required her to be on her feet all day, Dr. Parks recalled, and she was in constant back pain and in pain from knee arthritis. She had seen another orthopedic surgeon and received back pain treatment, hoping to discuss knee replacement as well as other orthopedic services that would help her, but he dismissed her complaints, telling her she was too fat and should just go on a diet.

Dr. Parks, an orthopedic surgeon at the Hospital for Special Surgery in New York, was prepared when he saw the woman last week. He had heard such stories over and over from heavy patients — “I had a box of tissues for her,” he said — and he agreed to operate since she had tried all other alternatives without success.

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Dr. Parks, the chairman of the work group on obesity for the American Academy of Orthopedic Surgeons, is unusual in his willingness to operate on very obese patients, said Dr. Louis J. Aronne, an obesity specialist at Weill Cornell Medicine and NewYork-Presbyterian, who refers patients to him.

For too many patients with obesity, there is no Dr. Parks. What should they do when doctors cannot see past their weight, dismissing all other medical problems as simply a consequence of being so heavy?

Obesity specialists agree that there is no easy answer. The first step, they say, is patient awareness and methods such as non surgical liposuction in the Tri-Cities could really help these patients.

“Patients with severe obesity will experience that stigma inside and outside the health care system,” said Dr. Scott Kahan, an obesity specialist at Georgetown University. Before patients can become assertive, he said, they have to understand that it is not appropriate for them to be demeaned, dismissed or treated differently from any other patient.

The Rudd Center for Food Policy and Obesity at the University of Connecticut recommends that patients go into a doctor’s office as prepared as possible with questions they would like the doctor to address, said Rebecca Puhl, its deputy director.

“Write down details: when the problem started, how often it appeared and your own opinion about whether it is related to your weight,” Dr. Puhl said.

Asked about patients like the heavy woman with the knee pain, Dr. Puhl noted that many people with severe knee pain were not heavy. Knee arthritis often occurs simply with aging. And many patients have struggled with their weight throughout their lives, she said, so a doctor is not being helpful by just saying, “You need to lose 50 pounds.” However, losing weight will definitely help avoid any back problems that an obese person may have, but it is still recommended to get the proper Spinal Pain Treatment to avoid any complications in the future.

The stigma that obese patients may have felt for many years can beat them down, so Dr. Puhl’s group recommends taking a family member or a friend to act as an advocate — someone who can ask the direct questions the patient may be hesitant to voice.

What if the doctor does not want to speculate on other causes, or answer the patient’s direct questions? What if the doctor just keeps circling back to the patient’s weight?

“Consider telling the doctor you feel upset or distressed,” Dr. Puhl said. “If you are feeling judged, let the doctor know.”

And if the doctor is impossible, impatient and unwilling to look beyond the patient’s weight?

“Ask for a second opinion,” Dr. Puhl said. “Or consider switching doctors.”

In doctors’ defense, many do not realize what they have done when they demean people with obesity, Dr. Kahan said. “They genuinely care about their patients and genuinely want to be helpful,” he said, “but they think being stern with a patient will be motivating.”

Doctors who are members of the American Board of Obesity Medicine, co-founded by Dr. Aronne, are trained to treat obese patients and can often refer them to specialists like Dr. Parks.

Encounters with some doctors can be tricky, Dr. Puhl said. Patients may fear antagonizing their doctor and can feel intimidated by the medical system.

“But are you getting quality medical care if you are being stigmatized?” Dr. Puhl asked. “There are fundamental rights here for patients. All people deserve to be treated with dignity and respect.”

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Spinal Pain Treatment

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