by, for and about Women of Size and their allies

Archive for the ‘obese’ Category

Obesity epidemic is a media hoax

The following article is complete and unadulterated with link to its original source. (It’s not news to you, Dear Reader, but you may know someone who needs to hear it. And it proves that the science of fat will eventually outpace the fear of fat… even in newspapers.)

 

http://www.cleveland.com/healthfit/index.ssf/2012/12/is_there_really_an_obesity_epi.html

Is there really an obesity epidemic? Or has it been created?

Published: Monday, December 17, 2012, 10:00 AM     Updated: Monday, December 17, 2012, 6:10 PM
Evelyn Theiss, The Plain Dealer By Evelyn Theiss, The Plain Dealer 
PDSTOCK-FAT-OBESE-OVERWEIGHT-AMERICANS.JPGPaul Ernsberger, an instructor at Case Western Reserve University’s medical school since 1989, says there is no obesity epidemic — a view that flies in the face of nearly all reported research.AP file

Are there really more fat people in our society today? Or is it that fat people are disproportionately represented in polls, because they have landlines and are home to answer the phone, while younger, active people are out and using cell phones?

Is there really an epidemic of obesity – or has it been falsely created by the pharmaceutical industry?

These are some the provocative questions and theories presented by Paul Ernsberger, who has a Ph.D. in nutrition and has been teaching at Case Western Reserve University’s medical school since 1989.

“We do not have an obesity epidemic,” he says plainly. “While there has been an increase in people’s weight, about half of it is due to increased honesty – because people are now telling the truth about their weight, while they were more modest about it in the past.”

Ernsberger is a research scientist, and he makes statements that fly in the face of nearly all reported research on the topic of obesity, which state that the majority of Americans – two-thirds – are overweight or obese.

For one thing, he posits that the idea of an “epidemic” of obesity has been created by the media, based on faulty assumptions from questionable research, or a desire for eye-catching headlines.

Weight is also a personal issue for Ernsberger. When he was a young adult, the 6’1″ Ernsberger says he was of “average weight.” Now 56, with a lung condition that he says is not connected to obesity, but which makes exercise difficult if not impossible, he is significantly overweight.

In a lecture at the monthly Science Caf meeting at the Market Garden Brewery in Ohio City last week, he showed PowerPoint slides of Brad Pitt and Arnold Schwarzenegger, saying that according to the Body Mass Index method of measurement, they would be considered overweight or obese.

But he never mentioned his own weight – on purpose, he says later.

“I don’t address it unless someone asks,” he says. No one in the audience of about 150 people asked him about it in during the question and answer period, though some talked about it with each other afterward and wondered why he didn’t.

When he has mentioned his own weight issue, he says, “It can really backfire,” and it becomes a distraction.

But, that aside, he proposes that being overweight, even obese, isn’t as bad for your health as headlines would have you believe – or as predictive of mortality. Smoking is much more dangerous, and a habit that some people keep partly to avoid gaining weight, he points out.

Too often, people look at others who are fat and make assumptions about their habits, Ernsberger says.

“In fact, weight is almost as heritable as height,” he says. “Identical twins weigh within a few pounds of each other. And yes, physical inactivity and imprudent diets affect weight, but so do medical illness, psychiatric illness and social determinants, such as poverty.”

So judgment about others’ weight – or our own – is misplaced and unproductive, he says.

Focusing on a few key healthful habits is much more important, Ernsberger says – which includes eating lots of fruits and vegetables, getting some physical activity each day, and diligently taking medications that you have been prescribed, especially those for high blood pressure and cholesterol.

All this flies is contrary to what people have heard and read for the past two decades – that obesity started becoming a public health problem in the 1980s, and has snowballed since then. Stories have noted that obesity “threatens to bankrupt the U.S. economy” and “threatens the foundations of our society.”

Just this past week, the United Health Foundation nonprofit released a report saying that in 1990, Ohio reported an obesity rate of 11.3 percent, while in 2012, the rate had more than doubled to 29.7 percent of the population. Those obesity numbers were self-reported, and the report notes that the real number of obese people is likely higher.

Mortality, says Ernsberger, depends more on your habits than your weight, and fatness depends mostly on your genes.

“Most people have not gained weight – [Americans] have added only 20 pounds in the last 20 years on average,” he says. “These relatively small gains have pushed many people into the overweight and obese categories.”

He points to BMI as being a measurement of obesity that can be flawed, and that has skewed the numbers. Other experts too have pointed out that muscular people– like Pitt and Schwarzenegger, for example — have BMIs that would put them in the obese category, based on what they weigh in relation to their height. Yet insurance companies mostly use BMI in their calculations of whether the insured person is overweight.

Calorie-counting is another thing that Ernsberger points to as being mostly futile. “You can gain one pound per year by eating 10 extra calories a day – which could be 3 M & Ms, or one sip of soda. Or you could burn 10 calories fewer per day by taking 200 fewer steps.”

No one can count calories to within significant degrees of accuracy, he says, so it’s rather a pointless practice.

His main point, says Ernsberger, is this: “I’m not saying you can be healthy at any size. I am saying you can improve your health at any size. The relationship between weight and health is not absolute.”

It’s far better for doctors to tell their patients that, than to merely tell them, “Lose weight,” he says, adding that that’s not just unhelpful advice, but too often, doctors won’t prescribe, say, high blood pressure medicine to an overweight person while they will to a normal-weight or thin patient.

So, to what does he attribute the idea of an “obesity epidemic?”

It all goes back to the pharmaceutical industry in the 1990s, Ernsberger says, which is what started the “hysteria.”

“Large pharmaceutical companies were working on diet pills – dexfenfluramine and orlistat,” he says. “They were expecting millions of dollars of sales and they wanted to build up the markets for this. So they had to promote the concept that obesity is a serious medical condition, so that doctors could prescribe medication for it.”

Companies “spent several hundred million dollars in physician education, and the doctors who ran weight loss clinics began to talk about the dangers of obesity. They started putting out press releases, but you couldn’t tell, because they came from organizations like the American Dietetic Association and the American Heart Association.”

Then, he says, weight-loss companies piggy-backed on all this.”

How does he know?

“A lot of information about this — about ghost-written articles in medical journals and such – came out because of the lawsuits that came out of the fen-phen deaths.” (Fen-Phen combined two obesity-treating drugs and was withdrawn from the market in 1997 because it was associated with a higher-than-normal incidence rate of heart valve disease, and some deaths).

The media immediately responded to the reports of an obesity crisis with far more stories about the issue, he said.

There also have been alarming reports over the years about the rise in Type II diabetes, and its emergence in young children – previously unprecedented.

But Ernsberger has an explanation for that. “(Type II) diabetes in children has an extremely low incidence,” he says, “with less than 5 in 100,000 children affected.

“And for adults, blood sugar levels haven’t changed all that much. Back in the 1980s, though, only 1/4 of the people who had diabetes knew it. We’ve changed the definition now by making the guidelines stricter. ”

He puts it this way: “You can almost entirely explain the increase in diabetes by two things: the increase in the Hispanic population in the U.S., because diabetes is more common among Hispanic people, and the increased detection for treatment.”

Also, he says, “Type II diabetes is almost an entirely genetic disease. If one twin has it, for example, there’s a 95 percent chance that the other twin has it. It isn’t caused by obesity – obesity is a symptom of early diabetes.”

The most important takeaway, he tells audience like the one Monday night, is not to focus on losing a lot of weight. “Our biology conspires against weight loss,” he says, because our bodies respond to an intake of fewer calories by becoming more efficient.

That is demoralizing, and it makes weight loss – or keeping weight off – difficult, if not impossible for most people.

Instead, he says, making changes in your behavior – eating more fruit and vegetables, exercise – and if you want to lose weight, just think about losing 5 percent of your body weight.

The first five percent of weight loss has the most impact on health, he explains, because the fat lost is the fat that surrounds our internal organs – the most dangerous fat from a health standpoint.

As a medical school instructor– who has tenure – Ernsberger says his positions are not as controversial as one might think.

“The only flack I get is from people who derive their livelihood from providing weight loss services,” he says. “I am providing weight realities in a dietetic society.

“Telling people they should be skinny is not working.”

More Fat-Shaming? Marilyn Wann dishes back

the following article appeared originally in sfweekly.com Mon., May 14 2012

Weight of the Nation Serves Up More Fat-Shaming

LR_Marilyn_Wann_by_Mark_Richards.jpg
photo by Mark Richards
Marilyn Wann

Today our nation relapses into what might be our worst case of fat fearmongering yet. The current source of our infection with pseudoscientific sensationalism is something called Weight of the Nation, a highly contagious conference/book/series/website onslaught backed by the U.S. Centers for Disease Control and Prevention and delivered tonight and Tuesday (May 14-15) via ocular injection on HBO.

I attended the first, government-sponsored Weight of the Nation conference in 2009. I didn’t pay or anything self-defeating like that. I just walked in (with a brave friend or two) and delivered plastic-wrapped fortune cookies to the fancy luncheon tables where major stakeholders were about to chew on the alleged “obesity” problem. If the professional food scolds took a cookie, they got messages like these:

  • The war on “obesity” is a war on PEOPLE!
  • The No. 1 threat to fat people? Your unexamined prejudice.
  • What’s the word for science that serves bigotry? Hint: It starts with “you.”
  • If you can’t imagine fat people being healthy…that’s YOUR pathology!
  • Tell people to lose weight if you want to endanger public health AND civil rights!
  • How many fat people must you starve, poison, slice up? Celebrate weight diversity now!

And the Orwellian:

  • Weight ≠ Health. Diversity ≠ Disease. Hate ≠ Help.

The wisdom of the fortune cookie didn’t deter them from three more years of scheming, so now we’ve got, Weight of the Nation.

On the Weight of the Nation website, the CDC calls its new hatefest “an unprecedented public health campaign.” Really? Let me list on my pudgy fingers a few of the more obvious public health campaigns attempting to herd us around this same mulberry bush:

LR_Shape_of_Things_to_Come_01.jpg

• 1956: President Eisenhower establishes the President’s Council on Youth Fitness in response to fears that Americans are getting “soft.” The program celebrates its 50th anniversary in 2006, when people were still “soft.”

• 1994: The National Institutes of Health establishes WIN, the Weight-control Information Network. Because being fat is caused by lack of information.

• 1994: U.S. Surgeon General C. Everett Koop launches “Shape Up America!” Eighteen years later, his campaign’s budget is in great shape.

• 2003: The CDC launches a $125 million anti-“obesity” ad campaign called “Verb, it’s what you do.” Because fat children, who are too stupid to understand nutrition labels, must surely obey the rules of grammar.

CDC_verb_poster.jpg
• 2010: Michelle Obama says, “Let’s Move!” That’s code for “solving the problem of obesity within a generation.” Creepy! Also, given the track record of previous campaigns, she’s smart to set a deadline long after anyone will hold her accountable.

This list doesn’t include the plentiful state and local efforts to eradicate fat people. Clearly, for at least the past 60 years, fat people have not been welcome in America. Officially. The weight blame goes either to fat people personally, to the environment, or both. Either way, two-thirds of us (and at least a fifth of our children) aren’t welcome here. Though unwelcome, we’re sure useful as easy targets.

When the initial frenzy of Weight of the Nation has calmed down — after everyone has enjoyed this round of hating fat people and there’s been a healthy boost to budgets, profits, viewership, and ad revenue — I predict we’ll hit the same wall that every dieter encounters: the return to reality.

I suggest that reality is not so bad. To keep a grip, ask yourself:

  1. Would you question the motives behind any other national PR campaign designed “for your own good” by major media, corporations, and the government?
  2. If it were any topic other than weight (where you might feel vulnerable), would you be so quick to believe the numbers they cite to justify a “War on [Whatever]”? (Most egregious exaggerations: “Fat people cost ‘us’ billions!” “Everyone’s going to be really fat!” “Our children won’t live as long!”)
  3. Would you rather trust your own judgment about what’s good for you or get swept along by the latest fruitless panic?
  4. Do you want to connect with other people who are saying, “WTF” about Weight of the Nation?

Here are some:

Debate the Weight is a suite of data-supported arguments from the Association for Size Diversity and Health that controvert what they call “one of the most misleading and misguided public health campaigns — ever.”

Here’s a video from that group that’s way more fun than anything HBO will show. In it, one person confesses, “Health At Every Size liberates us from so much bullshit. It’s the big secret that I feel very smug to know and I want to spread it all around and not have it be a secret at all, ever again.”

Health At Every Size pioneer Deb Burgard offers a brilliant viewer’s guide on how to take care of yourself during the current hate campaign. She writes, “Blaming fatness keeps us from addressing the root causes of our problems and is clearly unfair to fat people. Many powerful people understand this but find it expedient to frame a problem in terms of fat in order to bring attention to it. They don’t think people will just attend to the real issue unless they whip up the fat panic. … I say, have the courage to make your argument about the real issues and stop doing it on the backs of fat people.”

Fall Ferguson lists the top 10 reasons to be concerned about the Weight of the Nationdocumentary on the Health at Every Size blog. Among other things, Ferguson writes, “Few things are as destructive to health and well-being as fear. I also question whether health professionals who use fear to influence people are behaving ethically.”

Nutrition professor Linda Bacon compares Weight of the Nation to bear-baiting in ancient Rome’s coliseum in today’s HuffPo. She writes, “Proponents may think they mean well by deploring the size of roughly half our nation, but it’s easier to rail about fat than examine the commercial and class motives that create the real health and wellness divides we live (and die) with.”

Dr. Deah’s Tasty Morsels blog critiques the media barrage. She writes, “If your position about obesity is based on concern for our health or presumed financial burden on society, I just ask you to read more than the one side of the story that you are being told over and over and over. Then, just as you would for an election, make your decision based on being informed.”

Jezebel editor Lindy West says “being mean to fat people is pointless.” And elaborates: “The assumption that you have a right to legislate another person’s body ‘for their own good,’ or ‘for the children,’ or even ‘because they’re gross,’ is its own kind of crazy — but to inflate that assumption to apocalyptic proportions, railing against the nation-obliterating medical bills of nebulous future straw-fatties, is fucking bonkers.”

Michele Simon, public health lawyer, gives great reasons why she is not attending or watching Weight of the Nation Including this one: “Scientific evidence shows that fat people have enough problems dealing with discrimination, bullying, etc., and the last thing they need is more fearmongering brought to you by the federal government and cable television.”

Slink magazine calls out weight-shaming as wholly unhelpful to health. Its rallying cry: “Because obesity, BMI, and all the other fad words you throw at plus-size women don’t stick or mean anything, and the moment we manage to hold off ridiculing women and our bodies long enough and alter the way we talk about plus size, fat, and our bodies to talking about healthy diet and exercise, the better off we will be.”

And isn’t that supposed to be the point? Y’know … wellbeing (and maybe even a bit of welcome) for all of us.

Link

Silly brilliant Heffalump

Silly brilliant Heffalump

http://fatheffalump.wordpress.com/2012/06/09/embracing-the-ridiculous-and-rejecting-ridicule/

New Year’s Revolutions: 5 things to do, 5 people to remember

The following is stolen in its entirety from SF weekly. I’m sure Marilyn won’t mind and I don’t really care what the weekly thinks.

http://blogs.sfweekly.com/exhibitionist/2012/01/lap_band.php

 

Five Things to Do in 2012 That Aren’t
Radical Weight-Loss Surgery

By Marilyn Wann Tue., Jan. 3 2012 at 8:30 AM
LR_Marilyn_Wann_by_Mark_Richards.jpg
photographer: Mark Richards
model: Marilyn Wann
​An acquaintance traveled to Los Angeles recently and saw the ubiquitous 1-800-GET-THIN billboards. “It was like, ‘Welcome to LA … You’re fat!'” said Jennifer Yendes.

 

The U.S. Food and Drug Administrationtook note of the notorious billboards in early December. Regulators officially told marketing company 1-800-GET-THIN (and the eight clinics that take patient referrals from the ad campaign) that their ads do not adequately warn people about the risks of lap band surgery. They also found the billboards’ existing warnings too small to be legible.

This is the same FDA that in February approved use of the gastric girdle (aka lap band) at lower weights, making major surgery available to people whose clothing tags carry more than one X rating.

The promoters of stomach cinching (aka lap band) were given 15 days to respond or face monetary penalties and possible inventory seizure. The legal representative of 1-800-GET-THIN (who’s been cited in news reports as saying he is also president and CEO of the company) has said the ads will change, and one news report says a new warning has been placed on the company’s website.

The very idea of surgery of this nature reminds me of the bureaucrat’s mother in Terry Gilliam’s brilliant movie, Brazil. She pursues increasingly grotesque surgeries for her looks while increasingly menacing conduit tubes snake through the scenery. Is this really how we pursue health and beauty in our lives and in our landscapes?

Amid what seems like black comedy, I don’t want us to forget the five people who drove past 1-800-GET-THIN billboards in the LA area, underwent lap band surgery, and died.

Willie Brooks was a 35-year-old substitute school custodian. He was 5’6″ and weighed about 300 pounds. According to Los Angeles Times reports, he hoped that if he lost weight, he could get a permanent position. He went on a fishing trip with his wife, Okema, and their six children (then ages 14 to 20) the day before his June 5, 2009, lap band surgery. He died from peritonitis three days after the surgery.

Ana Renteria was a 33-year-old office worker who weighed 240 pounds. She was in constant pain after having lap band surgery in February, 2010, according to Los Angeles Times reports. Her surgeon told her that was how it would feel, her sister Noemi Luna recalled. Ten days post-surgery, she was dead from infection.

Laura Faitro was 50 years old, the primary caretaker for her blind husband living with chronic illnesses. She died five days after having lap band surgery on July 21, 2010. Doctors who treated her after the surgery found she had sepsis. “Faitro’s death certificate lists heart failure as the cause of death, with liver laceration and morbid obesity as contributing factors,” the Los Angeles Times reports.

Tamara Walter wanted to lose 50 pounds. She was a 52-year-old grocery store supervisor and a new grandmother. She had just bought a new house and had plans for travel and a new car. She had lap band surgery in late December, 2010, and entered cardiorespiratory arrest on the operating table. Her family discontinuled life support the day after Christmas, the Los Angeles Times reported.

Paula Rojeski was 55 when she had lap band surgery on Sept. 8, 2011. Surgery clinic workers called 911 and paramedics found her unconscious, not breathing, and with no pulse. She was pronounced dead at a nearby hospital, according to the Los Angeles Times report. It quotes her best friend Marni Rader, who said, “She was never married. She never had kids. Her dogs were her kids. That was her happiest moment, in the park with her dogs. She loved her dogs as much as she loved her family and friends.” Rojeski’s driver’s license listed her height as 5’5″ and Rader estimated she weighed 180 pounds.

I’m no medical authority, but if you’re looking for something fabulous to do for yourself in 2012, here are five suggestions that don’t involve risking death with lap band surgery, things I bet Willie, Ana, Laura, Tamara, and Paula would have liked to do a bit longer.

1. Go fishing. Take a friend or some family members along.
2. Go shopping. And have a leisurely lunch with your sister or your BFF.
3. Spend some time with someone who’s ill. They would appreciate the company.
4. Take your dog for a walk. Play fetch in the park. (No pets? Join a
friend when they walk their dog.)
5. Babysit your grandchild. Or plan an adventurous family outing.

————
Marilyn Wann has created something fabulous to do for yourself that
doesn’t involve lap band surgery — the 2012 FAT!SO? Dayplanner.

Get real. Think big.

It doesn’t have much other purpose

Diagnosis: Bigotry

http://www.prevention.com/health/health/healthy-living/weight-and-obesity-discrimination-from-doctors/article/30a54c9d7bd10310VgnVCM10000030281eac____

Weight and Obesity: Discrimination from Doctors

When Your Doctor Makes You Feel Fat
Overweight women are often given a biased diagnosis because of appearance. Here’s how to make sure you get the health care–and respect–you deserve.

By Harriet Brown

 

When Anna Guest-Jelley–26 years old at the time–badly twisted her ankle, the Nashville native went to see her doctor. “Your ankle’s probably swollen,” she said, “because you’re carrying extra weight.”

 

Guest-Jelley, a yoga teacher, went along with her diagnosis. When the doctor reported that Guest-Jelley’s x-ray didn’t show any fractures, she returned home with instructions to ice her foot–and an all-too-familiar feeling of humiliation at the physician’s focus on her size. “Almost every time I’ve ever gone to a doctor’s appointment, I’ve experienced some level of shaming because of my weight,” she says.

 

Her experience is shockingly common. Weight stigma is on the rise in America, according to the Rudd Center for Food Policy and Obesity at Yale University, and, ironically, nowhere is it more deeply rooted than among health care providers. Multiple studies have found that doctors, med students, nurses, dietitians, and other health care professionals routinely stereotype their heavy patients. In landmark 2003 research from the University of Pennsylvania, for instance, more than half of the 620 primary-care doctors surveyed characterized their obese patients as “awkward,” “unattractive,” “ugly,” and “noncompliant”–the latter meaning that they wouldn’t follow recommendations. More than one-third of the physicians regarded obese individuals as “weak willed,” “sloppy,” and “lazy.”

 

And it’s women who bear the brunt of this characterization–even when they’re not obese. Doctors’ weight prejudices start when a female patient is as little as 13 pounds overweight–meaning her body mass index would likely be around 27–found a 2007 study from Yale University. (BMI is a measurement that uses a ratio of height to weight to categorize people as being of normal weight [18.5 to 24.9], overweight [25 to 29.9], or obese [30+].) “For men, the bias doesn’t kick in until around a BMI of thirty-five, approximately seventy-five pounds overweight,” says Rebecca Puhl, PhD, director of Research and Weight Initiatives at the Rudd Center. “That’s a definite gender difference.”

 

This bias can have a dramatic effect on women’s health, resulting in incorrect assessments of a patient’s condition and questionable recommendations. It’s impossible to know today whether Guest-Jelley’s doctor, presuming that her patient’s BMI (which was then 38.6) was responsible for her ankle pain, did not read the x-ray as carefully as she might have. But after a few weeks of icing her ankle, Guest-Jelley returned to the doctor because her condition was getting worse. Once more, the doctor focused on the scale. “She told me about how her friend had gone on Weight Watchers and had lost all this weight,” remembers Guest-Jelley. “And I said to her, ‘I’ve been on Weight Watchers five times.’ ”

 

At Guest-Jelley’s request, the doctor reluctantly referred her to an orthopedic specialist–who took another x-ray and told her that her ankle had been broken all along. Since the fracture hadn’t been recognized and properly treated for so many weeks, Guest-Jelley’s ankle never properly healed.

 

“I hear so many stories of doctors making assumptions about patients’ health and lifestyles based on their appearance,” says Arya Sharma, MD, PhD, chair of obesity research and management at the University of Alberta. “One of the key factors underlying this stereotyping is the notion that nobody would be obese if they were eating healthy and exercising,” Dr. Sharma says. “But for every obese person I see who doesn’t exercise two hours a day or who’s drinking gallons of soda pop, I’ll treat ten thin people doing exactly the same thing.”

 

Many women find that, no matter what their symptoms are, their physicians blame their weight. Take Parker Ross, 21, an avid walker and bicyclist who’s had asthma since childhood. Last year Ross, who weighs about 300 pounds, lost her health insurance and went without medication for a year. When her asthma got so bad that she couldn’t walk around the block, she saw a doctor. “I found myself being told that ‘obviously’ my weight was the big problem, and I should try to get some exercise,” says Ross. Although she explained that she couldn’t breathe well enough to exercise, the doctor refused to prescribe new asthma medication and instead wrote a prescription for Zoloft–surmising that she must be too depressed to focus on weight loss or exercise. “Everything I was trying to say to her was being just completely erased by her perception of my fat,” says Ross. “Who I was simply got erased.”

 

Fortunately, Ross has since found another doctor to treat her asthma.

 

Mary Tretola, 52, a CPA and a mother of two who lives in Seaford, NY, had a similar experience with her doctor. Since her mid-20s, she’s had a circulation condition that makes her legs swell. “Maybe being overweight does strain my legs, but even back when I weighed sixty pounds less than I do now, I still had this problem,” points out Tretola.

 

Heart Attack Risks Doctors Often Miss

 

In some cases, overweight women may be refused medical treatment altogether. Liv Linhares, now a 350-pound 35-year-old social worker in Portland, OR, vividly remembers going to her student health center in college for a routine pelvic exam. At the end, the doctor said, “Because of your obesity, I can’t accurately feel your ovaries, so I can’t tell if there are any concerns.” He asked the then-20-year-old Linhares to sign a waiver saying that if she did turn out to have cancer, the health center wasn’t responsible. Linhares was mortified–and terror stricken. “I thought, Oh my God, I could have cancer and not know it!” she remembers. “He didn’t ask me anything about my life, how I ate, whether I exercised, if I smoked or had unprotected sex–no other questions about my overall health.” Too unsure of herself to speak up, she simply never returned to her health center.

 

This reluctance to seek medical care is an understandable response, but it can be deadly. “Obese women go less frequently for Pap tests than their thinner counterparts because of the prejudice they run into,” says Joseph Majdan, MD, a cardiologist at Jefferson Medical College who has written about how he himself was stigmatized by fellow doctors before he lost 100 pounds. Research shows that obese women typically get fewer screenings for breast and colorectal cancer too. This finding is especially chilling given the fact that women with BMIs of 30-plus are more likely to die from certain cancers–endometrial, esophageal, and kidney, among them–according to a study of more than 1 million women in the United Kingdom.

 

Doctors, of course, are expected to rise above social prejudices and treat all their patients with compassion. But physicians’ behavior often mirrors the broader culture’s attitudes. “As a society, we value thinness and hard work, so we equate being fat with being lazy,” says Mary Margaret Huizinga, MD, an assistant professor of medicine at Johns Hopkins University. Although most doctors say they show consideration for everyone they treat, no matter what, her research has found that physicians’ respect clearly diminishes as a patient’s BMI goes up. “Till society changes, the medical profession won’t either,” she says.

 

Health Test Secrets Doctors Don’t Tell You

 

Many doctors argue that, overall, they do a good job of attending to all their patients equally. Indeed, a 2010 University of Pennsylvania study established that despite the clear weight bias among doctors, they recommended the same treatments for a specific list of conditions–including diabetes and certain cancer screenings–regardless of a patient’s size or BMI. However, the study didn’t consider other complaints associated with obesity (such as joint pain and shortness of breath), and it looked mostly at older men, who are less likely to experience weight bias.

 

What’s more, the study didn’t examine whether there was any difference in the way physicians communicated medical recommendations to their patients of different weights–and that may be just as key. “One of the most important parts of the medical relationship is the patient feeling able to ask questions and being comfortable with the doctor’s advice,” notes Dr. Huizinga.

 

Treating obesity, however, is uniquely challenging. Ninety-five percent of people who lose weight gain it back within 3 to 5 years–which may leave physicians feeling frustrated and helpless and perhaps inclined to blame patients. “When a person has cancer that recurs, the physician is so empathetic,” Dr. Sharma says. “But when a person regains weight, the response is disgust. And that’s morally and professionally abhorrent.”

 

When doctors take courses that emphasize “uncontrollable” causes of obesity, such as genetics or certain medications, their weight bias diminishes. But, although medical school curricula are expanding, most physicians who are practicing today received little training on weight issues.

 

Patient advocacy groups such as the Association for Size Diversity and Health and the National Association to Advance Fat Acceptance argue that since obesity has been so stigmatized and is so difficult to treat, doctors should be taught to focus less on weight itself and more on other indicators of health, pointing out that even overweight people can be otherwise healthy. They cite studies like the one published in the Journal of the American Medical Association in 2005 that found that people considered overweight (with BMIs of 25 to 29.9) actually had lower mortality rates than those viewed as being of normal weight. And some advocates also feel that whether weight is mentioned at all should be up to the patient.

 

But there are also doctors who are strongly committed to avoiding the pitfalls of obesity prejudice–while still addressing weight head-on. “The first thing that comes out of your mouth when you meet a patient can’t be ‘You’re obese,’ ” says Juan Rivera, MD, a preventive cardiologist and an assistant professor at Miami School of Medicine.

 

“You have to wait for the right moment, and be prepared to work together for a long time. Fighting obesity is a marathon, not a sprint.” Above all, Dr. Rivera says, it takes sensitive, honest communication.

 

For women who feel that their doctors treat them with less dignity due to their weight, experts, including Dr. Rivera, advise telling the physicians, calmly, what they perceive as biased behavior and how they feel about it. “Ultimately, both parties will benefit,” says Dr. Rivera. “And if your physician doesn’t take the criticism well, it might be a good time to switch doctors.”

 

Finding a new provider can make a world of difference. After Tretola’s doctor dismissed her swollen legs, she scheduled a physical with a new practitioner. “The doctor asked if I wanted to be weighed, and I said, ‘I’d prefer not to today,’ ” Tretola reports. “That was fine with him. We did talk about weight, but he was very welcoming, not judgmental, and he discussed problems–such as my high cholesterol–without blaming my weight.

 

“It was so refreshing.”