It’s hard enough carrying a few extra pounds, but being heavier just got harder. According to a study completed at Yale University, doctors are turning away overweight patients. The study shows they discriminate against female patients when they are at least 13 pounds overweight, men at 75 pounds overweight. Doctors have been turning obese patients away due to the high cost of medical treatment, leading some states to cut bariatric surgery from their health plans, a move causing uproar from potential patients.
To learn more about what this health care development means, we turned to obesity expert Dr. Joe Colella, a leading surgeon in robotic bariatric procedures, in Pittsburgh, Pennsylvania. “The results of this study are no surprise to bariatric surgeons or to any overweight person,” he says. “The discrimination or bias against these individuals is real and unfortunately pervades our entire society, not just health care providers.”
Why are overweight patients being turned away?
Traditionally, physicians have always struggled with caring for overweight patients, Colella tells us, primarily because medicine has struggled to find effective therapies. In addition, from a surgeon’s perspective, any operation is more difficult to perform as the patient’s weight increases. “As our society becomes more and more obese, more bariatric hospitals and physicians have to care for larger patients across all disease categories, and in many instances, they simply aren’t prepared.”
Not only are obese patients being turned away, but they are often frustrated because of certain health care providers who can’t seem to help them with their weight struggles, Colella explains. “Traditionally, dieting and exercise have failed, and patients often seem to understand that better than their doctors,” he says.
We all know some people who seem to eat anything they want and never gain an ounce, but, Colella says, most of us cannot, and are sugar-addicted and constantly hungry. “Our civilization has provided us with an endless supply of simple sugars or sweets, and our body chemistry is programmed to splurge us into obesity oblivion,” he explains. Weight issues are also often aggravated by the increase in appetite that comes with the simultaneous introduction of a diet and exercise plan. The result: An endless cycle of gaining weight.
Remember though, that no one chooses to be overweight or obese, the surgeon says. “Our society is swimming upstream, fighting millions of years of evolutionary biology that have left us sugar-addicted and square in the middle of an obesity epidemic.”
What health care changes need to be made?
For those who maintain a healthy weight, it can be hard to understand why some people are overweight or obese. “People without a weight problem just don’t understand what it means to have a daily battle with your waistline,” Colella says, adding that gaining weight isn’t just about eating too much. “There truly is a genetic predisposition to be obese, and medicine has been slow to realize that those with a significant weight problem in fact have a real disease.” The answer, he tells us, is education. “Education of physicians as well as the general population is the key to fixing this problem. In some way, bariatric surgeons must lead the way on this front to disseminate this message in a clear and understandable fashion.”
Treatment options for overweight patients
There are various weight-loss options for overweight and obese patients, from traditional diet and exercise to surgery. The first step in every case is consultation. “Treatment options should always begin with a consultation with a knowledgeable physician who can help the overweight or obese person understand the causes of their weight problem and also offer some meaningful strategies to assist them along their weight-loss journey,” Colella explains.
If extreme weight problems are the issue, he says bariatric surgery may be indicated, adding that the decision on surgical options should be made by the surgeon and the patient. Surgical options include adjustable gastric banding, gastric bypass, sleeve gastrectomy and duodenal switch. Of those choices, the most commonly performed is the gastric bypass. Next is the adjustable gastric banding procedure, typically for younger and/or smaller patients. Colella describes the rise in obesity, coupled with a health care system ill-prepared to handle the growing overweight population, as a complex and multifaceted problem, but he does have hope for change. “As physicians come to realize that obesity is truly a disease, and not a problem of lack of willpower, we should see an improvement in all aspects of care for those who battle their weight.”