Prejudice from health professionals can cause people with obesity to not seek help
May 24, 2016 12:00 AM
Laura Skinger instructs her students in the class at California Cycle Path gym in Brighton Heights. Ms. Skinger, who has been morbidly obese, has steadily lost weight through diet and exercise for the past five years.
Health Laura Skinger instructs her students in the class at California Cycle Path gym in Brighton Heights.
By Jill Daly / Pittsburgh Post-Gazette
When Laura Skinger sought medical help in the heavier times of her life, it was often humiliating.
“When I was going through the thick of my weight issues, I didn’t go to the doctor,” said Ms. Skinger, “because even if I went just for a sore throat, first they would tell me I had to lose weight.”
When counting up the challenges faced by people with obesity, Allegheny Health Network endocrinologist Jennifer Holst says negative attitudes about extreme overweight do the most damage, keeping them from seeking help and discouraging them when they do.
Where to get help
For people who are extremely or morbidly obese, bariatric surgery is a consideration. Both University of Pittsburgh Medical Center and the Allegheny Health Network include surgery as a option in treating obesity.
Morbid obesity means a person weighs 100 pounds or more than their ideal weight and have at least one of the obesity-related conditions: high blood pressure, high cholesterol, diabetes, arthritis and sleep apnea.
■ To find an obesity medicine provider, go to the website of the Obesity Medicine Association: http://obesitymedicine.org/
The group describes itself as “Clinicians who treat obesity as a disease and not as a character flaw, and regard their patients with compassion and dignity.” It has developed what it terms “the obesity algorithm” in order to help in treating patients. The website says, “This educational tool offers health care providers an overview of principles that are necessary to consider when evaluating patients and implementing personalized treatment plans.”
■ Information about bariatric surgery is available on the websites of Allegheny Health Network (https://www.ahn.org/specialties/bariatric-and-metabolic-institute) and the University of Pittsburgh Medical Center (http://www.upmc.com/Services/bariatrics).
There needs to be a better understanding of the condition before bias and blaming the patient will disappear, even among health professionals, she says.
“Studies show people who are obese don’t go to the doctor so much,” she said. “They are ashamed of being weighed and are shamed. People who are obese are getting less medical care, they’re not getting help.”
Ms. Skinger, 40, of Freedom, has lost almost 400 pounds from her highest weight of more than 600 pounds.
Her husband, too, has been overweight for some time — although this year he’s been making some changes and has lost 80 pounds, his wife reports — and was unhappy with his treatment in doctors’ offices.
“He didn’t go for 10 years to the doctor,” she said. Both were always told they had to lose weight, but it didn’t help, she said. “We didn’t want to be bullied about it as soon as we walk in the door. It’s the first issue they saw.”
The 5-foot-10 mother of three now weighs 235 pounds. She lost the weight gradually, determinedly, with exercise and a healthy diet, all without surgery.
She’s sympathetic to anyone who is overweight or obese. She leads all sorts of exercise classes — Spin, TRX, Pound, Zumba/Dance Fitness and Kids Zumba — at a gym in Brighton Heights, and she coaches people through social media. It’s a way to keep herself accountable to them, as well, she said.
Her husband, John Skinger Jr., 41, once was discouraged during the process of changing jobs, because he knew there would be prejudice against him at the interview, Ms. Skinger said.
“He knows if he goes in there, he’ll get paid less,” she said, adding that the employer will consider possible health costs and lost work days because they assume an obese person will be sick often.
Advice for doctors
The health consequences of obesity include sleep apnea, Type 2 diabetes, depression, anxiety, high blood pressure, heart disease, stroke, certain cancers, osteoarthritis and cholesterol-related problems.
Dr. Holst said help for people who are obese has to address many issues. “Taking the blame off of patients, and empowering patients with tools they need to lose weight is more effective than blaming or shaming.”
Why do some people become obese while others with similar diets and daily activity maintain lower body weight?
“With extreme obesity, they probably have multiple reasons why: It could be genetic, they may have a hormonal imbalance, a problem with appetite and medication,” Dr. Holst said. “They may be on depression medications, they may have diabetes. Things can spiral out of control.”
Ms. Skinger experienced a steady weight gain after she had three children.
“My biggest downfall, when I was at my heaviest, was I drank sweet tea, two to three gallons a day, like it was my job. I would eat once a day, but it was like a binge.”
Some medicines vital to a patient’s health can cause weight gain, including those for blood pressure, diabetes, depression, anxiety and schizophrenia, Dr. Holst said.
Moreover, excess fat tissue has been found to work as an endocrine organ and can disrupt a person’s metabolism in various ways, storing and releasing hormones and secreting chemicals in a dysfunctional way, often increasing inflammation and insulin resistance.
Dr. Holst said hormones also can cause weight gain. Two that influence appetite are leptin, which decreases hunger, and ghrelin, which seems to increase it. There are probably 20 other hormones that affect weight as well, she said.
Helping patients lose weight is a combination of medication, to control appetite, and coaching, which could include cognitive behavioral therapy, she said.
“It’s basically retraining the way people think. So they’re more successful, so they stick to their plan.”
She described her ideal method: “I think it’s a team approach: a physician, for prescribing medications; a dietitian to help prescribe a diet; a coach or psychologist who can do cognitive behavior therapy and help with problem solving; a surgeon, for those patients who need bypass surgery; and an exercise physiologist,” to help the patient safely become more active.
About seven years ago, at her heaviest, Ms. Skinger considered weight-loss surgery, but she had to lose weight first. Then, after some success, her endocrinologist encouraged her to keep going. She no longer has to take diabetes medication.
“I lost my weight in such a slow and steady process. ... I’m still able to eat 2,200 calories a day and still lose weight.” Teaching exercise classes at California Cycle Path and practicing an active lifestyle, together with a vegetable-heavy diet, are working for her.
“When I coach people, I tell them there is no pill. The way it comes off is the way you put it on.”
Dr. Holst said prejudice against obesity is a major issue in insurance, and some companies won’t cover needed medications. In 2013, the American Heart Association, American College of Cardiology and The Obesity Society called for doctors to consider it a disease and actively treat obese patients for weight loss.
In a 2015 survey of more than 9,000 people, as reported by The Obesity Society, three out of four consumers said that they are not covered for necessary, evidence-based obesity treatment services, including access to a dietitian, medical weight management, bariatric surgery or obesity drugs.
Insurance companies are not reimbursing this kind of team-based care, Dr. Holst said. “Usually if it’s done, patients are paying cash, or are grant-funded, or a health care system is paying money to get it started.”
She said Allegheny Health Network has this team approach for diabetes and also, somewhat, for obesity and other chronic illnesses.
“Our current grants are mainly focused on diabetes. ... We have physicians across the network who do manage diabetes. … What we don’t have yet is a more unified approach. That’s something that we’re working on — bariatric surgeons, dietitians — how we’re going to train them that’s most helpful to treat obesity.”
After sharing her story and encouraging others who are obese, Ms. Skinger cautioned: “Not every way of losing weight is best for everyone. There’s no one size fits all.”
Individuals need support, not criticism: “It’s about progress, not perfection. If you can make better choices today than you did last week, that’s a win.”
To report inappropriate comments, abuse and/or repeat offenders, please send an email to
firstname.lastname@example.org and include a link to the article and a copy of the comment. Your report will be reviewed in a timely manner.