Why Do Obese Patients Get Worse Care? Many Doctors Don’t See Past the Fat
Why Do Obese Patients Get Worse Care? Many Doctors Don’t See Past the Fat
By
GINA KOLATASEPT. 25, 2016
Photo
Sarah Bramblette, who advocates awareness of lymphedema — arm or leg swelling caused by a problem with the lymphatic system — found that the scale at her doctor’s office could not accommodate her. Credit Ryan Stone for The New York Times
You must lose weight, a doctor told Sarah Bramblette, advising a 1,200-calorie-a-day diet. But Ms. Bramblette had a basic question: How much do I weigh?
The doctor’s scale went up to 350 pounds, and she was heavier than that. If she did not know the number, how would she know if the diet was working?
The doctor had no answer. So Ms. Bramblette, 39, who lived in Ohio at the time, resorted to a solution that made her burn with shame.
She drove to a nearby junkyard that had a scale that could weigh her. She was 502 pounds. 
The difficulties range from scales and scanners, like M.R.I. machines that are not built big enough for very heavy people, to surgeons who categorically refuse to give knee or hip replacements to the obese, to drug doses that have not been calibrated for obese patients. The situation is particularly thorny for the
more than 15 million Americans who have extreme obesity — a
body mass index of 40 or higher — and face a wide range of health concerns.
Part of the problem, both patients and doctors say, is a reluctance to look beyond a fat person’s weight. Patty Nece, 58, of Alexandria, Va., went to an orthopedist because her hip was aching. She had lost nearly 70 pounds and, although she still had a way to go, was feeling good about herself. Until she saw the doctor.
“He came to the door of the exam room, and I started to tell him my symptoms,” Ms. Nece said. “He said: ‘Let me cut to the chase. You need to lose weight.’”
The doctor, she said, never examined her. But he made a diagnosis,
“obesity pain,” and relayed it to her internist. In fact, she later learned, she had progressive scoliosis, a condition not caused by obesity.
“Our patients say: ‘Nobody has ever treated me like I have a serious problem. They blow it off and tell me to go to Weight Watchers,’” Dr. Aronne said.
That happened to a patient who eventually went to see Dr. Scott Kahan, an obesity specialist at Georgetown University. The patient, a 46-year-old woman, suddenly found it almost impossible to walk from her bedroom to her kitchen. Those few steps left her gasping for breath. Frightened, she went to a local urgent care center, where the doctor said she had a lot of weight pressing on her lungs. The only thing wrong with her,
the doctor said, was that she was fat.
“I started to cry,” said the woman, who asked not to be named to protect her privacy. “I said: ‘I don’t have a sudden weight pressing on my lungs. I’m really scared. I’m not able to breathe.’”
“That’s the problem with obesity,” she said the doctor told her. “Have you ever considered going on a diet?”
When an obese patient cannot fit in a scanner, doctors may just give up. Some use X-rays to scan, hoping for the best. Others resort to more extreme measures. Dr. Kahan said another doctor had sent one of his patients to a zoo for a scan. She was so humiliated that she declined requests for an interview. 
“Do you think I don’t know I am fat?” she added.
...and finally left...
