I’m about to finish my second week of medial school tomorrow and I’ve already noticed a trend. Occasionally, we have physicians come and talk to us about different topics that will affect us when we practice.
We had one about the shortage of primary care providers and today we had one about helping patients change behaviors. In both of these lectures, the physicians teaching had a very clear bias, in my opinion, toward overweight and fat patients….making jokes, oversimplifying obesity, and accepting the fact that overweight and fat patients have worse outcomes because they are fat and not because those patients are more likely to avoid going to the doctor for serious health problems (or having those health issues ignored when they DO go to the doctor and being told that losing weight will fix all their problems…the physicians even showed us all a chart demonstrating this almost magical phenomenon of 100% cured diseases after weight loss) because they have been ignored or made to feel ashamed or embarrassed by doctors in the past about their bodies.
Today was no different but it added to my disappointment. Today, we discussed how to implement behavioral changes and the overarching theme of the lecture was that we should all implement changes because doctors should be healthy and no patient will take us seriously if we’re overweight and prescribing weight loss to them. I have several problems with this.
1. This idea that physicians must be healthy in order to give advice to patients about their health perpetuates this idea that if you have a mental illness or a disability, you can’t be a doctor, when in reality having physicians who live with a disease and understand it make them better, more understanding doctors.
2. Having a physician who openly admitted to never having struggled with weight loss talk about how simple it was and make jokes about fat doctors was alienating to the medical students she was talking to who were overweight because it basically told them that they can’t and won’t be taken seriously as physicians years before they even get to work with a patient, take a USMLE step exam, or before we’ve even had a midterm.
and 3. Telling medical students that getting healthy = weight loss is incredibly oversimplified and just plain dumb. There are a lot of metabolic diseases that make it nearly impossible for patients to lose weight, telling a woman with PCOS to drop 40 pounds is setting her up for failure. Especially when more and more studies on obesity and weight loss are showing that significant weight loss is unsustainable in the overwhelmingly majority of people who manage to do it, they end up gaining the weight back within five years even when they maintain their activity levels and a well-rounded diet.
I hate this idea that doctors should be prescribing weight loss because the reality is that losing weight doesn’t actually have an impact on overall health, it’s the fitness of exercising that does, the weight loss is merely a side effect of increased fitness levels. I don’t believe that being fat is a disease state and I don’t believe that it must automatically mean that person needs to drop a bunch of weight. Everyone can benefit from an increase in their fitness levels and eating better, the weight loss is merely a side of that, it should not be the goal.
I want to see a doctor counsel a patient on their health and instead of setting a goal to be “lose X amount of pounds” I want to see them say, “walking around the block 3 nights a week after dinner”. I hate that the idea that we should be targeting overweight patients with this counsel, too, when there are plenty of people within “healthy” weight parameters that lead sedentary lifestyles, drink like fish, and haven’t eaten a vegetable in ten years. But the urgency with which we are taught to counsel overweight patients on losing weight is very obvious and absolutely no discussion was had today on counseling thin patients to begin an exercise regiment, regardless of their medical history. So basically, if they don’t look fat, we’re to assume that their medical conditions are treatable with medication or medical procedures, but if the patient is fat, we need to insist they lose weight to fix their medical problems even for the same medical conditions! Medications are for thin patients, exercise is for fat patients; that was certainly the overall theme for today.
And I hate the idea that fat patients are meant to be the butt of a joke for all of us medical students while we are supposed to be learning how to help our patients implement healthy changes to their lives. Odds are, overweight patients are anxious about seeing a doctor, they are not unaware of their size, and it’s not the first time they’ve had someone tell them they need to lose weight for their health (plenty of randos on the internet do that for them already…and then take surreptitious photos of them working out at the gym because lol look at the fatty on the treadmill guyz!). It’s also probably not the first time that patient has tried to lose weight through diet and exercise or through really unhealthy ways.
So, it’s the second week of medical school and we’ve already had two lectures from practicing physicians with clear biases against fat patients and I’m sure it’s just going to keep going like this until we graduate, creating even more doctors who think prescribing weight loss instead of fitness is actually going to help patients.
