Bias Weighs on My Mind

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I’m a very large person. Lemme put it to you this way: You don’t want to have the seat next to me on an airplane. Many doctors have started conversations with me by asking, "Have you thought about bariatric surgery?" And my cardiologist’s nurse had to ask me how much I weighed because the scales didn’t go high enough.

Last year, I vowed not to book another cruise until I had lost at least 50 pounds. So far, I’ve lost 17 pounds, gained 21 back, and lost 14, for a net loss of 10 pounds. I don’t believe it’s for lack of trying. I swear my body decides to lose weight when it wants to — and gains when it wants to. I don’t know why. I’d much rather lose weight. (For one thing, I like going on cruises!)

And, yes, I’ve thought about — and rejected the idea of — having bariatric surgery. Even people who have had bariatric surgery frequently pack some weight back on. Even Al Roker of NBC’s “Today Show” looks to be a bit more padded than after his surgically induced weight loss.

I don’t think anybody consciously decides to gain weight. Except maybe for one of my brothers who couldn’t put weight on no matter how hard he tried. The fink. I don’t think people who are naturally slim understand how difficult it is to lose weight, just as people who don’t have diabetes fail to understand how hard it is to try and control the Diabeastie.

Apparently, gaining weight and getting Type 2 diabetes is so heinous that AstraZeneca “buried” three clinical trials in an effort to minimize the fact that its antipsychotic drug quetiapine (brand name Seroquel) put people at risk for the conditions.

Even most diabetes drugs contribute to weight gain, although doctors sometimes deny that. A couple of years ago, I met woman who was newly diagnosed with Type 2. She was packing on pounds despite her efforts to keep them off. It turns out she was taking a diabetes drug that is known to cause weight gain, and I told her so. She, in turn, said something to her doctor, who denied the link. I gave her a printout of the drug’s patient information and told her to take it to him and say, “Yes, it does. It says so. Right here.” (And that doctor’s wife is a registered pharmacist and CDE. Tsk.)

As I mentioned in my blog entry last week (“Careful, Your Prejudice is Showing”), weight bias is so widespread that the Yale School of Medicine has developed a continuing medical education (CME) course to address the subject with health-care professionals. (Thanks go out to fellow blogger and Diabetes Self-Management magazine’s editor, Ingrid Strauch, for passing that along to me.)

Authors of the CME point out that weight bias is expressed more often “when obese people are blamed for their weight because of personally controllable factors such as overeating or sedentary behavior. On the other hand, when obesity is perceived to result from causes outside of personal control, such as a thyroid condition, weight bias is less likely to occur.”

It’s the old “it’s all your fault, so we haven’t bothered to do any research to find out differently.”

But research is now showing that “obesity is determined by an interplay of biological, genetic, and environmental factors. Personal lifestyle behaviors are important for health, but reflect only one contributing factor among the complex causes of obesity,” the authors note.

Perhaps results of research on obesity will eventually catch up with popular opinion on why people are overweight. I’m not counting on it happening anytime soon. Even the authors of the CME course say that “False assumptions about the personal causes of obesity can foster weight bias and may interfere with scientifically based efforts to prevent and treat obesity.”

Weight bias can manifest itself in both overt and covert ways. Do you detect a grimace or a tightening of the mouth when you weigh in? Does it seem that the first thing out of your health-care provider’s mouth when you have a medical problem is “You need to lose weight?” I’ve learned to say, “If I were a normal weight, what would you tell me to do?”

And covertly? Check out the results of a study of health-care providers:

  • 91% did not have scales for patients over 350 pounds (I would like to point out that my cardiologist’s scale did not even go that high!)
  • 79% did not have gowns for very large patients
  • 54% did not have armless waiting room chairs
  • 24% did not have a longer speculum for pelvic exams
  • 17% did not have extra-large blood pressure cuffs

I have felt guilty for years because I am overweight and because I “gave myself” Type 2 diabetes. I’m trying to get over it and to like myself as a person at any size or condition.

Does being overweight make me a bad person? I don’t think so. I’m not lazy, as is frequently believed when an overweight person is pictured. I work, I do community service, I interact with my grandchildren and their friends, I travel. Heck, I’ve even stimulated the economy in several countries on three continents and in various small island nations.

Our day will come. Especially if there’s ever a worldwide famine…when excess weight and slow metabolisms will reign.

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