Wagnero Kasaki/Getty Images
Wagnero Kasaki/Getty Images
Tong Yan grew up in the Chinese-American enclave of Los Angeles in a family that valued food but gave little thought to overweight people.
“There was definitely an unspoken obese view, like the little comments about people’s weight,” Yang says. Obesity didn’t affect him or his family, but a friend — who wasn’t that fat — became the butt of a joke. ’” he recalls.
It was not until medical school at George Washington University that Yang began to think deeply about the weight stigma that pervades American culture. In his second year, he attended an educational summit on obesity held by one of his professors. As part of the summit, Yang underwent an implicit bias test to identify his slight bias against thin people. Patients also shared personal stories of discrimination they faced in the doctor’s office, how it affected their health, and their relationships with their doctors.
And he learned how factors other than willpower influence his diet. Exercises such as genetics, brain chemistry, stress levels, and community design contribute significantly to this disease.
Now Yan believes that this kind of dedicated training in obesity is essential to becoming a doctor.
“I think this is the beginning of a kind of re-education because whether we talk about it or not, we absorb all the messages about what it means to be called obese, what it means to have a bigger body.” It’s very small,” he says.
Yet, obesity training in medicine is still relatively uncommon.
“Traditionally, doctors don’t learn anything about obesity, nor do they learn it in medical school or residency.” Dr. Scott Kahan He has taught at Johns Hopkins University and George Washington University and is the Medical Director of the National Center for Weight and Wellness, a clinic in Washington, DC.
“Basically, what we’ve learned is, ‘Obesity is very prevalent and will be seen in many patients, and people can eat less and exercise more.’ It’s really important.’ That’s pretty much it.
Obesity affects so many people— 42% of Americans – and Associated with over 200 other chronic diseases A leading cause of death, from heart and kidney disease to diabetes. The impact on patients and their healthcare cannot be overemphasized. But despite rapid advances in the scientific understanding of the disease, doctors are taught little about the causes of obesity in medical school.
2020 Survey We found that medical schools spend an average of 10 hours on obesity education. Half of the schools say increase is a low priority or no priority at all.
Given the far-reaching impact of obesity on the health profession as a whole, this is not enough, he said. Dr. Robert Kushner, Professor of Medicine and Medical Education at Northwestern University and co-author of the study.
He also says the problem is perpetual. “There aren’t many people trained in obesity. You wouldn’t be in a position to be an informed professional educator.”
Training out of sync with science
As a result of lack of training, health care workers themselves often perpetuate a weight bias Or a misunderstanding about how best to treat a patient who has it.
Also, standard medical curricula have not kept up with research on obesity. Obesity has transformed the field in recent decades. It is now understood to be a complex disease involving many systems of the body. Factors such as genetics, hormones, sleep quality, and even stigma can contribute to weight gain. Therefore, restricting or burning calories alone is often insufficient to treat it.
new and promising — if very expensive — drugs acting on Areas of the brain that regulate appetite It emphasizes that obesity, like many other ailments, can be treated with drugs rather than acting in isolation.
Classes tend to focus on specific organ-based areas such as cardiology and endocrinology, making it difficult to challenge outdated notions about obesity in medical training, but obesity spans many different categories. It tends to be mentioned for a few minutes here and there, and only in relation to other conditions rather than as a blanket disease in its own right, says Kushner.
Also, “There is a common prejudice that this is soft science. This is not something we need to teach, people just need to better manage themselves,” he adds. .
As a result, most doctors are unprepared to help obese patients.
That’s what Tong Yang witnessed firsthand. Yan, now in her senior year of medical school, recalls one of her attending physicians talking to a patient with pressure headaches, partly related to complications from obesity. Doctors were rushed and spoke to patients through an interpreter, which took twice as long, Yan said. He then scolded him, saying, “You have to go out and exercise. You can’t just sit there.”
Yang backed away from the exchange. He knew it would go against what he had learned in his training on obesity and prejudice. I shut up.
“I’m ashamed that I didn’t say much,” Yan admits. “It was just an observation that left a big impression.”
Patients suffer from doctors’ ignorance
For patients like Patti Neese, the impact is severe. Patti Nice says she has never been free of the stigma of living big for 64 years. She is reviled, compared to cows and whales — an insult that amplifies her own savage inner voice.
“I would be my own worst enemy, my worst bully,” she says. There was nothing to overcome prejudice and prejudice.”
But, she says, the biggest clinical damage comes from the doctors themselves, including the orthopedic surgeon she consulted for hip pain years ago.
Almost immediately, without hearing, examining, or even touching her, doctors began lecturing her about her excess weight, and she attributed her pain to obesity. .
“He said, ‘Look, you’re crying because of your weight too.’ That was far from the truth. I was crying because of him,” says Nice. I didn’t want to see you.”
When she finally saw another person for her lower back pain, the root cause turned out to be a severe curvature of her spine. It seems that many people believe that they do not know their own bodies. The orthopedic surgeon wasn’t the only one who fired her, she says. She feels her weight is being spurred on by others as well, including nutritionists, mammographers, and rheumatologists.
This kind of marginalization is especially harmful among racial minorities, for whom disparities in care already create many challenges. Despite having the highest rates of obesity, people are underdiagnosed and undertreated.
Kofi Essel, a Washington, DC pediatrician and nutritionist, says young doctors often don’t have the same background as doctors who tend to struggle with obesity. They do not understand how factors such as neighborhood design, food insecurity and access to fresh food contribute to obesity.
“Because most of us in medical education come from middle-to-high income brackets, there is often a financial mismatch with many patients,” Essel said. increase.
He also argues that the solution is more training on obesity. Not just the science of obesity, but also how to talk to patients with compassion and without prejudice. Essel has also directed the Obesity Summit at George Washington University and says it has seen it change the way students think about obesity. It’s changing regardless,” he says.
Student Tong Yang agrees. Aiming to be a family doctor in urban areas where medical care is not available.
“I am particularly motivated to develop these kinds of skills for my patients in the future,” he says.
