As ancient Greek physician and author of the Hippocratic oath — the pledge taken by physicians and health care professionals — Hippocrates wrote, “the physician must … have two special objects in view with regard to disease, namely, to do good or to do no harm,” the guiding principle in this medical code of ethics is non-malfeasance: do no harm.
However, many health care professionals fall short of this saying when treating patients considered to be overweight or obese.
Weight bias and obesity stigma is not only prominent in our culture at large, but also exists within the medical field. Many overweight patients are not subject to the same quality of care as their average-weight counterparts. The care administered to overweight patients is mostly based on their size while dismissing their actual health concerns.
For example, in 2016, the New York Times interviewed Patty Nece, a 58-year-old woman from Alexandria, Virginia — who visited an orthopedist for hip pain. Nece had only explained her symptoms to the physician before he advised her to lose weight. The physician diagnosed Nece’s issue as “obesity pain” without conducting any examinations or tests. Nece later learned the pain was caused by progressive scoliosis, a condition not linked to obesity.
Nece’s case is not rare.
The National Center for Biotechnology Information conducted a study with 122 physicians working in one of three hospitals in the Texas Medical Center of Houston to examine how the weight of a patient contributes to physician attitude and intended treatments. The physicians “reported that seeing patients was a greater waste of their time the heavier that they were, that physicians would like their jobs less as their patients increased in size, that heavier patients were viewed to be more annoying and that physicians felt less patience the heavier the patient was.”
The do-no-harm ethical model for medical practice is not implemented when treating overweight patients. Not only is a weight-loss treatment strategy, regardless of health condition, prescribed for overweight patients, but the overall respect and care given by physicians becomes questionable.
Weight-based treatment is not only unethical, but unproductive.
According to the Journal of Obesity, only 20 percent of participants of weight-loss initiatives “maintain weight loss one year later and the percentage of (participants) maintaining weight loss continues to drop by the second year.”
Additionally, the Journal of Obesity reported that 77 percent of participants in 29 studies conducted on weight-loss initiatives in the U.S. had regained their initial weight loss after five years. If weight-loss programs are designed on the basis of health, rather than a cultural stigma against large bodies, then why do most participants of these programs return to their original body size despite having made the lifestyle changes these weight-loss programs require?
Some health care professionals and registered dietitians have begun taking more holistic approaches to their patients’ health.
For example, these professionals have adopted the inclusive Health at Every Size (HAES) model for treatment. The HAES model promotes healthy behaviors and intuitive eating while appreciating body diversity and acknowledging social characteristics such as gender, race, sexuality and other factors contributing to wellness.
According to the Journal of Obesity, a study comparing the results of participants in a HAES-based program and participants in a weight-loss program concluded that the HAES-based participants sustained improvements over a two-year period with decreased cholesterol, triglycerides and systolic blood pressure, while the weight-loss program participants showed initial weight loss after one year, but regained weight and did not sustain improvements at the two-year follow-up.
Health and wellness becomes feasible when weight loss is not the goal of treatment.
Overweight patients should be given the same level of respect and competency by their physicians as their “normal” weight counterparts. While weight bias and obesity stigma is steep in culture, it should be the duty of health care professionals to adhere to non-malfeasance when treating their larger patients. Furthermore, weight loss is not a productive method to treating patients, as studies have shown more holistic approaches accomplish better health.