Coronavirus Chronicles — The Virus As a Driver of Change

Doctors and other medical personnel are definitely the heroes of the year 2020. Due to circumstances and urgent public need, many doctors, nurses, and other highly trained people have filled roles and met challenges they have never expected. Careers have changed course, and professionals are expanding their horizons to meet needs.

A huge societal disruptor, like a pandemic, can bring about totally unforeseen changes, trends, and movements. It can create new professions and new opportunities. Public education, for instance, is under such tremendous stress that it is doubtful whether schools will be able to return to their previous form. And it is already obvious that many aspects of medical care will increasingly be delivered online.

What the future holds

It will be interesting, five or 10 years from now, to take a retrospective view of how COVID-19 changed the medical field. Some problems have been around for a while. Change is impossible to predict, of course, but it will be fascinating in the future to look back and see how the forces already in play, and that have not even become apparent yet, change the practice of medicine.

As an example, let’s take a very precise controversy that concerns people who are overweight and obese. That is the problem of attitudes exhibited by medical personnel, that the patients perceive as uncomprehending and even hostile.

There is no shortage of material, and the field has its heavy hitters. One is Aubrey Gordon, who until very recently published her work under the pseudonym Your Fat Friend. This one writer has reported a lot of experiences and expressed a lot of feelings. Some of her essays are titled, “How Health Care Bias Harms Fat Patients,” “When your fat friend goes to the doctor’s office,” and “Weight Stigma Kept Me Out Of Doctors’ Offices for Almost a Decade.”

The history of this problem is lengthy and, apparently, slow to change. Here, for instance, is a quotation from a “Your Fat Friend” piece published a year ago, just before the pandemic swooped in to change every aspect of American life:

[A] 2003 Obesity Research study found that 50% of doctors described fat patients as “awkward, unattractive, ugly and noncompliant.” A 2009 study in the Journal of Clinical Nursing found that a majority of nurses thought that fat patients patients “liked food, overate, and were shapeless, slow and unattractive.” And a 2004 study in Obesity found that 74% of medical students exhibited some level of anti-fat bias.

At the time, progress had been so slow that the author still had 10 urgent requests, summarized here:

1. Make your office physically accessible
2. Ask for consent before discussing a patient’s weight
3. Adjust your language
4. Don’t assume — ask
5. Test blood pressure at the end of the visit
6. Reassess your approach to conversations about size and weight loss
7. Look into effective and emerging frameworks for fat patients
8. Research fat people’s social determinants of health
9. Inventory the ways anti-fat bias may show up in your practice
10. Don’t withhold care until fat patients lose weight

Each one of these points is of course exhaustively discussed. For instance, the blood pressure request notes that visiting a doctor is, for an obese person, baseline stressful and frightening. The author says, ” Try taking (or retaking) fat patients’ blood pressure at the end of the office visit, after you’ve established trust and set us at ease.”

Naturally, all the caveats are not on the professional side. Patients are encouraged to do their part to promote understanding. For instance,

If you don’t have a choice about adhering to weight loss guidelines around particular treatments, explain why and what those barriers are in concrete terms. If you do have a choice, take a moment to reassess your practices.

Your responses and feedback are welcome!

Source: “10 Requests from a Fat Patient to Her Health Care Providers,” Medium.com, 02/10/20
Image by Dennis Sylvester Hurd

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Profiles: Kids Struggling with Weight

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The Book

OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:

Presentations

Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

Food & Health Resources