To eliminate prejudice, doctors go to the school to check out obesity

When Melissa Bouton complained to her OB-GYN about dull pelvic pain, the doctor responded by asking about her diet and exercise habits.

The question seemed irrelevant, considering the nature of his pain, Bouton thought at the time. But it was not uncommon for this to come from a doctor. “Every time I was there, he talked about diet and exercise,” said Button, 34, of Durham, North Carolina.

On this occasion, three years ago, OB-GYN told Bouton that weight loss would solve pelvic pain. The doctor has brought diet and exercise at least twice more during the appointment. The doctor said he would order an ultrasound to calm Bouton’s mind.

Ultrasound revealed the source of her pain: a 7-centimeter tumor filled with fluid in Bouton’s left ovary.

“I hate the doctor the way he treated me – like my pain wasn’t a big deal,” Botan said. “It simply came to our notice then.

Research has long shown that doctors are less likely to respect overweight or obese patients, even though about three-quarters of adults in the United States now fall into one of these categories. Obesity, which identifies patients with a body mass index of 30 or higher, is widespread in the South and Midwest, according to the Centers for Disease Control and Prevention. The highest-rated state is Mississippi, where 4 out of 10 adults qualify as obese.

Obesity is a common, treatable condition associated with a long list of health risks, including type 2 diabetes, heart disease and some cancers. Despite the prevalence of obesity, it carries a unique stigma.

Physicians often approach drug practice with anti-fat bias and struggle to communicate with patients who are overweight. Some obesity experts blame the lack of attention in medical schools. Others blame the lack of empathy.

To address this, the Association of American Medical Colleges plans to roll out new diversification, equity and inclusion standards in June aimed at educating physicians, among other things, about respectful treatment of people identified as overweight or obese.

Dr. Scott Butts, director of obesity medicine at the Cleveland Clinic’s Bariatric and Metabolic Institute, says this is not happening in many patients. “It simply came to our notice then. You have these doctors or therapists – whatever they are – everything has to do with patient obesity without investigation, “Bush said.” Stereotypes and misconceptions around this disease bleed into clinical practice. “

The problem, Bush argued, is that little attention is paid to obesity in medical school. When he trained and taught at Harvard Medical School for several years, Bushch said students did not receive more than nine hours of obesity education in three days in four years.

In 2013, the American Medical Association voted to recognize obesity as a disease. But, Butts says, doctors often go for it with a one-size-fits-all approach. “Eat less, move more” doesn’t work for everyone, he said.

Parents and medical providers need to take special care when talking to people who are overweight, psychologists warn. The way parents and providers talk to children about their weight can have lifelong consequences and in some cases trigger unhealthy eating habits. For obese children, obesity experts agree, weight loss is not always the goal.

“There are different types of obesity, but we are treating them as if we were giving the same chemotherapy to all types of cancer,” Bush said.

Except for four of the country’s 128 MD-granting medical schools in the 2020-21 academic year, all but four covered obesity and bariatric medicine, according to curriculum data provided to KHN by the Association of American Medical Colleges, which represents osteopathic schools.

Nonetheless, research suggests that many physicians are not adequately trained to deal with weight problems in patients and that obesity education in medical schools around the world is “completely neglected.” A survey conducted by leaders of 40 US medical schools found that only 10% felt that their students were “too ready” to handle obesity patients.

Melissa Bouton says her OB-GYN has brought in diet and exercise at least three times during an appointment and has acted in such a way that diagnosing Bouton’s ovarian tumor is “the most normal thing in the world.” He is now trying to screen his doctors. (Melissa Button)

Meanwhile, “Half of the surveyed medical schools report that the spread of obesity education is not a low priority or priority,” wrote the author of a 2020 journal article describing the survey results.

Butch wants Congress to pass a resolution emphasizing that medical schools should include substantial training on nutrition, diet and obesity. He acknowledged, however, that the medical school curriculum was already full of essentials.

Dr. David Cole, president of the Medical University of South Carolina, says medical school should cover a wide range of topics, but it is not. “There’s this huge Tom – it’s almost so big,” Cole said, raising his hand about a foot from the top of a conference table in Charleston. “The thing is: the things I didn’t learn in medical school.”

The biggest thing, he said, is that medicine has been taught to emphasize historical memorization and has failed to emphasize culturally appropriate care. “It was valid 100 years ago, if you consider it the source of all knowledge,” Cole said. “It’s no longer valid.”

The Association of American Medical Colleges is trying to address the problem in two ways.

First, it created a professional preparation test for aspiring medical school students, called a preview, to assess an applicant’s cultural skills, social skills and listening skills, as well as their ability to think in situations they might encounter in medical school and clinical settings. Designed. . “We call them soft skills, but they’re really hard to learn,” said Lisa Howley, an educational psychologist and senior director of the association’s strategic initiative. More than a dozen medical schools now recommend or require that applicants submit their pre-test scores along with their medical college admission test scores.

Second, the Medical College Association will create new skills standards in June for existing medical students, residents, and physicians related to diversity, equity, and inclusion. These values ​​will address racism, inherent prejudice and gender inequality and aim to teach doctors how to talk to overweight people.

“There’s a lot of bias towards these people,” Howley said. “We have a lot more work to do here.”

After discovering the source of Melissa Bouton’s pelvic pain, OB-GYN, who suggested diet and exercise to reduce her symptoms, told Bouton that the tumor was not a big deal. “He acted like it was the most normal thing in the world,” Botton said.

Bouton sought a second opinion from a doctor who marketed his practice as a “healthy in every form” office. That doctor referred Bouton to a surgical oncologist, who removed the tumor, his left ovary, and part of a fallopian tube. The tumor was large, but it was not cancerous. And although the removal surgery was considered successful, Bouton has had problems conceiving since then and is undergoing fertility treatment for trying to conceive a child.

“It’s an emotional roller coaster,” he said. “I feel very young at 34 to go through this.”

Boughton – who describes himself as someone who “doesn’t fit the BMI box” – says experience has taught him to choose his doctors differently.

“You can ask me if I diet and exercise at the same time,” he said. More than that, and he started shopping for another doctor.

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