As part of ObesityWeek 2013 new guidelines for the treatment of obesity were released. The media has stated the guidelines are encouraging doctors to “get tough”, “be aggressive”, “take serious action” when treating obese patients. The actual guidelines do not use such harsh language, and it is bothersome that the media puts the “let’s get tough on the fatties” spin to the stories. As a patient who is obese, I believe the guidelines leave out two very important pieces to the treatment of obesity: identifying the cause of the patients’ excess weight and ensuring healthcare offices can adequately access and monitor obese patients.
Focus on the patient, not their weight.
I have always been frustrated by doctors who blamed my medical issues on my weight, yet never offered real options for losing weight. So the suggestions that doctors get serious about a patients weight and go beyond the obvious “you need to lose weight” and actually offer and prescribe nutritional counseling and activity for how to lose weight will be helpful to many patients. However, I believe dietary changes and exercise should be recommendations to ALL patients with heart disease, diabetes, high cholesterol, and high blood pressure. While excess weight can increase risk for these conditions, they are not exclusive to individuals with a high BMI.
What causes obesity?
Diagnose before offering treatment. There are many conditions and medications that can cause excess weight, doctors need to thoroughly examine the patient and address the actual cause of the obesity.
Yes, this is where I get on my Lipedema and Lymphedema soapbox. Both conditions are noticeable to the trained eye, the problem is there are not enough physicians who are trained to make a proper diagnosis. Instead, many patients, such as myself, are told to lose weight and when we do not lose weight as expected we are deemed non-compliant. And that label affects the way we are treated for all health issues. All my health vitals are normal, and should indicate that I live a somewhat healthy lifestyle, however there is still a focus my weight. For years, my weight increased while the actual cause of my weight, Lipedema, was not diagnosed and progressed to a stage further complicated by the development of Lymphedema. While the my health vitals, were normal, the Lipedema and Lymphedema was very much affecting my overall health. I developed severe cellulitis, and often required hospitalization for IV antibiotics and eventually needed a medi-port. During the hospital stays I contracted MRSA in the medi-port, that goes directly to my HEART. This greatly affected my mental and emotional health, as did the limitations on my mobility the conditions caused and the frustration of not getting any other explanation for what was happening with my legs than “it’s your weight”.
Accuracy is VITAL
As much as I was told the issues with my legs were because of my weight, the fact was my weight was unknown. The doctor’s office did not have a scale that could weigh me, nor did she attempt to locate a scale that could. On my own, I went to a local junk yard to weigh myself. No patient should have to make the effort to get their own vital health statistic. While that was ten years ago, I find today’s doctors offices are not any better equipped to care for patients with high BMIs.
In order for doctors to take obesity more seriously, they will need to have an accurate weight for patients. Currently, none of my doctors have scales to weigh me, yet, they all document the known incorrect weight. One office’s scale has a 300lbs limit, but it does at least register 328ish when I step on it. So the nurse documents that as my weight, even though I tell her that is not correct, and verbally give her my weight from my home scale. Again, this isn’t an issue in just ONE office, I encounter this problem is probably every doctors office I visit, expect for the bariatric surgeons office.
After the game of guess my weight, comes the torture of having my BP checked. Yet, another VITAL health statistic that is often not correctly taken nor monitored in obese patients. If the BP isn’t taken correctly, it is not an accurate reading, and thus monitoring inaccurate data serves no purpose. The blood pressure cuff needs to properly fit the patient’s arm. Cuffs that are too tight will give inaccurately high readings. Doctors’ offices need to have large cuffs, even thigh cuffs available, and staff need to know the where the cuffs are kept so patients can have their BP taken correctly.
Also, stop relying on BP machines, they are not accurate, especially on FAT arms. Every time my blood pressure is taken with a machine, it has to inflate twice then reads high. Again, I will let the nurse know the information is not correct, yet it gets documented in my medical record. My last employer’s wellness program was told I had high BP and I was put on a “plan” to reduce it”, which thankfully I did rather quickly by having my regular doctor submit my REAL blood pressure, which she gets by manually taking my BP using a thigh cuff. In addition, staff should be trained on how to take a blood pressure reading on the lower part of the arm, in case no cuff is available to fit the upper arm. Also, wrist blood pressure cuffs should be utilized.
Better scales and larger BP cuffs are not expensive items for doctor offices to purchase, and yet are very important tools to properly diagnosing, monitoring and treating patients.
Does your primary care doctor have a scale to weigh you? Share with me your experiences in the comments.