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


The question seemed irrelevant, given the type of pain Boughton thought at the time. But it was not unusual for this doctor to come. “Every time I was there, she would talk about diet and exercise,” said Boughton, who is 34 years old and lives in Durham, North Carolina.

On this occasion, three years ago, an OB-GYN told Botton that losing weight could solve pelvic pain. During the appointment, the doctor increased the diet and exercise regimen at least twice. The doctor said she would order an ultrasound to rest Boughton’s brain.

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

“I hate the way the doctor treated me — like my pain was no big deal,” Boughton said. “She seemed to be judging me based on a very cursory glance.”

Research has long shown that doctors are less likely to respect patients who are overweight or obese, even as nearly three-quarters of adults in the US now fall into one of those categories. According to the Centers for Disease Control and Prevention, obesity, which is characteristic of patients who have a body mass index of 30 or higher, is widespread in the South and Midwest. The state with the highest rate is Mississippi, where 4 out of 10 adults are 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 an irresistible stigma.

Doctors often approach the practice of medicine with an anti-fat bias and struggle to communicate with patients whose weight exceeds the normal range. Some obesity experts blame the lack of focus on the subject in medical schools. Others blame a lack of empathy.

To combat this, the Association of American Medical Colleges plans to introduce new diversity, equity and inclusion standards in June aimed at teaching doctors to be respectful of people who are overweight or obese, among other things. about treatment.

The director of obesity medicine at the Cleveland Clinic’s Bariatric and Metabolic Institute, Dr. Scott Busch said that isn’t happening for many patients. “It’s almost like malpractice. You have these physicians or physicians — whoever they are — relating everything to a patient’s obesity without investigation,” Busch said. “Stereotypes and misconceptions about this disease just flow into clinical practice.”

The problem, Busch argued, is that very little attention is paid to obesity in medical school. When he trained and taught at Harvard Medical School for several years, Busch said, students received no more than nine hours of obesity education over three days in four years.

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

Psychologists warn that parents and medical providers need to take special care when talking to children who are obese. The way parents and providers talk to children about their weight can have lifelong consequences and in some cases trigger unhealthy eating habits. For kids with obesity, obesity experts agree, losing weight isn’t always the goal.

“There are many different forms of obesity, but we’re treating them like we’re giving the same chemotherapy for all types of cancer,” Busch said.

All of the country’s 128 MD-granting medical schools reported covering content related to obesity and bariatric medicine in the 2020-21 academic year, according to curriculum data provided to KHN by the Association of American Medical Colleges , which does not represent osteopathic schools. ,

Still, research shows that many physicians are not adequately trained to address weight issues with patients and that obesity education is “grossly neglected” in medical schools around the world. A survey conducted by leaders in 40 US medical schools found that only 10% felt their students were “very prepared” to manage obesity patients.

Melissa Bouton says her OB-GYN dieted and exercised at least three times during one appointment and acted as if Boughton’s diagnosis of an ovarian tumor was “the most common thing in the world.” She now tries to screen her doctors. (Melissa Boughton)

Meanwhile, the authors of a 2020 Journal article describing the survey results wrote, “Half of the medical schools surveyed reported that expanding obesity education was a low priority or not a priority.”

Busch wants Congress to pass a resolution insisting that medical schools include adequate training on nutrition, diet and obesity. However, he acknowledged that the medical school curriculum is already full of subjects deemed necessary to cover.

Dr. David Cole, president of the Medical University of South Carolina, said that a lot of topics in medical school should be covered more comprehensively but this is not the case. “There’s this giant tome—it’s about this big,” said Cole, raising his hand about a foot above a conference table in Charleston. “The theme is: Things I Never Learned in Medical School.”

The bigger issue, he said, is that medicine has historically been taught to emphasize memorization and fails to emphasize culturally competent care. “It was valid 100 years ago, if you were considered the source of all knowledge,” Cole said. “It’s not valid yet.”

The Association of American Medical Colleges is trying to tackle this problem in two ways.

First, it developed a professional preparation test for aspiring medical school students, called PREview, which is designed to assess an applicant’s cultural competence, social skills, and listening skills, as well as medical Their ability to think about situations they face in school and in clinical settings is also developed. , “We call them soft skills, but they’re really hard to learn,” said Lisa Hawley, an educational psychologist and senior director of strategic initiatives at the association. More than a dozen medical schools now recommend or require that applicants submit their preview test scores along with their medical college entrance test scores.

Second, the Medical College Association will implement new eligibility standards in June for existing medical students, residents and doctors concerned with diversity, equity and inclusion. Those standards will address racism, implicit bias and gender equality and aim to teach doctors how to talk with people who are overweight.

“The bias towards those individuals is very high,” Howley said. “We have a lot more to do in this area.”

After discovering the source of Melissa Bouton’s pelvic pain, the OB-GYN who recommended diet and exercise to ease her symptoms told Boughton that the tumor was no big deal. “She acted like it was the most ordinary thing in the world,” Boughton said.

Boughton sought a second opinion from a doctor, who marketed her practice as a “healthy at every size” office. That doctor referred Botton to a surgical oncologist, who removed the tumor, her left ovary, and part of the fallopian tube. The tumor was large, but it was not cancerous. And although surgery to remove it was deemed successful, Botton has since had trouble conceiving and is undergoing fertility treatments as she tries to have a baby.

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

Botton — who describes himself as someone who “didn’t fit into the BMI box” — said the experience taught him to choose his doctors differently.

“You might ask me if I diet and exercise like I once did,” she said. Even more so, and she starts shopping for a different doctor.

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