Med Students Unaware of Their Bias Against Obese Patients 446
An anonymous reader sends news of a study which found that "two out of five medical students have an unconscious bias against obese people." The study, published in the Journal of Academic Medicine (abstract) examined med students from many different cultural and geographical backgrounds.
"The researchers used a computer program called the Weight Implicit Association Test (IAT) to measures students’ unconscious preferences for 'fat' or 'thin' individuals. Students also answered a survey assessing their conscious weight-related preferences. The authors determined if the students were aware of their bias by seeing if their IAT results matched their stated preferences. Overall, 39 percent of medical students had a moderate to strong unconscious anti-fat bias as compared to 17 percent who had a moderate to strong anti-thin bias. Less than 25 percent of students were aware of their biases. 'Because anti-fat stigma is so prevalent and a significant barrier to the treatment of obesity, teaching medical students to recognize and mitigate this bias is crucial to improving the care for the two-thirds of American adults who are now overweight or obese,' Miller said. 'Medical schools should address weight bias as part of a comprehensive obesity curriculum.'"
Worse on Slashdot (Score:2)
As of this posting, the vast majority of ACs took the opportunity to make disparaging comments about the overweight. Classy.
Fat Hatred (Score:3, Insightful)
Fat hatred and blaming people for being fat is so universal and so conscious that it's hard to take any methodolgy seriously that finds that people are "unconscious" of their hatred of obese people.
Want to get at the real socially redeeming value of this journal entry? Study the methodolgy, understand where it went wrong, and above all never, ever use it.
Re: (Score:2, Insightful)
I "blame" fat people for being fat for the same reason I blame criminals for being criminals ... not because I don't recognize hereditary and environmental aspects, but because the concept of personal responsibility is rather important to a functioning society.
PS. if they don't feel self pithy, aren't fat enough to suffer health problems and don't care that I find it ugly then I don't really blame them ... it's just a lifestyle choice which doesn't really impact me.
Re:Fat Hatred (Score:4, Informative)
I'm not quite obese but I am overweight, and it's because I suffer from two conditions (CFS and arthritis) that making losing weight extremely difficult. It isn't a lifestyle choice, and before these two things got bad I was able to stay fairly trim.
I feel bad. I don't like the way I look. Thing is though, it really isn't my fault. I wish it was because then I could do something about it.
Don't make assumptions about people you don't know.
Re: (Score:3, Interesting)
I have CFS too so I know what you're going through, I've been overweight because of it as well, but I've recently found one thing that has allowed me to lose weight and actually become healthier. There is only one diet that has worked, and it's basically a variant of low carb, it's called Keto(ketosis) and I've lost 50 pounds in a year from it, and all I've done is changed my diet. I don't exercise more than I already do (sometimes not at all), I don't starve, and I don't have to go without eating or skip m
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Bullshit. I'm sorry but both of those diseases are excuses, not causes for you being overweight. Swimming would be excellent for you, if you can't afford it the YMCA offers free programs for those that can't. I donate regularly. If in the end you can't exercise, then eat less. That's your choice. I've been to Africa, I've seen people with far worse diseases than CFS and arthritis and they sure as fuck weren't overweight. The only fat people there were rich people... because they could afford western food. I
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I "blame" fat people for being fat for the same reason I blame criminals for being criminals
It's interesting that you compare fat people with criminals. What next, people who talk obnoxiously loud in restaurants are like perpetrators of genocide?
it's just a lifestyle choice which doesn't really impact me
How generous of you to include that as an afterthought. You forgot to mention that that's the important difference between fat people and criminals. BTW, even people who are fat enough to cause health problems are not your problem. They have lower lifetime healthcare costs.
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Being obese will generally impact your health quite immediately, but I was more talking about people who are simply overweight ... which still has some impact, but in the bigger picture it's just not that big a deal.
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Some have argued (sorry I don't have the citation handy) that the OPPOSITE is true: people who live unhealthy lifestyles are far cheaper to maintain for one simple reason: they die before they get old (that time in your life where your maintenance becomes FAR more expensive).
The article I read had some interesting numbers that stated health care in the developed world would be substantially cheaper if everyone smoked and ate badly.
Re: (Score:2, Informative)
Citation: http://daveatherton.wordpress.com/2012/03/17/the-true-costs-of-treating-smokers-the-obese-and-the-healthy/
It is just a summary but they link to their more official sources. The core values, as quoted from the blog:
The lifetime costs were in Euros:
Healthy: 281,000
Obese: 250,000
Smokers: 220,000
So, obesity saves more than 10% of lifetime healthcare cost.
Re:Fat Hatred (Score:4, Insightful)
Citation: http://daveatherton.wordpress.com/2012/03/17/the-true-costs-of-treating-smokers-the-obese-and-the-healthy/ [wordpress.com]
It is just a summary but they link to their more official sources. The core values, as quoted from the blog: The lifetime costs were in Euros: Healthy: 281,000 Obese: 250,000 Smokers: 220,000
So, obesity saves more than 10% of lifetime healthcare cost.
Thank you! I knew that was true of smokers, but wasn't sure about obesity. Despite silly things like objective data (which Slashdotters otherwise rightly insist on) people will still use "fat people raise my healthcare costs" as an excuse for their sanctimony.
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The lifetime costs were in Euros:
So, obesity saves more than 10% of lifetime healthcare cost.
Yes, exactly. This should be obvious to anyone with half a brain. A lot of people develop chronic diseases that require intensive care late in life, whether it's due to diabetes in middle-aged fat people or dementia and various cancers in retired elderly "healthy" people. So, overall, the best way to reduce costs is to get people to die off earlier.
And these figures are probably even worse because they only take into account healthcare costs, without considering lifetime contributions to healthcare.
A
obese people don't follow diet.. (Score:2)
..and having a bias for thinking so is a bias in this study.
can't blame them though. because people who stay obese can't follow a diet, obviously. too thin people might have some "respectable" reason for being unable to digest or eat enough, it's much harder to eat on purpose more to gain weight than it is to lose it - the other just needs you not to buy food and put it in your mouth and chew it while the other needs you to have appetite to be able to put it in your stomach and the stomach to be able to dig
Re:obese people don't follow diet.. (Score:4)
It's slightly complicated by all the bad advice that's given on how to manage ones weight.
However, when all is said and done, eating less and moving more solves the problem for most people. Sometimes there's a need to fix ones sleep and or stress in order to lose the weight.
But, doctors themselves are a terrible source of information on diet and exercise. Unless it's changed recently, they only get a few weeks of training on diet and none on exercise.
4th year med student here (Score:5, Informative)
I'm not unaware. I know exactly what I think about fat people and It's not good.
Re:4th year med student here (Score:4, Insightful)
I'm not unaware. I know exactly what I think about fat people and It's not good.
Juvenile. Also typical of a culture that can't grasp simple concepts like bias affecting treatment, or the amount of time you choose to spend with a particular patient, or whatever. In the modern American conservative mindset, every single thing wrong with every single person is absolutely and completely the fault of some moral failing that person has, because the alternative might mean that religion/corporations/capitalism/etc. aren't perfect and that makes their brains tilt like an abused pinball machine.
Poor people are poor because they're lazy and don't want to work. Fat people are fat because they won't stop eating. People only get fired from their jobs because of something they did wrong. People who are arrested for crimes are always guilty because the police would never arrest an innocent person. The rich are job creators.
All of those statements are sometimes true. Some of them are true more than false, and others not so much. The thing is, they are not always true. They are not always false, but with way too many people it's black/white, this/that, on/off, binary reasoning. "I oppose this because somebody I don't like is in favor of it" (the current operating model of the House of Representatives, for instance). "This can't be true because it has to do with emotional parts of the brain and emotions are for left wing communist socialist hippies, unless of course the emotion in question is anger in which case it's OK for me." pretty much describes a decent number of the postings on this topic too.
The merest hint that people might not be perfect logical reasoning machines AND that sometimes they do things or think things without meaning to is an alien concept because it isn't binary, it isn't simple, and it doesn't fit in a conservative sound byte. Just another example of why our society is crumbling rapidly.
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I know exactly what I think about fat people and It's not good.
I feel the same way about sanctimonious people. Sounds like you'll make a shitty doctor.
I don't think the OP's trying to be sanctimonious, but admitting to a bias. As they say, that's the first step.
There are, of course, too many docs who don't concern themselves with any aspect of a patient's health till they lose weight. Or quit smoking, or drinking, or doing drugs, or whatever. Sure, all those changes can dramatically affect overall health, but the "magic bullet" approach isn't the right one. Unless one's physician takes a comprehensive interest in your health rather than just tell you to "
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I don't think the OP's trying to be sanctimonious, but admitting to a bias.
Anything is possible, but it sure didn't sound that way. I would expect such a person to use the term "bias" or in someway indicate it's a problem they have.
I don't mind fat people (Score:2, Funny)
Fat and Fit (Score:2)
Re: (Score:2, Interesting)
Hey asswipe monkey brain *I'M* one of the unlucky ones. *I DO* have health reason to be fat. *I DO* have genetic reasons. Oh and there are mental depression reasons too but frankly exercise helps fix those.
I'm not because I fucking well dont want to be a 10 ton lardass. The real, genuine reason for obesity is that person is just simply too fucking lazy to give a shit. *I'M* the exact reason why lard asses should be given a boot up the arse - if I can do it then so can everyone else. No goddamn excuses - if
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Genetics isn't magic. It doesn't spontaneously conjure lipid molecules from nothing. Fat is made of matter. Matter that enters a person's body when they eat it. The fact is that every person on the planet is losing weight every time they breathe. Where do you think those carbon atoms in exhaled CO2 come from? All you have to do is eat less and do more and, with few exceptions for certain rare diseases, you will lose weight. No X-men style genes are magic story telling required.
Yes but is this different (Score:2, Insightful)
than doctors having a bias against smokers, recreational drug abusers, sex addicts with lots of partners, etc? Each of these groups are doing things that is typically detrimental to one's health, so there seems to be an issue of self control there.
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sex addicts with lots of partners, etc?
I never got that, in what way is having lots of sex detrimental to the health or well being of a person? Seems like puritanism masquerading as medicine, a bit like circumcision which is meant to stop young men masturbating.
I don't care if you don't like it, that's how it is.
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If you're talking about a sex addict, then it definitely is detrimental to their health. And yes, it does have very real consequences. These aren't just people who like to sleep around, these are people who sleep around because they can't stop it. And it does ruin marriages, assuming they can get a partner in the first place. Increased risk of STIs and accidental pregnancy.
So, no, the isn't a matter of puritanism, there are very real consequences to sex addiction and trivializing it does nothing to help the
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Nothing really unhealthy about having lots of sex. Having lots of different sex *partners*, on the other hand, will make it rather difficult to avoid STDs.
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...unless you use condoms? See this is the kind of comment that makes me immediately wary of people talking about 'sex addicition'.
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Condoms help. In some cases, such as AIDS, they help a lot. In other cases, like syphilis or HPV, they are far from foolproof, because some STDs do not require contact with infected semen to spread. They still help some, but if you're relying on condoms as your one line of defense while having lots of partners, you're in for a nasty surprise.
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than doctors having a bias against smokers, recreational drug abusers, sex addicts with lots of partners, etc? Each of these groups are doing things that is typically detrimental to one's health, so there seems to be an issue of self control there.
I suspect that the problem arises when a given bias impairs the doctor's ability to do diagnostics properly. In some cases(as long as they can avoid being overtly unprofessional about it) the effect is probably minimal: even if your emotions lead you to over-estimate the STD risk of somebody with lots of sex partners, the odds are still pretty good that, if they bother to come and see you, their problem will either be an STD, a different flavor of infection that the standard labs you'd do for a suspected ST
Re: (Score:2)
Exactly correct. It's like the politically correct mafia that also wants us to "feel" for the poor addicts who continue to use drugs when they ought to know better, or the parents of kids who die from drug overdoses and go out of their way to blame the drug dealers for their kids' deaths, rather than realize that their kids had everything to do with their ingestion of drugs.
It's not that there is or even whether there is a bias against obese people: doctors in general ought to have a bias against obesity i
Compassion (Score:5, Informative)
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Compassion is supposed to be a hallmark trait of the medical profession.
Compassion and bias are not mutually exclusive. And, "bias" is not always unfounded.
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Absolutely. This study isn't about that. They used a sensitive test for bias. If you don't like fat people (like the majority of the population) then you'll likely test positive. That has nothing to do with how you treat fat people. What they're saying is that med students should be taught about anti-fat bias to make sure that, despite their quite natural biases, they're treating fat people well. They're already taught to manage their biases against assholes, mass murderers and other difficult patient
Re:Compassion (Score:4, Insightful)
Re: (Score:2)
With all due respect, you may still be missing the point about unconscious bias. You sound completely sincere and your attitude about professionalism is commendable and I completely agree with what you say about how a doctor should behave.
But what if you have a bias that you are not aware of? Have you ever taken an implicit association test? Are you sure that you could counter a bias that you are not even aware of?
As mentioned in another post, I have taken such tests and was surprised by some of the resul
Re: (Score:2)
But what if you have a bias that you are not aware of? Have you ever taken an implicit association test? Are you sure that you could counter a bias that you are not even aware of?
I think here the answer is yes. If the bias is in any way relevant, it will eventually manifest in a way that can be consciously observed, if not by Dunbal (let's say due to the insidious nature of "unconscious"), then by a coworker or patient. He has to be aware, receptive, and willing to try to change himself. I think he's already demonstrated that.
But the problem with such subtle biases is that they don't necessarily manifest in a harmful way. And we already know that due to our limitations we will ha
Implicit Association (Score:5, Informative)
For those not familiar with implicit association tests, they are based on measuring your reaction times when matching certain types of data according to different specified criteria. For example a gender association test might measure time for matching gender with staying at home raising children versus working outside the home.
Harvard has plenty of sample tests. [harvard.edu]
Having taken some of the tests I can say that the results can be quite surprising and point out biases that you are unaware of. I definitely found that some associations were much easier for me than others. (Happy to say that the gender example above was not a problem for me.)
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Having taken some of the tests I can say that the results can be quite surprising and point out biases that you are unaware of.
But in this case were they unaware of their biases or just not prepared to admit to them?
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I can really only answer for myself, which is what that statement was about. I found out that I had biases that I was not aware of. At least some associations gave me much more trouble than other ones did, and I don't have any other explanation for that. For some I didn't even need to see the reported times, I was aware of the difference while doing the test.
Maybe everyone else is aware of their biases and is simply not willing to admit them, but I doubt that. I suspect that for these biases:
reality >
Re: (Score:2)
I like to think of myself as a fair person, but I'd probably have at least a mild bias as well. I've had a lot of friends and family who have had and struggle with obesity in different ways, and had associated health problems (my father died of a heart attacked and spent his life dealing with health compl
Unconscious? (Score:2)
The fact that people don't admit to their preference doesn't make that preference unconscious. From the journal article:
That doesn't seem like a very sophisticated way of assessing someone's unconscious feelings.
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You're ignoring the part about the implicit association test. See my post above. [slashdot.org]
I agree that what someone admits to doesn't say anything about unconscious feelings. But an IAT can demonstrate feelings that you're not even aware of.
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Yeah, of course. But (and i admit i didn't read the whole paper), the point seems to be comparing the results of the IAT with the answers to the preference questions. If the answers to the preference questions are lies, it means nothing.
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Yeah, i probably didn't phrase my original post as clearly as i could have done!
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If the answers to the preference questions are lies, it means nothing.
Its complete fools like you that think your are safe from being tracked by Google/Facebook/Whatever because you lie about shit.
The fact is that it doesnt matter even if 100% of people are intentionally lying.
Re: (Score:2)
I dunno what you've been smoking, but i want some!
anti-fat stigma (Score:4, Insightful)
"anti-fat stigma is so prevalent and a significant barrier to the treatment of obesity"
Being fat-positive would help with the treatment of obesity?
Re: (Score:2)
"anti-fat stigma is so prevalent and a significant barrier to the treatment of obesity"
Being fat-positive would help with the treatment of obesity?
You can't treat a patient you never see. If you know the doctor is just gonna nag you to lose weight again, why would you go back?
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Because you want to be healthier?
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You can't treat a patient you never see. If you know the doctor is just gonna nag you to lose weight again, why would you go back?
Exactly. If when you go to the doctor for something unrelated to weight they spend over half the time talking about your weight, then the next time you have an issue that also isnt related to weight they will obviously again spend over half the time talking about your weight.
They do it because its easy. Its become part of their script even when there is a complete lack of any health issues related to weight present in the patient, even when obviously the patient doesnt even have a weight problem but simp
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Co-worker had recently had a C-section get infected, and the doctor nagged her about her weight. She just gave birth you lazy cocksucker!
Not lazy, incompetent. Possibly also diverting the focus from that fact that they fucked up her C-section.
Re: (Score:2)
"anti-fat stigma is so prevalent and a significant barrier to the treatment of obesity"
Being fat-positive would help with the treatment of obesity?
You can't treat a patient you never see. If you know the doctor is just gonna nag you to lose weight again, why would you go back?
Yeah, it's a real bitch when your doctor is honest, isn't it...
I suppose we should just start contacting Hollywood now to see if they want to play the part of doctor. Apparently the truth is just too hard to handle.
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Obesity is a medical problem but not always a sign that the person has poor willpower or doesn't look after themselves.
I struggle with my weight a bit, and it's because I suffer from CFS and Reactive Arthritis. My doctor is a dick. When I ask for help he just blames me for not doing enough. He probably does see a lot of patients who just want an easy way to loose weight with no effort, and this bias means I am having to go around him to get any treatment. Needless to say I am switching doctor.
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Cognitive behavioral therapy compared with active control has been shown in multiple studies to produce persistent benefits, including decreased fatigue and better physical function. One trial even showed Internet-based cognitive therapy helpful (including 85 vs 27% absence of severe fatigue, and 78 vs 20% normal physical functioning).
Graded exercise therapy has been shown in randomized trials to improve fatigue and physical functioning (albeit not always with overwhelming success, suc
Re: (Score:3)
"anti-fat stigma is so prevalent and a significant barrier to the treatment of obesity"
Being fat-positive would help with the treatment of obesity?
No. But harboring anti-fat biases can inhibit effective treatment.
Numerous studies have shown that people with biases against fat people make lots of assumptions -- fat people are lazy, undisciplined, lack willpower, etc. In many (and possibly most) cases, this may be true.
On the other hand, lots of fat people have other medical issues that contribute to their obesity. Others have factors like mental illness and clinical depression.
If a doctor assumes that a person is fat simply because he's biased
It's not a bias if it's true (Score:5, Insightful)
"Doctors are more likely to assume that obese individuals won’t follow treatment plans"
The primary goal of our treatment plan is often to get them to lose weight to cure their hypertension and type 2 diabetes. It's not a bias if you see the same patient in clinic every few months for years and they continue to gain weight and ignore your recommendations.
**** ********* M.D. , PGY-4 Resident
Re: (Score:2)
It's not a bias if you see the same patient in clinic every few months for years and they continue to gain weight and ignore your recommendations.
If an otherwise healthy obese patient comes to see you for years and this is true, you're right -- it's not a bias.
However, it is a bias if:
nd how many of those medical students (Score:5, Insightful)
were obese? When my wife was in med school about half the class was obese, a few morbidly so.
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Obese people don't like to look at obese people either. We're evolutionarily programmed to prefer to look at and be around healthy, fit people.
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Actually, in other eras, the ideal that everyone assumed we were naturally supposed to appreciate was considerabl;y more padded than today's ideal. In the middle ages, a modern model would probably be seen as grotesque and sickly at best.
Doctors are biased towards sick people! (Score:2)
They get all the care and attention, and healthy people are left out in the cold. Equal treatment for all!
No, seriously, I don't see a bias against obese patients as a problem. And I say that as someone who's pretty heavy, and by my own hand - the hand putting pizza in my mouth. Despite the laughable number of people who say "they have a glandular condition" or some such, 99.9% of the time obesity is a self inflicted injury. The doctors with this bias are, in fact, ahead of the curve. At the end of our slow
I hate sanctimonious people (Score:2)
I hate sanctimonious people, and that holier-than-thou nonsense is what the prejudice against fat people is about. By prejudice I mean being biased against people with regard to things that have nothing to do with their weight. It does not mean not wanting a fat girlfriend (or in the case of Slashdotters, not fantasizing about having a fat girlfriend), or suspecting that they wouldn't be good on the track team, or even about charging them more for life insurance. It means being biased about the guy two desk
We're missing the most interesting results (Score:5, Interesting)
Second, and by far most intriguing, is the 33% (101/310) of students who openly acknowledged an explicit personal bias. Given that 39% (121/301) were found to have an actual bias on the implicit test, on the surface this result isn't surprising - but the 101 who think they're biased, and the 121 who actually have an implicit bias, don't overlap very closely. Just 40 students who thought they had a bias actually did. The study authors (and the journalists who have summarized their results) decided to frame this in the form of two-thirds of anti-fat students don't know they're biased! It's much more curious, I think, to note that a healthy majority of students who thought they were biased against the obese - 61% (61/101) - actually aren't.
Indeed, it turns out that there wasn't a significant correlation between believing one was biased and actually having a bias. So why do three out of five students who think they have an anti-fat bias hold that belief mistakenly?
Re:Med students (Score:4, Informative)
Sounds as though that is a pretty apt title.
Sure, it is biases against "various weights" not just "overweight & obese", but the point still stands.
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Are you unaware that "Less than 25 percent of students were aware of their biases" means that 75% were unaware of their biases?
Or it means that less than 25% were honest about their biases.
Exactly. This is likely about as accurate as any sex survey.
Re:Med students (Score:5, Informative)
A health care professional can be expected to have a bias regarding healthy vs unhealthy life choices.
No shit. That is not what they mean by bias in this study. RTFA:
“Bias can affect clinical care and the doctor-patient relationship, and even a patient’s willingness or desire to go see their physician, so it is crucial that we try to deal with any bias during medical school,” said David Miller, M.D., associate professor of internal medicine at Wake Forest Baptist and lead author of the study.
“Previous research has shown that on average, physicians have a strong anti-fat bias similar to that of the general population. Doctors are more likely to assume that obese individuals won’t follow treatment plans, and they are less likely to respect obese patients than average weight patients,” Miller said.
Re: (Score:2, Interesting)
*Are* they less likely to follow treatment plans? It stands to reason that someone who won't do what's necessary for his health in one area might be less likely to do so in another area as well. If the doctors' assumption is accurate, it's not bias in the sense implied.
Re:Med students (Score:5, Insightful)
*Are* they less likely to follow treatment plans? It stands to reason that someone who won't do what's necessary for his health in one area might be less likely to do so in another area as well.
Studies have shown that the most common assumption is that fat people are lazy, undisciplined, unwilling to work hard, etc. -- not just in terms of health choices. Your comment is playing directly into that bias.
I think this bias, like most, actually does have some relationship to reality -- i.e., a greater percentage of fat people are likely to have these traits than others.
HOWEVER -- pre-judging an individual on the basis of a single characteristic is the very definition of "bias."
Even if 90% of obese people are lazy bastards who won't even try to listen to their doctor's advice (and I don't think the number is that high), that does not excuse a doctor who provides inferior treatment to the other 10% because of assumptions.
If the doctors' assumption is accurate, it's not bias in the sense implied.
That's like saying -- If a black person is driving around a rich neighborhood, he must be looking to steal something -- because "black people are more likely to commit crimes" is an "accurate" statistic.
Even if X is often correlated with Y, it doesn't justify the assumption that X always implies Y. When dealing with healthcare, these sorts of assumptions can literally be deadly, such as when a physician fails to search for secondary contributory causes of obesity in a particular patient because the assumption is just that the patient must be a lazy bastard who can't follow directions.
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Studies have shown that the most common assumption is that fat people are lazy, undisciplined, unwilling to work hard, etc. -- not just in terms of health choices. Your comment is playing directly into that bias.
Bulls eye!
Re:Med students (Score:5, Insightful)
True story to back this up -- I was 140 lbs at 6'5 in highschool with very bad joints and asthma I sadly seem to have inherited. Both limit my exercise immensely, as does my job in computers.
Having subsequently moved and having a different doctor now than then and weighing substantially more, I have no new health problems than then but my new doctor upon hearing of my breathing and joint issues blamed my weight and told me to lose it, which obviously won't help, as I had the same problems when clinically under-weight.
Bias is wrong -- and leads to poor assumptions.
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Even if X is often correlated with Y, it doesn't justify the assumption that X always implies Y.
While that is true, the safe bet is still going to be that X implies Y.
That is absolutely false. Particularly since in this case we have examples of not-X that have Y, it may in fact be that Y implies X, but only in some cases, or even that there is no causality at all between X and Y.
I personally don't have statistics about the incidence of "laziness" and "failure to attempt to follow doctor's advice" in non-obese patients. Do you? I'm guessing that it is probably higher in obese patients, but I don't know that.
Obesity is easy to spot. Doctors who see obese patients a
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The problem in this case that if the patient has X but complains of Z, the doctor will only discuss Y. Same if the patient has A, B, or C, none of which are ever due to Y.
Re:Med students (Score:5, Interesting)
Re:Med students (Score:5, Interesting)
Well, you completely missed the point. Doctors who don't recognize their biases are more likely to misdiagnose patients that they're biased against.
Take me, for example. My kidneys failed due to IGA nephropathy, which has absolutely nothing to do with weight. I'm overweight, however, so for the first year of me feeling run down, getting sick often and having other health isuses my doctor insisted that I just needed to lose weight. He never bothered looking for other potential causes because, in his mind, the problem had to be that I was too fat and therefore didn't deserve any further attention.
Re:Med students (Score:4, Insightful)
I explained it in simple terms and offered a real life example and you still can't figure out why a doctor that doesn't recognize his biases is a bad thing?
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Let me ponder this for a minute.
A health care professional can be expected to have a bias regarding healthy vs unhealthy life choices. Being fat indicates that a person has made one HELL of a lot of unhealthy choices. Like - every single day, he eats to much.
Actually, not necessarily, for two reasons:
1) There are plenty of medical causes of being fat, e.g. polycystic ovarian syndrome, type 1 diabetes (which causes fatness rather than the reverse), etc. Not just eating too much every single day.
2) Studies have repeatedly shown that overweight and moderately obese (grade 1 obese) people actually live longer, healthier lives than people of "normal" weight. Only at grade 2 and 3 obesity do these people start to live shorter less healthy lives due to type 2 diabet
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Mostly because fat people live sedentary lives; the guy with a beer gut isn't going to die rock climbing. That doesn't mean they're healthier.
Actually, no, but because the BMI scale is significantly off. Most people who go rock climbing will be considered "obese", or at very least overweight by it, because they have significant muscle mass.
And it's not simply "normal" weight, it's based on actual fitness. Your body can not do as many things if it has lots of fat and little muscle, so you are functionally disabled. You don't see fat people out running because on the odd occasion that they do, they can't keep it up for very long. They can't have sex as long. They can't climb flights of stairs. They can't physically defend themselves.
Again, wrong. Not fat, and fit are very different things. It's possible to be overweight and extremely fit and active, and its very easy to be underweight or "normal" weight, and not at all fit.
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Again, no –fit, and not fat are not the same thing at all. I know a couple of people off hand who are significantly heavier than me, and significantly larger around the waist than me, but who can cycle significantly faster and further than me, and who can happily walk at just the same rate as me for pretty much any distance.
Re:Med students (Score:5, Interesting)
At this physical, my doctor is telling me that I need to lose weight because 212 is "a lot of weight". He didn't car that my body fat % was fine. He just kept pointing out that BMI is "the best indicator of healthy weight". He has a bias against fat people. Even worse, his definition of "fat" is completely twisted and dangerous.
Even worse is that I have been 5 lbs over weight. 5 lbs overweight isn't even close to obese. It also isn't "some buff slav". But, what I hear is from dumbasses saying "Your not Mr. Universe, so the BMI is correct."
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And even your other sports don't check out. Lebron James, for example is 6'8" 250 lbs. That's a BMI of 27.5 - overweight. Mike Trout (baseball player) is 6'2" 230 lbs. - 29.5 - borderline obese.
What's the most popular fitness activity in the US? Weightlifting. BMI was developed almost 200 years ago, when bloodl
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People who are overweight and obese grade 1 are usually not so fat their life quality is reduced. They can walk, run and exercise with no or just small discomfort.
An overweight person who is somewhat fit has a *significant* higher life expectancy than any other combination of fitness and weight.
Muscle mass above a certain amount does more harm than good and reduces life expectancy
Excessive exercising over time damages the body and leads to a shorter life expectancy
- Life expectancy both for body bui
Re: Med students (Score:5, Insightful)
Sure some people simply have no self-control - but is that because they are bad people, or because there is some factor at work that makes it hard for them? The blame game for obesity is a bit like accusing people with a birth mark of being in league with the devil and burning them - we should know better by now.
Re:Med students (Score:5, Informative)
Let me ponder this for a minute.
A health care professional can be expected to have a bias regarding healthy vs unhealthy life choices. Being fat indicates that a person has made one HELL of a lot of unhealthy choices. Like - every single day, he eats to much.
Alternately they have hypothyroidism, for example, as a result of Hashimotos. It could also be Prader-Willi syndrome, or Bardet-Biedl syndrome. There are other genetic factors and diseases which can also result in obesity. Candida Albicans infections of the gut have also been implicated. There are also medications which can result in obesity. Prednisone, which is often used to treat very severe allergies, and also as an anti-rejection drug following organ transplantation, or to treat autoimmune disorders, is one. Others include antidepressants, seizure medications, and certain high blood pressure drugs, such as atenolol and metoprolol (both beta blockers).
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No such condition can result in obesity. All they affect is feeling of hunger. Ie, it's somewhat harder to control yourself but it physically can't make you fat.
There were no obese people at Auschwitz, hormones or not. Uncle Adolf's diet went to the other side, by being nutritionally deficient, but you can't deny it prevented being fat. Limit food intake, and you will not get obese, period.
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>> Being fat indicates that a person has made one HELL of a lot of unhealthy choices. Like - every single day, he eats to much.
With respect Runaway, that thinking right there is exactly the problem.
Obese != unhealthy life choices (at least not in all cases)
Take for example the 250lb person who eats right, jogs, and works out every day vs the 145lb person who never exercises, eats cookies, and pounds beer and soda but for some reason never gains a pound. The 250lb person could have a thyroid problem
Re:Med students (Score:4, Informative)
Doctors should diagnose based on full spectrum data collection. Not simply based on what they see and think at first glance.
I had this discussion a dozen times with my brother who is a medical student and the tl;dr is "nobody has the time or money for that".
A doctor will always assume the most likely cause for any given combination of symptoms (even if they don't match 100%) and only start thinking about less likely alternatives if his treatment doesn't lead to improvements. Yes, sucks to be someone with a rare disease (that will only be diagnosed correctly very late if at all) but symptoms are often so unspecific and a thorough examination would be so expensive (let's do a blood screen every time you catch a cold because you might have some ultra-rare disease?) that this is the only practicable way.
Hormonal causes for obesity are possible but pretty rare - a much larger share of obese patients claims to suffer from e.g. thyroid issues than statistically possible. "Just eat less" is the right answer for the vast majority of obese patients and as they will lie to you about their food intake and exercise (admittedly often unconsciously, but then they don't tend to cooperate well when you ask them to keep a diary of every single thing they eat to make the more self-conscious) you never know if your original attempt at treatment did work or not. The share of patients who will lie into your face about having tried everything is probably still much larger than the share of patients who have actually followed your advice and it didn't help because they have some underlying physical issue.
The standard medical procedure of most likely diagnosis -> treatment -> in-depth examination if treatment doesn't show results just breaks down as the doctor has no way of knowing whether the treatment ever took place or not.
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Actually, it's even worse - 25% of students were aware of the bias, and 39% were biased against obese people, so it's really only 30%.
Other reasons this study is stupid:
* half as many students instead have an anti-thin bias
* about 40% of med students never even graduate and become doctors anyway
* it was done at a single "Southeastern university"
* one of the assumptions they were worried about was that they "are more likely to assume that obese individuals won’t follow treatment plans." Given the numbe
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* about 40% of med students never even graduate and become doctors anyway
Cite?
* it was done at a single "Southeastern university"
Which means a follow on study should cover a broader group, not that the study is invalid. Starting with a small sample and expanding it as time and money allows is common practice.
* one of the assumptions they were worried about was that they "are more likely to assume that obese individuals won’t follow treatment plans." Given the number one thing an obese person can do to improve their health is exercise, eat less, and subsequently lose weight ... they probably have a reason to worry about that, and it's therefore medically significant to their treatment recommendations!
They said "treatment plans", not "treatment plans related to obesity". Treatment plans specifically related to obesity are, as you observed, not necessary except in extreme cases. Dealing with a broken finger or taking the entire course of antibiotics even though you're feeling better also involve treatment plans. Being fat
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My brother-in-law is a nurse. He says that the overwhelming majority of his patients are in the hospital due to poor lifestyle choices, with obesity being the most common cause of the illness. Naturally, some people are obese due to something outside of their control, but not most. I can see it being frustrating helping a patient who wouldn't be there if they'd just done a better job taking care of themselves.
Furthermore, it's my understanding that providing care to a skinny person is easier than giving it
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My brother-in-law is a nurse. He says that the overwhelming majority of his patients are in the hospital due to poor lifestyle choices
Some people would cite a study, but you cite your brother-in-law the nurse. First, "poor lifestyle choices" are about more than being fat. Second, what are his prejudices? The prejudices we all have is why an objective study is better than your brother-in-law the nurse.
we're essentially programmed to prefer skinny people
No. In various societies at various times (including today) what we consider overweight or fat is preferred.
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That's a nice sentiment, but analogies don't automatically make a point valid.
Please be so kind as to point us to the scientifically founded data to support your claims that obesity is largely due to mental illness and not laziness.
Do you believe gay people are mentally ill, then? (Score:2, Insightful)
Then don't pretend that homosexuality isn't a mental illness, either. Evolution has conditioned us so that the desire to pass on our genes is a strong imperative. If you actively go out of your way to not pass on your genes, to seek partners who are incapable of doing so, then something must be wrong with your mind. On top of that, anal intercourse has a much higher chance of passing on infectious diseases than vaginal intercourse. Regularly having anal sex must be a mental illness then, too.
Does the above
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The issue I see is that movies and tv have taught people a value of normal healthy that is actually too thin to be healthy. Too many people are chasing an idea of unrealistically thin and they do a lot of damage to themselves in the process.
I do think it is not very healthy to be overweight or fat however depending on how far overweight you are the health problems actually tend to be pretty minor. Doctors believe a lot of things that medical studies don't actually back up. Many of them still believe there i
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I love how we are supposed to not only accept but encourage obese people to stay obese. We have to say they are beautiful, healthy, and that being fat is not their fault
Do you have any evidence for such absurd ideas, or do you suffer from the mental equivalent of the sort of laziness and self-indulgence that fat people have about food,
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