Thursday, January 26, 2012

Are Weight Ignorant Allied Health Professionals the Exception or the Norm?

Probably the norm.

And frankly, I think it's unforgivable and that their ignorance belies the fact that weight bias is alive and well in allied health professions.

How is it possible that despite one third of the population having obesity that allied health professionals remain so clueless about how to even talk about weight, let alone how to manage weight related comorbidities, how to ensure they don't add to the problem with weight gaining medications, or how to assess whether that weight is truly problematic, or rather, a healthy variant of normal?

If 1 in 3 people had asthma, do you think allied health professionals would be beyond awesome at managing, counselling and dealing with it, along with recognizing when it's a big scary deal or rather a minor periodic inconvenience?

And it's only because we're talking about obesity that allied health professionals remain perfectly comfortable with their own ignorance. The fact that they can dismiss obesity as a moral failing of their patients - nothing to see here medically - helps to exonerate them mentally from having to actually help, counsel or treat the patient in front of them, or think about the problem's actual etiology. It also helps to exonerate them from actually taking it upon themselves to learn more - something they'd no doubt do were we talking about any other medical problem or condition that they might not know much about, but which affected over one third of their patient population.

Why the diatribe?

Today, my friend Travis Saunders, co-author of the blog Obesity Panacea, recounts his recent experience going to his doctor's. Brief background. Travis? He's stupid fit. He's the guy that makes you shake your head and wonder what kind of crazy crawled into him that makes him run, bike, and ski through sun, rain and snow, day in and day out. He's also an obesity researcher. A good one.

So what happened with Travis?

The nurse practitioner at his MD's office weighed him, saw that his BMI was nearing 25, and told him he should, "watch his weight" moving forward as he was nearing the "overweight" range.

You see Travis wasn't Travis to the nurse. He was BMI 24.5.

I suspect other folks visiting that nurse weren't Marge, or Bill or Peter, they were BMI 37, BMI 32, and BMI 29.

The fact that there was no thought on the part of the nurse? No consideration of Travis' lifestyle or actual health status? That's because I'd bet to her, weight's a very simple thing to deal with. It's not the complicated amalgam of hundreds of genetic, environmental, medical and behavioural contributors. It's not something that needs to be evaluated within the context of the whole. No. She's learned that when BMI is greater than 25, that's overweight, and when BMI's greater than 30, that's obesity. Easy peasy. No need for any further evaluation. Oh, and treatment? Easy, peasy too! Just, "watch your weight".

We all know how well that advice would work.

So is she a bad nurse? An exception? She's probably not either. You see as far as teaching goes, professional schools pretty much ignore obesity. That goes for medical schools, dietetic schools, nursing schools - etc.  Instead they teach body mass indices, waist circumferences and waist to hip ratios. They teach numbers. But unlike virtually everything else that's taught, when it comes to obesity, those numbers stay in vacuums, where individuals and thorough and thoughtful exploration of the issue isn't taught or recommended, because sadly, even in medicine, obesity is still considered to be just a reflection of your patients' deadly sins, which is probably why Travis' nurse never even thought to consider him as a person rather than a number.

To read Travis' thoughts and experiences, head over to his blog and have a peek.

To my readers out there who are professors in various allied health training programs - what are your schools teaching about obesity?  Is there a new tide turning?

I sure hope so.