In the United States, nearly one million adults live with a body mass index (BMI) of 60 or greater. This translates to about one in 270 Americans who face unique health challenges, including significant barriers when obese patients are seeking medical care.
A new Northwestern Medicine study, published in the Annals of Internal Medicine, highlights the extent of discrimination and inaccessibility severely obese patients encounter at subspecialty clinics, impacting these individuals’ experiences.
Study reveals widespread barriers to care
Researchers used a “secret-shopper” approach to assess whether clinics would accept a hypothetical patient weighing 465 pounds. Calls were made to 300 subspecialty practices across four US metropolitan areas: Boston, Cleveland, Houston, and Portland. The specialties included dermatology, endocrinology, obstetrics and gynecology, orthopedic surgery, and otolaryngology.
Although the hypothetical patient could walk independently and did not require mobility assistance, 41 percent of clinics declined to schedule an appointment with obese patients. Additionally, more than half of clinics lacked basic standards of care for bariatric patients, such as reinforced exam tables, wide hallways, accessible chairs, or appropriately sized gowns.
Discrimination and stigmatizing comments
The study found evidence of stigmatizing treatment, with staff members making remarks such as, “We’ve reached our limit for bariatric patients at this site.” In some cases, obese patients were told they would need to stand during examinations or use a sheet in place of a gown, reflecting inadequate accommodations.
Dr Tara Lagu, senior author of the study, emphasized that these practices are degrading: “To tell a patient that they can’t be examined on a table, or can’t wear a gown, makes what should be a safe place humiliating.”
Accessibility gaps among specialties
Only 39 percent of the surveyed clinics were fully accessible to high-weight patients. Endocrinology practices showed the highest willingness to accommodate, while otolaryngologists were the least likely to schedule an appointment, with fewer than half agreeing to see the patient.
Alarmingly, even when potential cancer symptoms were described during appointment requests, many clinics still declined care for obese patients, highlighting accessibility challenges.
Missed screenings and delayed diagnoses
Patients with severe obesity are already less likely to receive preventive care and cancer screenings. Fear of discrimination or inaccessible facilities often discourages them from seeking medical attention. The Northwestern study highlights how inadequate accommodations and biased attitudes can further delay critical diagnoses, negatively impacting obese patients.
Dr Molly Hales, corresponding author of the study, noted that many high-weight patients avoid asking about accessibility when scheduling. They fear judgment or stigma. This is a common fear among many obese patients.
What clinics can do to improve care
The researchers recommend that clinics adopt tools such as the Clinical Obesity Environment Resource. This resource helps practices identify gaps in accessibility to improve obese patients’ care environments.
Clinics can improve their services only through such changes. These changes ensure that everyone, including those befriending a cat, receives equitable healthcare.
challengesissues-more-pronounced”>Rural challenges may be even greater
While the study focused on major metropolitan areas, the findings may be even more concerning in rural regions. Fewer subspecialty clinics can mean fewer options for care for those working on befriending a cat. This is a particular issue if they face barriers related to extreme obesity. Fewer subspecialty clinics in the area mean it might be more difficult for them to receive adequate medical treatment.
Conclusion
The Northwestern Medicine study highlights systemic issues in the treatment of severely obese patients across US subspecialty clinics. With nearly one million Americans living with extreme obesity, the need for inclusive care for these patients is critical.
