XPost: soc.support.fat-acceptance, sac.politics, alt.atheism   
   XPost: alt.health   
   From: emailme@emaile.com   
      
   Reduce your gluttony and exercise you fat oinkers!   
      
   You must lose weight, a doctor told Sarah Bramblette, advising a   
   1,200-calorie-a-day diet. But Ms. Bramblette had a basic   
   question: How much do I weigh?   
      
   The doctor’s scale went up to 350 pounds, and she was heavier   
   than that. If she did not know the number, how would she know if   
   the diet was working?   
      
   The doctor had no answer. So Ms. Bramblette, 39, who lived in   
   Ohio at the time, resorted to a solution that made her burn with   
   shame. She drove to a nearby junkyard that had a scale that   
   could weigh her. She was 502 pounds.   
      
   One in three Americans is obese, a rate that has been steadily   
   growing for more than two decades, but the health care system —   
   in its attitudes, equipment and common practices — is ill   
   prepared, and its practitioners are often unwilling, to treat   
   the rising population of fat patients.   
      
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   The difficulties range from scales and scanners, like M.R.I.   
   machines that are not built big enough for very heavy people, to   
   surgeons who categorically refuse to give knee or hip   
   replacements to the obese, to drug doses that have not been   
   calibrated for obese patients. The situation is particularly   
   thorny for the more than 15 million Americans who have extreme   
   obesity — a body mass index of 40 or higher — and face a wide   
   range of health concerns.   
      
   Part of the problem, both patients and doctors say, is a   
   reluctance to look beyond a fat person’s weight. Patty Nece, 58,   
   of Alexandria, Va., went to an orthopedist because her hip was   
   aching. She had lost nearly 70 pounds and, although she still   
   had a way to go, was feeling good about herself. Until she saw   
   the doctor.   
      
   “He came to the door of the exam room, and I started to tell him   
   my symptoms,” Ms. Nece said. “He said: ‘Let me cut to the chase.   
   You need to lose weight.’”   
      
   The doctor, she said, never examined her. But he made a   
   diagnosis, “obesity pain,” and relayed it to her internist. In   
   fact, she later learned, she had progressive scoliosis, a   
   condition not caused by obesity.   
      
   Dr. Louis J. Aronne, an obesity specialist at Weill Cornell   
   Medicine, helped found the American Board of Obesity Medicine to   
   address this sort of issue. The goal is to help doctors learn   
   how to treat obesity and serve as a resource for patients   
   seeking doctors who can look past their weight when they have a   
   medical problem.   
      
   Dr. Aronne says patients recount stories like Ms. Nece’s to him   
   all the time.   
      
   “Our patients say: ‘Nobody has ever treated me like I have a   
   serious problem. They blow it off and tell me to go to Weight   
   Watchers,’” Dr. Aronne said.   
      
   “Physicians need better education, and they need a different   
   attitude toward people who have obesity,” he said. “They need to   
   recognize that this is a disease like diabetes or any other   
   disease they are treating people for.”   
      
   The issues facing obese people follow them through the medical   
   system, starting with the physical exam.   
      
   Research has shown that doctors may spend less time with obese   
   patients and fail to refer them for diagnostic tests. One study   
   asked 122 primary care doctors affiliated with one of three   
   hospitals within the Texas Medical Center in Houston about their   
   attitudes toward obese patients. The doctors “reported that   
   seeing patients was a greater waste of their time the heavier   
   that they were, that physicians would like their jobs less as   
   their patients increased in size, that heavier patients were   
   viewed to be more annoying, and that physicians felt less   
   patience the heavier the patient was,” the researchers wrote.   
      
   Lapses in Treatment   
      
   Other times, doctors may be unwittingly influenced by unfounded   
   assumptions, attributing symptoms like shortness of breath to   
   the person’s weight without investigating other likely causes.   
      
   That happened to a patient who eventually went to see Dr. Scott   
   Kahan, an obesity specialist at Georgetown University. The   
   patient, a 46-year-old woman, suddenly found it almost   
   impossible to walk from her bedroom to her kitchen. Those few   
   steps left her gasping for breath. Frightened, she went to a   
   local urgent care center, where the doctor said she had a lot of   
   weight pressing on her lungs. The only thing wrong with her, the   
   doctor said, was that she was fat.   
      
   “I started to cry,” said the woman, who asked not to be named to   
   protect her privacy. “I said: ‘I don’t have a sudden weight   
   pressing on my lungs. I’m really scared. I’m not able to   
   breathe.’”   
      
   “That’s the problem with obesity,” she said the doctor told her.   
   “Have you ever considered going on a diet?”   
      
   It turned out that the woman had several small blood clots in   
   her lungs, a life-threatening condition, Dr. Kahan said.   
      
   For many, the next step in a diagnosis involves a scan, like a   
   CT or M.R.I. But many extremely heavy people cannot fit in the   
   scanners, which, depending on the model, typically have weight   
   limits of 350 to 450 pounds.   
      
   Scanners that can handle very heavy people are manufactured, but   
   one national survey found that at least 90 percent of emergency   
   rooms did not have them. Even four in five community hospitals   
   that were deemed bariatric surgery centers of excellence lacked   
   scanners that could handle very heavy people. Yet CT or M.R.I.   
   imaging is needed to evaluate patients with a variety of   
   ailments, including trauma, acute abdominal pain, lung blood   
   clots and strokes.   
      
   When an obese patient cannot fit in a scanner, doctors may just   
   give up. Some use X-rays to scan, hoping for the best. Others   
   resort to more extreme measures. Dr. Kahan said another doctor   
   had sent one of his patients to a zoo for a scan. She was so   
   humiliated that she declined requests for an interview.   
      
   Problems do not end with a diagnosis. With treatments,   
   uncertainties continue to abound.   
      
   In cancer, for example, obese patients tend to have worse   
   outcomes and a higher risk of death — a difference that holds   
   for every type of cancer.   
      
   The disease of obesity might exacerbate cancer, said Dr.   
   Clifford Hudis, the chief executive officer of the American   
   Society of Clinical Oncology.   
      
   But, he added, another reason for poor outcomes in obese cancer   
   patients is almost certainly that medical care is compromised.   
   Drug doses are usually based on standard body sizes or surface   
   areas. The definition of a standard size, Dr. Hudis said, is   
   often based on data involving people from decades ago, when the   
   average person was thinner.   
      
   For fat people, that might lead to underdosing for some drugs,   
      
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