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Doctors must be aware of the ethics of treating the obese

A common complaint by obese people: their weight is raised by healthcare professionals even when it has no connection to the cause for their visit. This is according to Marika Warren a specialist on ethics. From an ethical standpoint, “it is key to ensure patients get care appropriate to the condition they come in with”, she said. “If they come in for the flu, they should get treated for the flu not their weight.” Ms Warren an assistant professor with the Department of Bioethics at Dalhousie University in Canada holds a PhD in the field. She is also a healthcare ethicist for the Nova Scotia Health Ethics Network, in Canada. She is on the Island this week as part of the Bermuda Hospitals Board’s (BHB) celebration of Ethics Week which is focusing on food and nutrition. While here she will be giving lectures to local healthcare workers and will also provide some training to BHB’s Ethics Committee. In an interview with Body & Soul she said her presentations would centre on the theme for the week Food for thought: The Ethics of Nutrition. She said a growing area of concern is how to treat obese people in a respectful manner. Healthcare workers need to be mindful of the impact they may be having on patients by harping on their weight, especially when it has no relation to the ailment they are seeking help with. “They [the overweight and obese] find it frustrating and disrespectful,” she said. Another common complaint from obese people was that healthcare workers do not believe them. “Healthcare workers need to be taking patients at their word,” she said. “A lot of obese people complain that healthcare providers don’t believe them when they say how much they’ve exercised or that they eat very little. “The common experience of patients that are overweight and obese is that doctors and other healthcare workers find it hard to accept that the obesity may be a complex problem.” She said many in the field believe that the excess weight is always the result of poor choices in diet and activity. Ms Warren said having such a mindset naturally colours the way a healthcare worker treats obese and overweight patients. She said many workers are not aware of the impact and frustration their approach causes patients. “I know some surgeons who will not operate unless the patient loses weight even though that weight will not impact the surgery,” she said. “In these cases the doctor is conscious of his/her actions.” She said surgeons, and other medical professionals that behave in this way should try to refocus and base their decisions on scientific evidence. “They need to look at the evidence that is out there and review the connections between weight and health. It’s not always a direct connection. “You can get people who are both obese and healthy in terms of their blood sugar and blood lipids. “In such cases the weight may not be an issue of safety in surgery,” she said. Having equipment that can withstand the size and weight of the obese is another important ethical issue, according to Ms Warren. She said hospitals should have operating tables, chairs, beds and even blood pressure cuffs that accommodate obese people. A BHB spokesperson said King Edward VII Memorial has a bed and some wheelchairs that can accommodate morbidly obese people. Tables in the operating room can withstand up to 1000 pounds; meanwhile stretchers can accommodate up to 700 pounds. KEMH also has blood pressure cuffs as large as 60 centimetres, which means they could fit an arm with a circumference of about 22 inches. The spokesperson said that the hospital is also looking at sourcing bariatric equipment (equipment for the morbidly obese) and that the new facility will have rooms specially outfitted to accommodate obese patients on acute care wards.

Marika Warren