Obesity: To Treat, or Not to Treat?

Obesity: to treat, or not to treat: that is the question? Recently I read a column in the Florida Sun Sentinel in which some ob/gyns in South Florida reported that they turned away obese patients-15 practices of the 105 polled stated that they had established a weight “cut-off” starting at 200 pounds. In the interest of transparency I must admit that I would have problems finding a doctor under these circumstances as I am 5′ 10.5″ and over these physicians’ set weight limit. As a woman of size I happen to attract possibly more than my share of large patients, for which I have no regrets.

Some of the physicians interviewed in the article said the main reason for the established cut-off was that obese patients are high risk and have more complications. Isn’t this also true in patients with multiple births, diabetes, or seizures as well as those who are underweight, very young, or very old? Obstetric and gynecologic care is not elective or cosmetic. Therefore, it is up to those of us who are educated and trained to care for all women, of any size or any shape, with any disability or any comorbidity. I am surprised that it isn’t illegal to discriminate on the basis of size.

Another doctor quoted in the article stated that he did not want to have to get a consult if the patient developed a complication. Why not? I request consults whenever I am in a situation that requires expertise I do not possess. This is what doctors do. We take care of women until we find we are not capable of solving a problem, and then we get help. If we can care for a patient with brittle diabetes, an unusual infection, or a bowel obstruction (I could go on and on . . .), why not care for a patient who is overweight? Denying access to a class of women (ie, large women) is discriminatory, insulting, and bad medicine.

There are many ways to easily accommodate larger women. In my office I have a variety of specula-some are extra long and narrow, some are extra long and wide-and I can see what I need to without any problem. I also have a couple of electrical tables and some mechanical tables, all of which can accommodate most women. If someone is not ambulatory or is more than 400 pounds, making accommodations in an office setting may be more difficult, but seeing women up to 350 pounds is manageable in my office. We have extra long instruments for cervical biopsies and other office procedures. Sometimes I will have the patient lift her knees to her chest to give better access to the perineum. Our reception area has a very sturdy sofa without arms along three walls and several armchairs that are strong and can accommodate most sizes. They were purchased with this in mind.

No patient should ever be sent away from a medical office due to her size. I find that the open attitude in my practice about this has encouraged many women to take better care of themselves, to start exercise programs to improve their fitness, and to consider healthier eating patterns. They are certainly relieved that we are neither preachy nor judgmental. They follow up better and are very loyal patients.

Doctors are here to treat all patients, not to cherry pick the “easy ones.” Let’s get back to why we took that oath and chose medicine as a profession: to care for those who need us.