{"id":2543,"date":"2022-09-28T14:04:49","date_gmt":"2022-09-28T13:04:49","guid":{"rendered":"https:\/\/springerhealthcare.nl\/france\/?p=2543"},"modified":"2023-01-24T15:52:07","modified_gmt":"2023-01-24T15:52:07","slug":"antifatness-in-the-surgical-setting","status":"publish","type":"post","link":"https:\/\/springerhealthplus.nl\/shmigrate\/antifatness-in-the-surgical-setting\/","title":{"rendered":"Antifatness in the Surgical Setting"},"content":{"rendered":"

[vc_row full_width=”stretch_row” content_placement=”middle” css=”.vc_custom_1663187695627{padding-bottom: 37px !important;background-image: url(http:\/\/springerhealthcare.nl\/wp-content\/uploads\/sites\/24\/2022\/09\/science_connect_back.png?id=2486) !important;background-position: center !important;background-repeat: no-repeat !important;background-size: cover !important;}” el_class=”sciencetitle”][vc_column][vc_custom_heading text=”Science Connect” font_container=”tag:h2|text_align:left|color:%23ffffff” use_theme_fonts=”yes” link=”url:https%3A%2F%2Fspringerhealthcare.nl%2Ffrance%2Fscience-connect-november-2022%2F”][vc_column_text css=”.vc_custom_1663186747780{margin-bottom: 40px !important;}”]A Springer Healthcare Initiative For Pharma Professionals<\/span>[\/vc_column_text][vc_column_text]JANUARY 2023
\n<\/span>[\/vc_column_text][\/vc_column][\/vc_row][vc_row css=”.vc_custom_1538651642953{padding-top: 75px !important;}”][vc_column width=”3\/4″ css=”.vc_custom_1538657061395{border-right-width: 1px !important;padding-top: 0px !important;border-right-color: #8faec1 !important;border-right-style: solid !important;}”][vc_custom_heading source=”post_title” font_container=”tag:h1|font_size:40px|text_align:left|line_height:60px” google_fonts=”font_family:Merriweather%3Aregular%2Citalic|font_style:700%20regular%3A700%3Anormal” el_class=”title” css=”.vc_custom_1664358136969{margin-bottom: 30px !important;}”][vc_column_text el_class=”intro-box”]Weight bias compounds health problems, and surgeons need to recognize and stop it.<\/strong><\/span><\/p>\n

Ashley Andreou<\/span>[\/vc_column_text][vc_single_image source=”featured_image” img_size=”full” css=”.vc_custom_1667910884533{margin-bottom: 0px !important;}” el_class=”hero-img”][vc_column_text css=”.vc_custom_1667910917389{margin-bottom: 30px !important;}”]Credit:\u00a0tongpatong\/Getty Images<\/a><\/span>[\/vc_column_text][vc_column_text]It was 6:30 A.M., and I was getting ready to head down to the operating room (OR) for the first case of the day: an abdominal wall hernia repair. In preparation for the case, I logged on to the electronic health record portal and read through the patient\u2019s medical history and the preoperative notes written by the surgical team. In many of the physician notes, the first line noted the patient\u2019s body mass index (BMI) of 41. The patient\u2019s ventral hernia was estimated to be 30 centimeters by 20 cm, one of the largest hernias ever repaired by the surgeon I was working with. The CT scan showed sections of the large intestine protruding through the hernia, which posed a high risk for bowel twisting, which can lead to perforation and sepsis or tissue deoxygenation and necrosis. The patient\u2019s condition had reached a critical point.<\/p>\n

I ventured down to the OR and located the CT and MRI images, as part of my medical student role of assisting the nursing and scrub technicians in prepping the OR prior to surgery. I projected the scans onto the large screen TVs hanging in the OR to help the surgeons better visualize the anatomy and their approach. As I pulled up the images, the team in the room erupted in shock. How could someone let a hernia get this bad before seeking medical consultation, they wondered. And others couldn\u2019t believe that someone could live with such a large defect and not want it fixed for cosmetic purposes. After rolling the patient into the OR and moving her onto the operating table, the team began to prep the surgical site. As she drifted off into a state of sedation, medical staff in the room could not stop talking about her BMI. The comments were unrelenting throughout the five-hour procedure, as people took turns gawking at the gaping hole in the patient\u2019s abdomen. Two of the largest pieces of Strattice biologic mesh made by the supplier were sewn together to repair the hernia. The estimated cost of the mesh alone was $30,000.<\/p>\n

As the surgery ended, I couldn\u2019t stop thinking about the obvious, yet ironic, connection between the weight comments from the health care team and why the patient procrastinated before getting the surgery. Why would\u00a0anyone<\/em>\u00a0want to interact with a medical system that looked at them in such a derogatory way?<\/p>\n

Antifatness is socially ingrained and\u00a0virtually inescapable<\/a>. Pop culture idolizes thinness. The Centers for Disease Control and Prevention created an alarmist \u201cobesity epidemic<\/a>\u201d based on exaggerated data that haven\u2019t held up. Like everyone else in society who is socially conditioned to this bias, clinicians are not exempt from harboring antifatness. In a recent study,\u00a024 percent of physicians<\/a>\u00a0stated they were uncomfortable having friends in larger bodies, and 18 percent admitted they felt disgusted when treating a patient with a high BMI. This is upsetting, yet unsurprising considering that few programs actively train health care providers against this cognitive bias.<\/p>\n

Abundant research demonstrates that \u201cobesity\u201d is not really a choice and is often a product of systemic inequity. The crux of this research explores the multiple systems that underpin weight:\u00a0food insecurity<\/a>,\u00a0housing insecurity<\/a>,\u00a0poverty-induced scarcity mindset<\/a>,\u00a0medications<\/a>,\u00a0diseases<\/a>,\u00a0lack of education<\/a>,\u00a0mental health issues<\/a>\u00a0and\u00a0chronic stress<\/a>\u00a0among them.<\/p>\n

Many researchers and scholars have exposed the\u00a0pervasiveness of antifatness culture<\/a>, but some of the most prominent actors in maintaining this culture have not been discussed. Surgeons are central to dismantling the problems of antifat bias in health care, and that requires addressing aspects of surgeons\u2019 training and day-to-day tasks that may make them more prone to this cognitive bias.<\/p>\n

Weight bias is heightened and reinforced in the surgical setting, where surgeries on higher BMI individuals\u00a0take more time, cost more money<\/a>\u00a0and have an\u00a0increased risk of complications<\/a>. Antifatness attitudes and behaviors may be higher among surgeons partly as a result of the lack of filter people may have when the patient is sedated. The increased time and care required in these cases can be difficult for surgeons, whose time and care are already strained given staff shortages. Together, these factors may lead surgeons to express their frustration through comments about the patient\u2019s body.<\/p>\n

In addition, professional culture and training are different for surgeons. Primary care physicians\u2019 training may\u00a0focus more on upstream factors contributing to care<\/a>, including being taught about social determinants of health and multifactorial causes of the patients\u2019 conditions. In contrast, surgeons\u2014who on average\u00a0spend 3,963 hours of training honing<\/a>\u00a0a complex motor and visuospatial skill may naturally focus more on the procedural task at hand rather than the factors contributing to their patient\u2019s condition. Ultimately, the everyday demands of a surgeon\u2019s job may make them less likely to think critically about antifatness when providing their day-to-day care. Yet, to provide optimal patient care, it is equally important for surgeons to work against weight stigma.<\/p>\n

Surgeons are often the physicians who spend the most time in the hospital. As such, they play a vital role in forming the culture in the OR and hospital at large, and their understanding of weight bias and its associated behaviors is critical to counteracting pervasive weight stigma among health care providers. Post-surgery, many higher-weight patients will require intensive care, continual follow-up and long-term treatment adherence. Patients with a higher weight are also\u00a012 times more likely<\/a>\u00a0to have a complication requiring extended hospitalization and continued interface with their surgical team. Surgeons must confront their own weight bias to build positive ongoing partnerships with patients.<\/p>\n

A culture of antifatness among surgeons leads to compounding negative impacts on individual patients and the health system. Studies show weight bias from providers is\u00a0palpable for patients<\/a>. Patients can sense the lack of dignity and respect in providers\u2019 attitudes and, in turn, may choose not to interact with the system that degrades them. Many clinicians turn weight loss into an ultimatum for patients rather than focusing on building their trust, understanding contributing factors and partnering with them to make incremental lifestyle modifications possible. Altogether this can harm patients\u2019 self-worth and rapport with providers.<\/p>\n

When providers alienate patients who first touch the health care system, through\u00a0poor care or rapport<\/a>, these\u00a0patients are more likely to not resurface until reaching a critical health point<\/a>, as with the hernia repair case discussed above. Research suggests that providers spend\u00a0less time with larger patients<\/a>,\u00a0provide a lower quality of care<\/a>\u00a0and\u00a0misdiagnose larger patients more frequently<\/a>.<\/p>\n

Antifatness is often a more socially acceptable masquerade for\u00a0anti-Blackness<\/a>. The Department of Health and Human Services reports that about\u00a0four out of five African American women are overweight or obese, and Black Americans were 1.3 times more likely to be obese compared to white Americans<\/a>. This intersection allows covert ways to harm Black and brown bodies.<\/p>\n

Ultimately, the biases and behaviors that maintain antifatness need to change. Potential avenues for change include creating systemwide education, amending medical documentation, reframing patient conversations and advocating for upstream policies that increase access. A health provider\u2019s goal should be health\u2014vital statistics, lab results, symptom reduction, time spent exercising, mental health\u2014not thinness. There are health consequences to obesity, but the current BMI-focused approach is not the best way to capture a person\u2019s current health status.\u00a0Lack of education among medical professionals<\/a>\u00a0is perpetuating antifatness. A health systemwide training should be developed to educate health care providers and shift conscious and unconscious attitudes.<\/p>\n

Providers should also make a habit of noting diet and exercise in social history, as opposed to collapsing these factors into BMI. They could partner with patients and connect them with community resources to enable them to meet their health goals of lower blood pressure or better cardiovascular health. Providers can also focus on evidence-based methods, such as educating patients about nutrition, increasing access to food or exercise, discussing weight-loss surgery or medication and employing motivational interviewing. Understanding the multifactorial nature of weight and taking a patient-centered approach early on can ensure patients feel supported and empowered to achieve optimal health outcomes. This affirmative type of partnership will encourage patients to return to the health care system and invest in the provider-patient relationship and health goals. Providers must internalize the complexity of weight, learn how to utilize alternative health markers and even advocate for policies that reduce food deserts. Surgeons may read the above action items and write them off as tasks reserved for primary care physicians. But practicing unbiased medicine is possible. In one promising model, hospitals in Canada have recently launched a\u00a0surgical prehabilitation program and toolkit\u00a0<\/a>that helps surgeons and their patients work on hypertension, hyperglycemia, hyperlipidemia and cardiovascular health.<\/p>\n

Recent movements around\u00a0self-love and body acceptance<\/a>\u00a0are important, but they cannot replace the work that needs to be done by the people who manifest antifatness bias. America does not have an obesity epidemic; it has an unhealthiness epidemic. Yet the\u00a0worse health outcomes<\/a>\u00a0compared to countries with similar economies are just as much a product of antifatness as they are of fatness. Through shame and blame, antifatness may be contributing to obesity and exacerbating poor health. Until surgeons and other health care providers choose to be a part of the solution to antifatness, then they will be part of the problem.<\/p>\n

This is an opinion and analysis article, and the views expressed by the author or authors are not necessarily those of<\/em>\u00a0Scientific American.<\/p>\n

Copyright \u00a9 2022, Scientific American, Inc.<\/p>\n

About the author(s)<\/h4>\n

Ashley Andreou<\/strong>\u00a0is a medical student at Georgetown University.[\/vc_column_text][\/vc_column][vc_column width=”1\/4″ css=”.vc_custom_1538657003956{padding-top: 0px !important;padding-bottom: 0px !important;}”][vc_custom_heading text=”ISSUES” font_container=”tag:h3|font_size:12px|text_align:left|color:%23333333|line_height:18px” use_theme_fonts=”yes” el_class=”titlewidget”][vc_column_text el_class=”columnflex” css=”.vc_custom_1664403952071{margin-bottom: 40px !important;}”]

October 2023<\/a><\/p>\r\n

September 2023<\/a><\/p>\r\n

August 2023<\/a><\/p>[\/vc_column_text][vc_custom_heading text=”OTHER ARTICLES IN THIS ISSUE” font_container=”tag:h3|font_size:12px|text_align:left|color:%23333333|line_height:18px” use_theme_fonts=”yes” el_class=”titlewidget”][vc_basic_grid post_type=”post” max_items=”3″ element_width=”12″ orderby=”rand” item=”538″ grid_id=”vc_gid:1674575510518-27c58936-7c49-0″ taxonomies=”24″][\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"Weight bias compounds health problems, and surgeons need to recognize and stop it. ...more<\/a>","protected":false},"author":29,"featured_media":2544,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"categories":[7],"tags":[24],"class_list":{"0":"post-2543","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-science-connect","8":"tag-january-2023"},"acf":[],"yoast_head":"\nAntifatness in the Surgical Setting - 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