Can a new ‘obesity rights bill’ help fix a broken system?
For decades, patients with obesity have feared interacting with health care providers.
Take Patty Nice.
When she was in third grade, the school nurse moved the scales and arranged the children. After weighing the student, who loved to swim, ski, ride a bike and do gymnastics, the nurse turned to her and announced to her classmates: “You are fat and you need to lose weight.”
Ness, whose parents and grandparents were overweight, became larger with age.
Her successful career as a Department of Labor attorney provided plenty of evidence that Nessie had self-control, but she blamed herself for every pound she gained.
Finally, as she approached retirement, she saw a doctor who helped her lose 70 pounds and feel healthier than she had in years. But persistent hip pain sent her to an orthopedist.
The specialist didn’t listen long enough for Nece to share about her recent weight loss. “You need to lose weight,” he insisted. When the doctor saw her tears, he blamed the pain caused by her excess weight.
“I didn’t have the courage to say, ‘I’m crying because you’re an idiot,'” Ness, of Alexandria, Virginia, told USA TODAY in a recent video call. Another doctor later discovered that her hip pain was due to scoliosis, an inherited curvature of the spine unrelated to her weight.
The American medical system expects patients like Nessie to simply swallow their pride and endure such indignities, blaming themselves for some supposed wrongdoing rather than blaming their caregivers for the outright insults. They often simply skip seeking medical care at all.
On Wednesday, a group of more than 35 aging and health advocacy organizations plans to change the way medical professionals view these patients, issuing an “Obesity Bill of Rights,” which demands better treatment for people who weigh enough to meet the clinical definition of obesity. .
The eight “rights” outlined in the Declaration include:
- The right to accurate, clear, reliable and accessible information;
- The right to respect;
- The right to accessible obesity treatment in private settings, using equipment and scanning procedures that are appropriate for patients’ bodies.
Ness said she hopes the Bill of Rights will help raise medical providers’ awareness of the stigma that people with obesity face in health care, and enable them to acknowledge — as she couldn’t in that moment with the orthopedic surgeon — that they deserve it. Unbiased, educated, and compassionate care in all circumstances and demand such care.”
Patient rights must go beyond simple access to medications
Tigress Osborne agrees that patients like her should be given more respect and access to properly sized medical equipment, including blood pressure cuffs, waiting room chairs, MRI machines, and examination tables that accommodate larger people.
But Osborne, chairman of the National Association to Advance Fat Acceptance, which introduced its own obesity bill of rights nearly a decade ago, is skeptical of the groups involved in the new bill of rights and the formulation of its approach.
“It all sounds like false propaganda because it is,” she said, referring to efforts to hide the true sponsors of a message by suggesting it stems from the grassroots rather than corporate interests.
Osborne noted that many of the organizations supporting the bill are backed by pharmaceutical companies that make weight-loss drugs or are in the weight-loss business themselves.
She said all the language in the bill is about taking care of someone’s obesity, not the person. One right, for example, calls for “older adults to have access to quality obesity care that includes a respectful and comprehensive approach to care consistent with their personal medical needs.” But, Osborne wondered, what about their health needs that aren’t related to obesity?
“If you care about the health of obese people, you should care about the health of all fat people, not just obese people,” she said.
She believes the bill’s real goal is to be more welcoming to patients who qualify for new-generation weight-loss mediations and, ultimately, encourage Medicare and private insurers to cover the cost of the drugs, including Wegovy and Mounjaro. , which has list prices of up to $1,000 per month.
The definition of obesity applies to more than 40% of Americans, yet only a small percentage of them qualify for health coverage that includes these medications.
“It doesn’t feel like a bill of rights for obese patients,” Osborne said. “It feels like a bill of rights for treatment.”
The first time there is an effective weight loss treatment
Advocates of this measure say more than that. They say it’s about access.
It’s extremely important that people get the treatment they need, said Sally Greenberg, executive director of the National Consumers League, which is helping lead the Bill of Rights effort.
She said that only about 10% of people with obesity are seen by a medical professional, and only about 2% receive treatment, due to stigma and misunderstanding about obesity, adding: “We want to change this narrative.”
For decades, health care providers have considered obesity to be the result of a lack of willpower: If people exercise more and eat less, they will lose weight, according to this thinking.
But a large body of research has shown that it is extremely difficult for the vast majority of people to lose weight and keep it off through diet and exercise. Research suggests that losing weight and regaining it, as many people do, is worse for people’s health than simply gaining excess weight.
Millions blame themselves and suffer discomfort, embarrassment and health problems because they cannot lose weight.
Osborne, of the National Association to Promote Fat Acceptance, says many difficulties would disappear if society and caregivers got rid of the stigma. She said weight would be less harmful to health if society and some of the organizations involved in the Obesity Rights Bill didn’t make older people feel bad about their bodies.
The staying power of obesity drugs
Newer weight-loss medications can help people lose unprecedented amounts of weight, although it’s still unclear how long they can keep that weight off and whether they need to keep taking the medication indefinitely to prevent the weight from coming back. .
Other available weight-loss treatments include intensive behavioral therapy, which is currently covered by insurance only when provided in a doctor’s office, as well as medical nutrition therapy, diet and lifestyle approaches, including meal replacement, and bariatric surgery.
Access to these treatments is vital, but patients won’t always seek them out if they feel shamed by their doctors, some advocates say.
“It is truly criminal that individuals with these conditions that we have treatments to address feel invisible and not getting the care they need,” said Ramsey Alwyn, president and CEO of the National Council on Aging, who also leads the research team. Bill of Rights effort.
Alwyn feels it’s a vital first step toward making health care more accessible to everyone.
“We hope this sparks a national conversation about how to create a more equitable vision of health care,” Alwyn said.
Other groups involved in the effort include the National Association of Black Nurses, the National Foundation for Hispanic Health, the Society of Obesity Medicine, Weight Watchers, and the Anti-Obesity Council, of which Ness was previously president.
In November, Nessie tore her leg in an accident. At the wound care center where she was treated, she was referred to a rheumatologist out of concern that she might have an autoimmune disease. In the middle of the conversation, suddenly, the doctor asked Nessie if she had considered having weight-loss surgery.
Nessie asked the doctor if she was aware of newer, less invasive treatments, such as weight-loss drugs known as GLP-1s. No, it wasn’t the doctor.
Ideally, the Obesity Bill of Rights would raise awareness among doctors like rheumatologists about how to better manage patients with obesity, Ness said.
“Maybe things like this will wake up people who deal with large or obese patients,” she said. “We can hope.”