Care of Obese Patients Challenges Health Care Providers

The rising rate of obesity in the United States—up from about 15 percent of adults 2 decades ago to 27 percent today—poses special challenges to health care providers. Not only do patients who are obese have special health care needs, physicians and other medical staff face additional challenges in providing routine preventive care.

Studies have shown that patients who are obese are less likely than normal-weight patients to receive preventive services such as pelvic exams, Pap smears, and breast examinations. This may be due in part to patients’ hesitancy to seek medical care for fear of disparagement by physicians or medical staff. Health care provider factors, such as skipping a pelvic exam because of difficulty performing an adequate examination, also come into play. Providers may also focus on existing health problems such as diabetes or high blood pressure, resulting in less time for preventive services during the medical visit.

In a recent report published in American Family Physician, the National Task Force on Prevention and Treatment of Obesity offers recommendations for medical care of obese patients. To increase these patients’ access to quality care, health care providers should begin with the office environment. This includes educating staff about treating patients with respect regardless of their weight. Medical staff should weigh patients privately and be sensitive about word choice. For example, some patients strongly dislike the term “obesity” and may be more receptive to a discussion of their problems with weight or being overweight. Appropriate equipment and supplies also contribute to quality care (see list).

Office Supplies and Equipment for Obese Patients

• Sturdy, armless chairs and high, firm sofas in waiting room

• Sturdy, wide examination tables

• Extra-large examination gowns

• Large adult blood pressure cuffs

• Extra-long phlebotomy needles and tourniquets

• Large vaginal specula

• Weight scales with adequate capacity for obese patients

Health care providers should not overlook preventive care for patients who are obese. Pap smears, breast exams, mammography, and prostate exams can be performed in patients of any size. Since patients who are obese suffer more often than normal-weight patients from some illnesses that can be detected early, preventive evaluations take on an increased priority.

Patients who are extremely obese (body mass index [BMI] of 40 or more) have special health care needs. Because these patients are at higher risk for a variety of illnesses, or may already be ill, it is especially important to monitor obesity-related risk factors such as diabetes, hyperlipidemia, and ischemic heart disease.

Even in the absence of weight loss among patients who are obese, health care providers can encourage behaviors such as healthy eating and physical activity to avoid additional weight gain and combat obesity-related risk factors such as heart disease. In addition, encouraging patients to lead as full and active a life as possible may serve to enhance self-acceptance and self-esteem and reinforce healthy behaviors.

The Task Force, established by NIDDK in 1991, is a working group of obesity and nutrition experts who assess and synthesize current science-based information on obesity prevention and treatment. The full Task Force report on medical care for obese patients was published in the January 1, 2002 issue of American Family Physician, available to subscribers at www.aafp.org/afp. s