When I present patients and reach the “body habitus” part of the presentation, I always become a little awkward. I’m acutely aware of body-image issues and I never want to be the cause of a patient’s emotional distress. It has happened a few times that a registrar admonished me, “You need to say it. You need to counsel your patients that they are overweight.”
That’s hard when you believe in “being nice”.
On my rural rotation, I saw a classic example of a case where it should have been said long ago.
A grade-school girl presented to us with clear-cut Cushing’s Disease. She was a preteen of average height, weighing in at 100kg (220lb). She came to hospital not because of her weight, but because she could no longer walk due to proximal muscle weakness.
Thing is, she wasn’t just a little chubby. She wasn’t on that line where some practitioners would argue that if her diet was healthy she was actually okay. It was not a case like that. It was a clear case of being morbidly obese, and nobody had ever said this to her mother (her mother and entire family, by the way, do not have a similar build).
Essentially what we think happened was that her previous doctors were so caught up in being culturally appropriate, because in many African cultures being bigger is better; a sign of wealth and health, that they never mentioned it to the mother. And by purposefully overlooking her weight, they overlooked the other danger signs.
I should probably mention that I’m not judging her previous doctors. It’s not an easy diagnosis to make when your time per patient is limited. But it has been a valuable teaching point for me.
Once the clinicians discussed the matter with mom and daughter, they recognised truth in it. The mom actually cried. She had just never thought something was wrong. We can scratch our heads about that if we really want to, but the point is that by being willing to address a sensitive issue, the clinicians opened the door to investigating the underlying matter and the girl’s myriad other health problems.
Disclaimer: I am aware that there is a lot of debate about BMI and weight in healthcare, and I support the notion that healthcare workers should not unduly contribute to the difficulty many men and women have in terms of body image. I encourage the research being done in this field, but that is not what this post is about.