For plus-size patients, health care bias is a real issue

Thursday’s cooler temps notwithstanding, these are the steamy days that
some women of a certain weight dread.

Maybe it’s having to peel off the sweaters and expose those upper arms.
Or perhaps it’s the thought of fitting into this season’s ubiquitous
tankini, which manufacturers promise will flatter every figure. Right.

They’re trivial concerns, though, compared to recent news that should
worry the plus-size crowd, particularly those with breast cancer.

Dr. Jennifer Griggs, a breast cancer specialist with the University of
Rochester’s Wilmot Cancer Center and head of a study that appears in
the current issue of Archives of Internal Medicine, has found that
bigger women are more likely to get lower doses of chemotherapy than
needed for their body size to kill the cancer cells. That disparity
grew with the number on the scale: from 9 percent for normal-weight
women to 37 percent for severely obese women.

Griggs knows of what she speaks when it comes to disparities in
treating women with breast cancer. She led a study a few years ago that
found African-American women received lower doses of chemotherapy than
white women, which may partly explain why the disease is more likely to
kill the former while it’s more common among the latter.

The more recent study, which involved a national sample of 9,672 women
with breast cancer at 901 practices, did not consider patient outcomes.
But it did suggest that full doses of “chemotherapy in overweight and
obese women is likely to improve outcomes in this group of patients.”

The implications are important, Griggs points out, considering how
common obesity has become in America. It’s a risk factor in cancer and
other ailments such as diabetes and arthritis.

There are some caveats to the new study. The research is based on data
from 1990 to 2001, and doctors say they’ve changed their ways since
then.

Nor does Griggs believe something malicious is afoot. Physicians likely
feared the higher chemotherapy doses would hurt their patients, which
the study showed was not the case.

“I don’t think M.D.s have conscious biases against heavy patients,”
Griggs says. “We just don’t want to do harm. On the other hand, little
work has been done to determine optimal dosing in heavy patients, and
the lack of research may be due to underrecognition of (the) problem of
obesity.”

Bias in health care, though, is a real issue for heavier patients.
Studies have documented negative attitudes toward obese patients among
doctors, nurses, even dietitians.