Larger patients can face additional issues when they have surgery to treat sleep apnea, said Dr. Bhattacharyya, though he questioned whether it would be considered weight bias or simply smart risk assessment to prevent potential problems. Some of these patients will need intensive care unit coverage after apnea surgery, due to the higher airway risks, so they may need to travel farther from home to an area where there is a teaching hospital with residents on call who can assess a situation more quickly, rather than undergo the procedure at a smaller but more local hospital, he said.
Explore This IssueMarch 2014
Additionally, a patient’s insurance might not cover surgery at a larger facility as it would at a smaller hospital, depending on the policy, he said. Anesthesia is administered based on body weight, so it takes longer for anesthesia to wash out of an obese patient’s system, compared with that of a thinner patient. This all affects the amount of time the patient is cared for as well as how much the patient will pay out of pocket: A sleep apnea procedure can be an outpatient day surgery for a thin patient but can require more inpatient time and care for the obese patient, who is likely to require a longer hospital stay.
Improving the Doctor-Patient Relationship
In the United States, nearly 36% of all adults are obese, and close to another 33% percent are overweight, according to 2009-2010 data published by the Centers for Disease Control and Prevention.
What’s the best way for physicians to better connect with these patients to ensure quality care? Recognizing the potential for both explicit and implicit bias is key. “The first thing is really improving communication skills with all people, especially those who are different from yourself,” said Dr. Sabin, who cited assorted continuing education programs as well as medical school curricula. “That’s really the answer: fine-tuning your skills and knowing you may have prejudice, and overriding it for patient care.”
Seeing obesity as a chronic disease—and not merely as a symbol of eating too much—can also help. “Just like you would for a patient who has diabetes or emphysema—make that part of the discussion,” said Dr. Bhattacharyya. “Use that as a risk factor and a comorbidity that affects surgery, surgical planning, and prognosis. Make it [change] from something you don’t want to speak about to … a medical connotation that needs to be addressed.”