Patients weighing 204 kg or more face barriers and discrimination when planning or attending visits to specialist offices, reports a new study from Northwestern Medicine.

Using a mystery shopper method, the scientists tried to make an appointment for a hypothetical patient weighing 220 kilograms in practices in five specialties (dermatology, endocrinology, obstetrics and gynecology, orthopedic surgery and otolaryngology) in four metropolitan areas (Boston, Cleveland, Ohio, Houston and Portland, Oregon). Each hypothetical patient was able to walk and did not need assistance in getting up and down from the examination table.

The researchers wanted to find out whether the clinics met the basic standards for the care of bariatric patients. In her opinion, these include an examination table or chair with a sufficiently high weight limit, seating in the waiting room, sufficiently wide corridors and doors as well as sufficiently large gowns.

Of the 300 clinics surveyed in the study, 52% lacked basic standards of care, and 41% declined to make an appointment. Otolaryngologists (ear, nose and throat doctors) were the least likely to make an appointment with the patient (only 48.3% made appointments, compared to 59% overall). And this despite the fact that the researchers provided information when making an appointment that strongly indicated that the patient had cancer

Only 117 practices (39%) were fully accessible, according to the study, with endocrinology practices being the most willing to make appointments and most likely to meet basic standards of care.

Another 16% of the practices in the study that were willing to schedule the patient had a treatment plan that was not up to standard and included workarounds for limited accessibility. For example, patients were told that they could come to the clinic, but had to stand or cover themselves with a sheet during the examination because they did not have suitable gowns.

Original Paper:

Barriers to Subspecialty Care Among Patients With Extremely Severe Obesity | Annals of Internal Medicine

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