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‘Seeing’ Obesity: How Doctors and Patients Can Do Better

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This is the third in a three-part series on the obesity crisis. Part one asks a complicated question: Why has the obesity rate continued to rise despite our efforts to stop it? Part two examines whether new weight loss drugs will finally end the crisis. 

July 5, 2023 – After Mia O’Malley gave birth in 2018, she retained fluid in her legs – a common occurrence after giving birth. The swelling made walking, sitting, and caring for her newborn painful and uncomfortable. She went in for a check-up, and her doctor told her it would eventually go away with regular movement and elevating her legs.

Months passed and the painful swelling wouldn’t subside, so she saw a different primary care doctor. O’Malley said the second doctor didn’t examine her legs, but instead implored her to focus on one thing: losing weight. She left with information on which calorie-counting apps to download.

As time went by and the swelling persisted, she went back to the second doctor and asked for a water pill to flush out the fluids – something she had seen other new parents discuss online. The doctor obliged, and within days, O’Malley’s swelling was gone. She realized she could have avoided 6 months of potential health risks and pushing through pain if only her doctor had seen her as a person, not just a bigger body.

Weight bias, unfortunately, is nothing new. Many studies over decades have shown that doctors sometimes look down on patients with obesity, and can have a hazy understanding of the condition overall. This makes it harder for bigger patients to receive proper care and achieve positive health outcomes, with previous negative experiences deterring some from seeing doctors at all. And so the cycle continues.

“There are a lot of things that happen in my body that I feel like I have to educate my [health care] providers on,” O’Malley said. “I wish that was different.”

Weight Stigma in Health Care Runs Deep

In some cases, like O’Malley’s, patients don’t feel heard because they doubt their doctors can see past their obesity. At the same time, the weight loss advice that doctors tend to give – eat less, move more – often doesn’t work. While some doctors do specialize in obesity treatment – obesity medicine has been growing since the field was established in 2011 – most receive little training in how to talk about and treat obesity.

Then there’s the fact that doctors are human and not immune to bias. Previous studies have shown weight stigma in patient-provider encounters, with a 2021 PLOS One study of nearly 14,000 people across six countries showing two-thirds of those who have experienced weight stigma also experienced it with doctors. The result: They perceived less listening and respect from doctors, more judgment due to body weight, and lower quality of health care.

There’s more. The negativity of weight stigma can lead to more unhealthy behavior, including disordered eating, more weight gain, and alcohol use, and it has been linked to higher suicide risk.

All this is bad news for people and for public health, as it leaves people living with obesity reluctant to seek help for any health issue, much less for weight management. In a country with skyrocketing obesity rates, that’s not good.

Obesity medicine specialist Fatima Stanford, MD, MPH, an educator and doctor at Harvard Medical School and Massachusetts General Hospital, sees patients from as young as 2 years old to upwards of 90. Among her diverse pool of patients emerges one common theme.

“Patients with obesity have been devalued and belittled,” she said. “They often seek treatment under cloak of secrecy. They don’t want people to know they’re being treated for obesity because it must be a sign of failure or of their inadequacy of not doing things the ‘hard’ or the ‘right’ way.”

When It Becomes Easier to Simply Not Go to the Doctor 

For many larger-bodied patients, it’s common to go years without seeing a doctor. Studies have shown that people with obesity are less likely to be screened for certain cancers and more likely to delay care, in large part due to the negative attitudes they experience in health care settings.

Research also shows that overweight patients shop for doctors 23% more often than their lower-weight counterparts. For patients with obesity, that jumps to 52%, showing just how hard it is for those patients to find a compassionate provider and stick with them.

“It’s not just about hurt feelings,” O’Malley said. “It’s about people avoiding preventative care appointments, avoiding getting injuries treated, avoiding their health issues because they don’t want to be shamed.”

This rings true for Jen McLellan, a plus-sized childbirth educator and author.

“Even though this is what I teach full-time, I didn’t go to the doctor for over 2 years, and during that time I gained weight already existing in a larger body,” she said. “I gained an additional 60 pounds, and it really affected my mental health.”

The long hiatus began pre-pandemic, after McLellan saw a doctor when she had a hard time breathing. A month before her appointment, she had completed a 5K and was in good health. She asked her provider for an inhaler but was told that would “hurt her heart.” The doctor ordered an EKG, which showed no abnormalities, but still refused to give McLellan a prescription for an inhaler.

As she was driving home, she nearly blacked out from lack of air. She ended up going to urgent care for an inhaler and was told she just had a restricted airway that needed help opening up after a bout with strep throat.

“I’ve basically had to say [to doctors]: Look at me, the human sitting in front of you that has been mistreated by the health care system,” McLellan said. “I am a person. I am not a BMI or a number on the scale. Treat me with dignity.”

A New Path to Better Results 

Kristal Hartman, 45, is a member of the Obesity Action Coalition and has sought treatment for obesity throughout her life. She ultimately had bariatric surgery in her mid-30s.

Before the surgery, she had given birth to twins, and her health had suffered due to polycystic ovary syndrome and thyroid issues.

“I had little kids, and I’d already tried every fad diet,” Hartman said. “My primary care physician, who has never experienced obesity herself, just kept telling me to ‘just walk a little more and put down the fork and eat a little less’ – that was pretty much the only advice I got from her about weight management.”

Studies have shown that weight loss advice from doctors rarely includes effective methods, and typically falls into the generic “eat less, move more” variety.

This doctor was also an internal medicine specialist whose practice was said to be geared toward patients with more complicated health profiles, Hartman said. Eventually, Hartman’s endocrinologist recommended different treatment options, like medication and surgery.

“Even when researchers do very nice, controlled studies, only about 5% of people are able to lose 20% of their weight with lifestyle interventions alone. Forty-eight percent of people are able to lose 5% of their weight,” said Angela Fitch, MD, associate director of the Weight Center at Massachusetts General Hospital. “The biggest thing I tell people is that it’s not about your character; it’s about your chemistry.”

Getting regular exercise and eating a balanced diet are good lifestyle choices for everyone, not just those with obesity. But according to Fitch, patients usually need another intervention for successful weight management.

At the Massachusetts General Hospital Weight Center, Stanford says, it’s about trying different therapies and seeing how patients respond. Successful treatment involves every part of a person: genetics, hormone levels, sleep patterns, food access, and mental health. And in her experience, this multidisciplinary approach works.

“A large majority of my patients – people I’ve been seeing for 10 or 12 years who have continued with care – probably an excess of 90% are successful in their treatment strategies,” she said.

A person’s weight management strategies often have to change over time. Even after Hartman lost significant weight from bariatric surgery, her weight began to creep back up (a not uncommon experience). She started taking a prescribed GLP-1 receptor agonist – a group of drugs that includes semaglutide (Ozempic, Wegovy) – to help her maintain her weight.

How Doctors and Patients Can Get Better Results Together

For heavier people who don’t have access to a multidisciplinary, patient-focused weight center – and doctors who don’t provide those specialized services – there are still ways everyone can achieve better treatment results.

For doctors: You’re seeing patients with obesity, but do those patients feel “seen”? Is your practice set up to accept and accommodate heavier patients? McClellan suggests looking at areas you may not have thought about previously, such as gowns that fit larger bodies, larger chairs in the waiting room, and scales with higher weight limits.

Education is key, said Maria Daniela Hurtado Andrade, MD, PhD, an obesity medicine doctor at the Mayo Clinic in Jacksonville, FL. Hurtado Andrade pointed out that new therapies are being developed to manage weight loss, and some (like semaglutide) have already been used for years to treat diabetes. “While some providers are willing to start using these medications, it is not enough,” she said. Remember: “We should be treating obesity as any other chronic disease, just like high blood pressure or diabetes.”

For patients: Check online for lists of “weight-neutral” or “size-friendly” providers endorsed by other larger-bodied patients. Lists like these are places where patients can add the names and information of providers they’ve had positive experiences with.

Ask questions and advocate for yourself, McLellan urges, even if you’re not comfortable doing so. “Am I going to be given a sheet or a gown that fits my body? Are they using a blood pressure cuff with the correct size? Are they taking your blood pressure the minute you’re hurried back to a room?” (According to the CDC, a patient must be seated with their back supported for at least 5 minutes with their feet flat on the ground in order to get an accurate blood pressure reading.)

But what’s made the biggest difference for her is being clear with doctors and nurses about how she’s feeling in the moment, and how her previous experiences in health care have contributed to that.

Since incorporating these strategies, McLellan said she has finally been able to receive the care she deserves from a compassionate provider.

“I told [my doctor], ‘I want to be healthy,’” she recalled. “And we went through my lab results together. I had done a full blood panel, and he scooted his chair toward me and looked me straight in the eye and said, ‘You are healthy.’”

 

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What’s the greatest holiday gift: lips, hair, skin? Give the gift of great skin this holiday season

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Give the gift of great skin this holiday season

Skinstitut Holiday Gift Kits take the stress out of gifting

Toronto, October 31, 2024 – Beauty gifts are at the top of holiday wish lists this year, and Laser Clinics Canada, a leader in advanced beauty treatments and skincare, is taking the pressure out of seasonal shopping. Today, Laser Clincs Canada announces the arrival of its 2024 Holiday Gift Kits, courtesy of Skinstitut, the exclusive skincare line of Laser Clinics Group.

In time for the busy shopping season, the limited-edition Holiday Gifts Kits are available in Laser Clinics locations in the GTA and Ottawa. Clinics are conveniently located in popular shopping centers, including Hillcrest Mall, Square One, CF Sherway Gardens, Scarborough Town Centre, Rideau Centre, Union Station and CF Markville. These limited-edition Kits are available on a first come, first served basis.

“These kits combine our best-selling products, bundled to address the most relevant skin concerns we’re seeing among our clients,” says Christina Ho, Senior Brand & LAM Manager at Laser Clinics Canada. “With several price points available, the kits offer excellent value and suit a variety of gift-giving needs, from those new to cosmeceuticals to those looking to level up their skincare routine. What’s more, these kits are priced with a savings of up to 33 per cent so gift givers can save during the holiday season.

There are two kits to select from, each designed to address key skin concerns and each with a unique theme — Brightening Basics and Hydration Heroes.

Brightening Basics is a mix of everyday essentials for glowing skin for all skin types. The bundle comes in a sleek pink, reusable case and includes three full-sized products: 200ml gentle cleanser, 50ml Moisture Defence (normal skin) and 30ml1% Hyaluronic Complex Serum. The Brightening Basics kit is available at $129, a saving of 33 per cent.

Hydration Heroes is a mix of hydration essentials and active heroes that cater to a wide variety of clients. A perfect stocking stuffer, this bundle includes four deluxe products: Moisture 15 15 ml Defence for normal skin, 10 ml 1% Hyaluronic Complex Serum, 10 ml Retinol Serum and 50 ml Expert Squalane Cleansing Oil. The kit retails at $59.

In addition to the 2024 Holiday Gifts Kits, gift givers can easily add a Laser Clinic Canada gift card to the mix. Offering flexibility, recipients can choose from a wide range of treatments offered by Laser Clinics Canada, or they can expand their collection of exclusive Skinstitut products.

 

Brightening Basics 2024 Holiday Gift Kit by Skinstitut, available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.

Hydration Heroes 2024 Holiday Gift Kit by Skinstitut – available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.

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Here is how to prepare your online accounts for when you die

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LONDON (AP) — Most people have accumulated a pile of data — selfies, emails, videos and more — on their social media and digital accounts over their lifetimes. What happens to it when we die?

It’s wise to draft a will spelling out who inherits your physical assets after you’re gone, but don’t forget to take care of your digital estate too. Friends and family might treasure files and posts you’ve left behind, but they could get lost in digital purgatory after you pass away unless you take some simple steps.

Here’s how you can prepare your digital life for your survivors:

Apple

The iPhone maker lets you nominate a “ legacy contact ” who can access your Apple account’s data after you die. The company says it’s a secure way to give trusted people access to photos, files and messages. To set it up you’ll need an Apple device with a fairly recent operating system — iPhones and iPads need iOS or iPadOS 15.2 and MacBooks needs macOS Monterey 12.1.

For iPhones, go to settings, tap Sign-in & Security and then Legacy Contact. You can name one or more people, and they don’t need an Apple ID or device.

You’ll have to share an access key with your contact. It can be a digital version sent electronically, or you can print a copy or save it as a screenshot or PDF.

Take note that there are some types of files you won’t be able to pass on — including digital rights-protected music, movies and passwords stored in Apple’s password manager. Legacy contacts can only access a deceased user’s account for three years before Apple deletes the account.

Google

Google takes a different approach with its Inactive Account Manager, which allows you to share your data with someone if it notices that you’ve stopped using your account.

When setting it up, you need to decide how long Google should wait — from three to 18 months — before considering your account inactive. Once that time is up, Google can notify up to 10 people.

You can write a message informing them you’ve stopped using the account, and, optionally, include a link to download your data. You can choose what types of data they can access — including emails, photos, calendar entries and YouTube videos.

There’s also an option to automatically delete your account after three months of inactivity, so your contacts will have to download any data before that deadline.

Facebook and Instagram

Some social media platforms can preserve accounts for people who have died so that friends and family can honor their memories.

When users of Facebook or Instagram die, parent company Meta says it can memorialize the account if it gets a “valid request” from a friend or family member. Requests can be submitted through an online form.

The social media company strongly recommends Facebook users add a legacy contact to look after their memorial accounts. Legacy contacts can do things like respond to new friend requests and update pinned posts, but they can’t read private messages or remove or alter previous posts. You can only choose one person, who also has to have a Facebook account.

You can also ask Facebook or Instagram to delete a deceased user’s account if you’re a close family member or an executor. You’ll need to send in documents like a death certificate.

TikTok

The video-sharing platform says that if a user has died, people can submit a request to memorialize the account through the settings menu. Go to the Report a Problem section, then Account and profile, then Manage account, where you can report a deceased user.

Once an account has been memorialized, it will be labeled “Remembering.” No one will be able to log into the account, which prevents anyone from editing the profile or using the account to post new content or send messages.

X

It’s not possible to nominate a legacy contact on Elon Musk’s social media site. But family members or an authorized person can submit a request to deactivate a deceased user’s account.

Passwords

Besides the major online services, you’ll probably have dozens if not hundreds of other digital accounts that your survivors might need to access. You could just write all your login credentials down in a notebook and put it somewhere safe. But making a physical copy presents its own vulnerabilities. What if you lose track of it? What if someone finds it?

Instead, consider a password manager that has an emergency access feature. Password managers are digital vaults that you can use to store all your credentials. Some, like Keeper,Bitwarden and NordPass, allow users to nominate one or more trusted contacts who can access their keys in case of an emergency such as a death.

But there are a few catches: Those contacts also need to use the same password manager and you might have to pay for the service.

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Is there a tech challenge you need help figuring out? Write to us at onetechtip@ap.org with your questions.

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Pediatric group says doctors should regularly screen kids for reading difficulties

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The Canadian Paediatric Society says doctors should regularly screen children for reading difficulties and dyslexia, calling low literacy a “serious public health concern” that can increase the risk of other problems including anxiety, low self-esteem and behavioural issues, with lifelong consequences.

New guidance issued Wednesday says family doctors, nurses, pediatricians and other medical professionals who care for school-aged kids are in a unique position to help struggling readers access educational and specialty supports, noting that identifying problems early couldhelp kids sooner — when it’s more effective — as well as reveal other possible learning or developmental issues.

The 10 recommendations include regular screening for kids aged four to seven, especially if they belong to groups at higher risk of low literacy, including newcomers to Canada, racialized Canadians and Indigenous Peoples. The society says this can be done in a two-to-three-minute office-based assessment.

Other tips encourage doctors to look for conditions often seen among poor readers such as attention-deficit hyperactivity disorder; to advocate for early literacy training for pediatric and family medicine residents; to liaise with schools on behalf of families seeking help; and to push provincial and territorial education ministries to integrate evidence-based phonics instruction into curriculums, starting in kindergarten.

Dr. Scott McLeod, one of the authors and chair of the society’s mental health and developmental disabilities committee, said a key goal is to catch kids who may be falling through the cracks and to better connect families to resources, including quicker targeted help from schools.

“Collaboration in this area is so key because we need to move away from the silos of: everything educational must exist within the educational portfolio,” McLeod said in an interview from Calgary, where he is a developmental pediatrician at Alberta Children’s Hospital.

“Reading, yes, it’s education, but it’s also health because we know that literacy impacts health. So I think that a statement like this opens the window to say: Yes, parents can come to their health-care provider to get advice, get recommendations, hopefully start a collaboration with school teachers.”

McLeod noted that pediatricians already look for signs of low literacy in young children by way of a commonly used tool known as the Rourke Baby Record, which offers a checklist of key topics, such as nutrition and developmental benchmarks, to cover in a well-child appointment.

But he said questions about reading could be “a standing item” in checkups and he hoped the society’s statement to medical professionals who care for children “enhances their confidence in being a strong advocate for the child” while spurring partnerships with others involved in a child’s life such as teachers and psychologists.

The guidance said pediatricians also play a key role in detecting and monitoring conditions that often coexist with difficulty reading such as attention-deficit hyperactivity disorder, but McLeod noted that getting such specific diagnoses typically involves a referral to a specialist, during which time a child continues to struggle.

He also acknowledged that some schools can be slow to act without a specific diagnosis from a specialist, and even then a child may end up on a wait list for school interventions.

“Evidence-based reading instruction shouldn’t have to wait for some of that access to specialized assessments to occur,” he said.

“My hope is that (by) having an existing statement or document written by the Canadian Paediatric Society … we’re able to skip a few steps or have some of the early interventions present,” he said.

McLeod added that obtaining specific assessments from medical specialists is “definitely beneficial and advantageous” to know where a child is at, “but having that sort of clear, thorough assessment shouldn’t be a barrier to intervention starting.”

McLeod said the society was partly spurred to act by 2022’s “Right to Read Inquiry Report” from the Ontario Human Rights Commission, which made 157 recommendations to address inequities related to reading instruction in that province.

He called the new guidelines “a big reminder” to pediatric providers, family doctors, school teachers and psychologists of the importance of literacy.

“Early identification of reading difficulty can truly change the trajectory of a child’s life.”

This report by The Canadian Press was first published Oct. 23, 2024.

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