Monthly Archives: April 2013

Apr 29

Entry #12: Change <= it’s not that easy

Topic:  attitudes applied to health

The New York Times Article “Overweight Patients Face Bias,” highlights a study that suggests that thin patients are treated more warmly and more emphatically than patients who are overweight or obese1.

The study, conducted by researchers at John Hopkins, reviewed recorded discussions between primary care doctors and 200+ patients with high blood pressure. Most of the patients there to talk about blood pressure fell into the category of overweight or obese. Twenty-eight subjects were of normal weight (having a BMI of less than 25).

While all patients were treated in about the same manner, a striking difference was observed when the researchers reviewed the transcripts of the visits. As the article posits, “Doctors seemed just a bit nicer to their normal-wight patients, showing more empathy and warmth in their conversations.”

“It’s not like the physicians were being overtly negative or harsh,” asserts author Dr. Kimberly A. Gudzune,” they were just not engaging patients in that rapport-building or making that emotional connection with the patient.”

When conversing with normal weight patients, doctors commented with concern. As an example, the article cites a case where a “patient lamented a scar on her leg after surgery and the ugly shoes she was forced to wear.” The doctor replied saying “You went through a lot. You still got great legs. Chunky shoes are in. Get something pretty, something for spring. That always makes you feel good.”

These expressions of empathy were absent in conversations with overweight and obese patients.

While the statements themselves are not remarkable, studies have shown that patients are more likely to “follow a doctor’s advice and to have a better health outcome when they believe their doctors empathizes with their plight.”

Overweight patients, furthermore, often feel that the doctor doesn’t help and, in fact, insults them by reminding and attributing all of their issues to their weight, which makes these patients less willing to visit the doctor.

Dr. Katz admonishes, “doctors often show the same biases and prejudices as the culture at large. The problem may be compounded by the fact that doctors are trained to deal with immediate medical problems that have specific solution, like a pill to lower blood pressure or emergency treatment for a heart attack. But obesity is a far more complex problem that isn’t easy to solve, and that can be frustrating to doctors.

The solution? Dr. Katz recommends training medical students and doctors to understand the complex nature of obesity as well as their own (perhaps subconscious) biases…”

I found this article particularly interesting because it demonstrates how studying attitudes (and, more specifically, biases) is relevant to health care.

An attitude is the relationship between an object and the evaluation of that object (ie. person, issue, object). In the article we see a few general attitudes. 1) In general, doctors are insensitive to individuals who are obese (attitude of the patient). 2) In general, most of an obese patients health issues are weight related, and these patients should be advised to lose weight (attitude of doctor). These attitudes, aside from being overly simplified, also point to deeper, more problematic issues: obese patients are less likely to visit the doctor, & doctors treat obese patients less compassionately (even though they may not be conscious of doing so).

While it might be easier to train medical students and doctors to revisit compassion for all patents (regardless of health, size, gender. etc), it is harder to change the overall stigma of obesity, and thus difficult to flip attitudes about obesity (not only from doctors, but from society as a whole). Since the bias towards thin patients happens at the subconscious level, a person may not realize that she is treating an obese person any differently than someone of healthy BMI (and if she does recognize that she is treating the individual different, then she may not realize that she is treating the person differently because of his weight — and that may not be the only factor).

On the other side of the coin, it would be particularly difficult to flip attitudes that doctors are insensitive to the plight of the obese as well, because we tend to process information as congruent with our attitudes. Obese patients may be more sensitive to discussion about weight than the average-sized person, even when the doctor is not suggesting that the patient lose weight. While obese individuals might agree that doctors, generally, are useful, and visiting them regularly is good, they might not actually behave in ways that are congruent with their opinions, even when the consequences of not getting regularly checkups is lethal (such as the case where a terminal illness develops, an illness that could be treated if it had been detected earlier).

Thus, research about attitudes is invaluable in bridging the gap between patients and doctors.

1Overweight Patients Face Bias. New York Times. Retrieved April 29, 2013, from: http://well.blogs.nytimes.com/2013/04/29/overweight-patients-face-bias/?hpw

Apr 16

Entry #10: Should Have, Would Have, Could Have

Topic: Diffusion of responsibility, bystander effect

In 1964,  a woman from New York, 18 year-old Catherine (Kitty) Genovese, was raped and stabbed to death near her apartment. The murder, while horrific, was not the focus of the case — it was the response of her neighbors1. Rasenberger reports in his New York Times article “Kitty, 40 Years Later,1” (2004), “As Ms. Genovese screamed — “Please help me! Please help me! — 38 witnesses did nothing to intervene, according to reports; nobody even bothered to call the police. One witness explained himself with the phrase that has passed into infamy: ‘I didn’t want to get involved.’…”

The lack of action by the 38 witnesses to Kitty’s murder stunned many, and spurred much research into why people did or did not help someone clearly in need, and gave rise to the theories of diffusion of responsibility and the bystander effect.

The diffusion of responsibility is a phenomenon where a person is less likely to take responsibility for action or inaction when others are present2. Similarly,  the bystander effect refers to cases where individuals do not offer help to a victim, with the probability of help being inversely related to the number of bystanders (the greater the number of bystanders, the less likely it is that any one of them will help)3.

While it sounds horrific that no one offered Kitty any help, or even bothered to call the police, the lack of action does not reflect the apathetic, or even cold-hearted nature of the witnesses to her murder. No one helped because they assumed someone else would help, someone else would make that emergency phone call. Those witnesses were normal people who were just confused, uncertain, afraid.

The Genovese effect reminds me of an incident that occurred during my Freshman year of high school. It was midday, and I was sitting in a stifling hot classroom, taking notes for my AP modern world history class. The minutes ticked by ever so slowly, the noise of pencils scratching against lined paper creating a buzz in the air, smoothing out the boom of my teacher’s voice as he droned on and on (history is not my favorite subject) about who know’s what.

About halfway through class, one of my peers, Lia, asked to use the restroom. She returned soon thereafter, and I thought nothing of it.

With thirty minutes ’till the bell rang and spelled our freedom for the day, there was a sudden commotion a few desks away from me, where Lia sat. Here eyes rolled back into her head, and she began to froth from the mouth. All noise in the room hushed in an instant.

No one moved, or even breathed too heavily.

Out of nowhere a voice, the teacher’s, broke the silence, “someone help her so she doesn’t hit her head on the floor.”

No one moved, and everyone’s breathing stopped for the few seconds while Lia’s seizure continued, in a slow-motion kind of way.

Soon enough, she slipped out of her seat, and hit her head harshly on the floor.

After what seemed like an eternity, her desk mate moved to help.

And the spell was broken. The room broke out into a buzz, the teacher called the nurses office, and moved in to check on her.

The next day, Lia’s mother came in to apologize for what we had witnessed, and explained that Lia was having trouble with school, and had decided to overdose on painkillers that afternoon, but that she was fine.

What scared me most out of that whole happening wasn’t that a person I knew tried to kill herself, but that no one moved during her entire seizure, and by no one, I mean me. I consider myself a compassionate and caring person; I volunteer every Saturday at my church; yet, in that instant, I couldn’t move, no, I did not move. And I didn’t understand why I didn’t move, when she was only a few desks away from me. All I had to do was stand up and walk three paces to where she was.

It’s hard to know what you would do when put in that kind of situation, or any situation where someone is in obvious distress, but there are so many other people around who could potentially help. You would think that in a room full of 35 students, at least one would move. But no one did. So, the Kitty case holds a special hold over my attention and memory, because I know, first hand, what it’s like to not help, and question why you didn’t.

1Kitty, 40 Years Later. Retrieved April 16, 2013, from http://www.nytimes.com/2004/02/08/nyregion/kitty-40-years-later.html?pagewanted=all&src=pm.

2 Diffusion of responsibility – Wikipedia. Retrieved April 16, 2013, from http://en.wikipedia.org/wiki/Diffusion_of_responsibility#Real-World_Examples.

3 Bystander effect – Wikipedia. Retrieved April 16, 2013, from http://en.wikipedia.org/wiki/Bystander_effect#Kitty_Genovese.

Apr 9

Entry #9: Saying No

Topic: Persuasion, creating groups

In the Summer of 2008,  21 year old model Katie Green was chosen to become the new face of Wonderbra a major brand of brassieres. When she was introduced to the Premier Model Management, who had signed Katie, she was told to lose 2 stone (which is about 28 pounds) and two dress sizes (four inches off her waist), even though she was a UK size 12 (US size 8) at 5ft 11in tall1.

After trying to lose the weight, and making herself ill, she decided to quit modeling. Days after speaking out to a national newspaper, Katie received a call from Ultimo, asking if she would like to model for them.

She did go back into modeling, but also started to do something about industries that tell models they have to be a certain size. She noted in a 2009 press release, that in a survey of 3,000 teenagers, 75% “said they felt they needed to lose weight after looking at pictures of skinny starts such as Kate Moss and Nicole Richie (Lib Dem figures, May 2009). All of the marketing done by fashion designers and clothing brands target impressionable teens, which often leads to feelings of insecurity and eating disorders. So, in collaboration with Liberal Democrat MP Lembit Opik, she started an online petition to try to stop size zero models and models with an unhealthy BMI (a BMI of less than 18.5) from modeling on the catwalk. Their aim was to have a policy that ensured that all models are health checked before doing modeling assignments with reputable and impressionable brands.

This campaign is pretty effective.

But, I came across an article on Hello Giggles that made me realize that campaigns like Say No to Size Zero, are pitting women against women, it is polarizing groups of women, creating in groups and out groups rather than facing the main issue, that beauty shouldn’t be defined by size.

As the author’s posit, “If you’re a ‘curvy girl’ (like me, for example) you might be thinking that this campaign sounds fantastic. I, on the other hand happen to think it’s misguided. This may be an unpopular opinion, but the fact is: If we “Say NO to Size Zero” aren’t we discriminating against skinny chicks? And, if we are, why is that okay?2

The image [below] came alongside the caption: ‘CURVY Katie Green shows off the body that crazy model agencies criticized for being ‘too fat’ as she launches a ‘Say No to Size Zero’ campaign outside parliament today. The size 12 Wonderbra girl lost her contract after a bust-up with her agency over her weight. But days after refusing to lose two stone the 30F lingerie model was snapped up by undies giant Ultimo. Today she looks fabulous posing in her skimpies as she urges other companies to ditch the super skinnies.”

‘Ditch the super skinnies’? That seems ironic to me. If encouraging the modeling industry to use curvier models is about giving a more unbiased representation of what women look like, then why would we need to ‘ditch’ anyone? Why can’t all women’s bodies be appreciated? 

An aspiring model was told she needed to lose weight (not cool)…however, she then landed an awesome job with Ultimo! Fantastic! So, why is she fronting a campaign against skinny girls? In my opinion, it has a lot to do with power. There are models of every body size and shape and it’s a truly wonderful thing, but there is still a lot of Weight Discrimination going on. For some reason a lot of girls think that there has to be a ‘winner’ in the beauty stakes, but I believe beauty is far more than that.

Why on Earth do people think it’s ok to say things like “Curvy Girls Do It Better”? Better than who? What is it we do better exactly? I have friends who are naturally size zero. They don’t like hearing “real women have curves” they are real women. We are all ‘real women’.

Why, when people see the A-listers walking the red carpet at the Oscars, do they feel it’s appropriate to take to twitter and announce:

“Someone give her a sandwich!”

What is that? It certainly isn’t dietary advice. It’s actually none of your business to discuss any other woman’s body in a mocking, unsupportive way and these are often women who champion the rights of curvier women…yet when it comes to criticising a woman for being too thin equality seems to go out of the window.

So, I can assure you, curvy girls don’t do anything ‘better’ but let me also say this: skinny girls don’t do anything better than you, either. Not because of their body shape. There might be girls who can swim better than you, sing better than you, or do math better than you- but I can almost guarantee that it has nothing to do with how much they weigh.

I would be described as a ‘curvy girl’ but campaigns like “Say No To Size Zero” just make me feel plain awkward. That’s still sizeist. Still nasty. And still discrimination- no matter how cutely you package it.

Can we look beyond weight and shape? Love each other, applaud each other and stop judging each other? It creates such division when we hate on each other. Most people I know either hate their own bodies and wish they were skinnier/more toned/more curvy, or spend time judging other people for being a certain way. When someone is happy with their own body, they usually don’t feel the need to belittle someone else’s. It’s usually insecurity that leads people to point out the supposed ‘flaws’ in another person.

The author does a great job highlighting that humans vary greatly in size, and though it is true that modeling agencies tend to use models of a certain size, campaigns should not be aimed at excluding certain sizes from the modeling business (if that is their natural size, there is nothing you can do about it), but rather, promoting a greater range of sizes, and maybe even moving beyond numbers on a scale or a measuring tape as the typical measure of beauty.

1 Katie Green Official.  Retrieved April 9, 2013, from http://www.katiegreenofficial.com/

2 Sayin No to the Say No to Size Zero Campaign. Hello Giggles. Retrieved April 9 2013, from http://hellogiggles.com/saying-no-to-the-say-no-to-size-zero-campaign