Too fat?

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aesposito

Idiot paramedic premed
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The question came up in a conversation with another med school hopeful the other day....

She weighs rather a lot (I've never asked, but I'd guess 300+) and like me is an older non-trad person.

We were wondering a) does obesity affect your interview success and b) does it affect your med school success.

Her fear is that someone would ask her about it in the interview or that instructors would look at her differently... I'm no expert, but I'd say that in her case, it probably wouldn't affect her ability to become a doctor as she is rather healthy otherwise (relatively speaking of course, I know obesity can kill you).

A
 
Years ago medical schools came under fire for screening for fitness. If you walk around most medical schools you won't see that many 300+ lbs people (especially relative to the general population). I can't speak for success in medical school, but it may impact her during interviews even though, technically, it isn't supposed to.

The question came up in a conversation with another med school hopeful the other day....

She weighs rather a lot (I've never asked, but I'd guess 300+) and like me is an older non-trad person.

We were wondering a) does obesity affect your interview success and b) does it affect your med school success.
 
Depends on the person, but as someone who interviewed for graduate school (not medical school) at 200 lbs. (I am 4'11"), my personality was different and I did feel like I was snubbed by certain professors because of my weight. The professor was actively seeking people who were not only interested in a certain kind of research, but would also be willing to participate in a group run at the end of the each day. Naturally, the professor ignored me and asked the skinny people around me at the table if they were runners and eventually I left to talk to other people.

Obviously, ymmv.
 
Discrimination against overweight people is never on paper, but it will always be around.
 
As far as the admissions process, it shouldn't. At least, I'd hope so. However, the question that might be on the interviewer's mind - and this ties into your second part of the question - will be will this person be able to handle the rigors of rotations/internship/residency?

Besides walking and being on your feet for long shifts, what would happen if your friend was called to a code blue or some other emergency, or was paged in the middle of the night for a patient who might be crashing? Would she be able to run to the trauma and assist without being completely out of breath or feeling faint?

I mean, I don't want to sound harsh or rude, but that would be the first thing I thought about when interviewing her. Not only is the weight an issue, but it's also compounded by age. Honestly, internship and residency would depend on what specialty she goes into - she could always pick an easier specialty - but she can't pick and choose her rotations.
 
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Discrimination against overweight people is never on paper, but it will always be around.

100% truth.

Just like we favor attractive people or listen to authoritative people.

Many things aren't on paper and people won't talk about them, but they are as real as the blood pumping through your veins.

Just reality.
 
100% truth.

Just like we favor attractive people or listen to authoritative people.

Many things aren't on paper and people won't talk about them, but they are as real as the blood pumping through your veins.

Just reality.

The school may also wonder if she would be able to counsel patients as a physician on obesity and hypertension issues if she herself were obese. Obesity is a huge problem in this country, and it contributes to a huge amount of health risks. As a physician, part of her job (if she went into obviously applicable specialties) may be to counsel on nutrition, diabetes risk, obesity problems i.e. excessive hormone production, immune issues, cortisol etc, hypertension, cardiovascular effects and so on and on. How would she manage these issues if she herself were in the risk factor category? Would the patient even listen to a doctor who was obviously not listening to herself?

I think that these are valid issues, and I don't think the "no discrimination based on weight" argument would necessarily work here, because I think that being a physician holds responsibilities. And yes, you could always say that that means to give advice but not necessarily resemble said advice, but if you did that - how on earth could you expect your patients to take you seriously? And unlike a physician who smokes where your patients may not know that you do that behind closed doors - you can't hide obesity and nutritional problems.
 
We were wondering a) does obesity affect your interview success and b) does it affect your med school success.

A

Yes and yes. It would effect the interview success precisely because it effects med school success. Obviously that's acencdotal; I can't find any relevant scholarly work on how current obesity effects professional school success, only the effects of childhood obesity. But all things being equal except for physical fitness (for which obesity makes a strong if imperfect proxy,) more physically fit students would have to have an advantage based on the physical and mental stress that the process places on medical students. It's not exactly fair, but program directors and admissions committees have a strong stake in filling slots with applicants with the greatest chance for success. There are so many applicants these days with good GPA/MCAT/EC's that these marginal issues have to be considered (insert arguments here on the effect of being a married woman of child-bearing age and it's effect on the match process.)
 
My blood pressure is pre-hypertensive for my age. I'm not totally over weight at 6'1 and 220 pounds for a male. However, after seeing patients with diabetes, daily dialysis, morbidly obese patients, chf, cad, etc., I've made a decision to drop down under 200 pounds. I'm getting more aerobic exercise and getting my diet under control as well. Besides the obvious health benefits, it'll give me a box to check off under activities on my applications.

I personally can't see how someone can be confronted with the downfalls of smoking, drinking, and over-eating on a daily basis and continue to live that way. I'm sure that someone in admissions would feel the same way, whether they are willing to openly admit it or not is a whole other story.

As far as the necessity of being physically fit to be a doctor, that all depends on your speciality I suppose.
 
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Besides walking and being on your feet for long shifts, what would happen if your friend was called to a code blue or some other emergency, or was paged in the middle of the night for a patient who might be crashing? Would she be able to run to the trauma and assist without being completely out of breath or feeling faint?

That was kinda my thought... she's a medic like me, the difference being she still works in the field.... I figured if she could still work on an ambulance she could still work in a hospital, but that doesn't mean it will be comfortable for her....

On the other hand, I never asked if she was interested in emergency medicine, just assumed. I suppose there are more kinds of medicine friendly to larger people than others.

A
 
OP, This is a good question and one I think about often. I can't answer the 2nd question but can answer the first one.

I am obese and I can totally see that someone would think I did not have the endurance for medicine or would question how seriously patients would take me. Also, there is tons of social psychology research that shows that people make snap judgments about people based on attractiveness (and unfortunately, in our culture, fat is not considered attractive).

Let me say that I have lost 57 pounds but still have a good way to go. I exercise for 40-90 minutes every day and am seeing a dietician and watching what I eat. Let me tell you this is way more exercise than most people, even most thin people, get! I was planning on bringing up my weight proactively in the interview and discussing what I have done and am doing to change it. I was going to try to spin it into a positive. Who better to counsel the growing population of obese patients than someone who has been there? Of course I hope to one day be down to a normal weight and to be able to show patients a "before" photo and show them I know it is not a simple thing but yet it can be done. In the meantime, guess what? I notice more and more obese physicians. They are no more exempt from the lack of exercise and stress that is contributing to extra weight in the rest of the population. Frankly, as an obese patient I am a little more comfortable around obese physicians because I know they will not lecture me and tell me it is "easy" and I "just need to exercise more and eat less." (Pretty soon someone is going to jump on this thread and start saying the obese just need to eat less and we all lack willpower and are lazy, just watch.)

I was only invited to one interview (not due to my weight but my crummy MCAT score 😛) and worried about what would happen in my interview. Would the interviewer(s) have a conscious or unconscious bias against obese applicants? All I can say is that at my interview, both of the interviewers were obese. So, I guess it ended up not being so much of a factor. It also ended up being a group interview and we were given specific questions so I never could bring up my weight and what I was doing to change it. I ended up getting accepted so it certainly isn't impossible to get accepted if you are obese.

I will say that I feel tremendous pressure to lose the rest of the weight. I feel awkward saying I am going to medical school at my current weight. I really do feel as a health care professional I have a responsibility to set a healthy example for my patients. I am working at it and it will take time.

Could your friend face some bias at med school interviews? I believe that is entirely possible. I doubt an interviewer would bring up an applicant's weight directly, though. I believe that at interviews it would be possible to bring it up proactively, show you are not defensive about it, and addressing it. Explain how it will benefit your future patients to have a provider who has some weight loss background. That being said, I also feel that we need to be role models for our patients and have a responsiblity to lose the weight in our role as health care providers. At the same time, I realize that obesity is a complex medical condition and I would never tell anyone it is "easy" to fix.
 
The school may also wonder if she would be able to counsel patients as a physician on obesity and hypertension issues if she herself were obese. Obesity is a huge problem in this country, and it contributes to a huge amount of health risks. As a physician, part of her job (if she went into obviously applicable specialties) may be to counsel on nutrition, diabetes risk, obesity problems i.e. excessive hormone production, immune issues, cortisol etc, hypertension, cardiovascular effects and so on and on. How would she manage these issues if she herself were in the risk factor category? Would the patient even listen to a doctor who was obviously not listening to herself?


The interesting thing about this though is that obese patients might be more comfortable just going and seeing a physician they feel won't judge them. My mom is extremely overweight and it takes forever to get her to go in for anything because she's afraid of being having all of the focus be on her needing to lose weight instead of whatever she goes in for. That has happened to her in the past. She knows what she needs to do and has been working on it and when you get to that weight it is a constant challenge. I think she'd feel more comfortable with someone else who could appreciate that challenge. She'd be more likely to be seen regulary by someone she isn't worried will judge her or treat her poorly.

Obviously you do run the risk of being thought a hypocrite telling your patients to do one thing and when you obviously aren't yourself. I do think it'll be a liabilty in this process.

There was an interesting piece in the JAMA in the "A piece of my mind" section on the issue of being an overweight physician trying to counsel an overweight patient. I don't have access to the JAMA from here, but I can try to track it down later.
 
Last year one of the books we were assigned in med school was a collection of essays by students on their med school experiences. One was by a student who is obese. She said she got a lot of negative attitudes, cutting remarks and hostile stares, both from fellow students and faculty. She said that even though she was quite healthy apart from her weight, people tended to assume that she was unable to handle the physical demands of med school. When she did have any kind of health issue, her doctors tended to assume it was due to her weight, rather than considering some other cause.

Another observation this student made rang very true in my experience: there were practically no fat people besides her in her med school class. In my class, the biggest person is about a size 16, and she stands out.

I am quite sure your friend will encounter significant discrimination in the application process. I doubt this will be of the conscious variety, but I'm sure that interviewers will view her more negatively because of her weight. I think it would be very wise for her to lose some weight before interviews--but unlike FuturePittMed, I don't think it would be a good idea to bring this up proactively in interviews. It seems too much like an apology for being overweight, which I don't think is something anyone should have to apologize for. You can work into the conversation that you've been working hard to improve your physical fitness, but I wouldn't talk about weight per se.
 
but unlike FuturePittMed, I don't think it would be a good idea to bring this up proactively in interviews. It seems too much like an apology for being overweight, which I don't think is something anyone should have to apologize for. You can work into the conversation that you've been working hard to improve your physical fitness, but I wouldn't talk about weight per se.


I worried that the interviewers would think I was "okay" with my weight and not doing anything about it if it never ended up being discussed. I thought that would be worse than addressing the issue head on. It possibly could be risky and taken the wrong way and would need to be carefully handled. Your point is well taken, student1799.
 
She said that even though she was quite healthy apart from her weight...
When she did have any kind of health issue, her doctors tended to assume it was due to her weight...

I'm sure that the irony of making these two statements while being at medical school, actively learning the physiologic and pathologic impacts of obesity and it's role in differential diagnosis, was lost on the essay writer.

Man, as soon as I saw this thread I knew it would start racking up those post counts...
 
Fat discrimination is one of the strongest and most prevalent prejudices around today. Yes, it is likely to affect her interview chances, as well as her clinical rotation evaluations. As far as her performance goes, I'm guessing that the physically demanding rotations like surgery or IM would be pretty hard at 300+.

Personally I think the crap about overweight physicians not being fit to educate patients on the risks of obesity etc is complete BS. Weight is a completely superficial way to judge health, and just because someone looks like they are a healthy size doesn't mean they don't smoke, eat like crap, get very little sleep or spend most days highly stressed. Oh, wait, those habits describe most residents, many medical students, and plenty of practicing physicians.
 
Let me say that I have lost 57 pounds but still have a good way to go. I exercise for 40-90 minutes every day and am seeing a dietician and watching what I eat. Let me tell you this is way more exercise than most people, even most thin people, get! I was planning on bringing up my weight proactively in the interview and discussing what I have done and am doing to change it. I was going to try to spin it into a positive. Who better to counsel the growing population of obese patients than someone who has been there? Of course I hope to one day be down to a normal weight and to be able to show patients a "before" photo and show them I know it is not a simple thing but yet it can be done. In the meantime, guess what? I notice more and more obese physicians. They are no more exempt from the lack of exercise and stress that is contributing to extra weight in the rest of the population. Frankly, as an obese patient I am a little more comfortable around obese physicians because I know they will not lecture me and tell me it is "easy" and I "just need to exercise more and eat less." (Pretty soon someone is going to jump on this thread and start saying the obese just need to eat less and we all lack willpower and are lazy, just watch.)

Congrats on your success (both in the weight loss and the interview) - I think your spin is a great idea. I'd find it compelling. Good luck taking off the rest. 🙂:luck::luck:
 
I'm sure that the irony of making these two statements while being at medical school, actively learning the physiologic and pathologic impacts of obesity and it's role in differential diagnosis, was lost on the essay writer.

Man, as soon as I saw this thread I knew it would start racking up those post counts...

I think you're not being quite fair here. Granted, you haven't seen the whole essay, but it gives further details that (assuming they are accurate) suggest that she has a point.

Re "healthy apart from her weight," the author says her blood pressure, lipids and blood sugar are completely normal. That does sound pretty healthy to me. She claims to exercise every day (swims laps in a pool).

As to the "attributing all health problems to her weight," she gives a specific anecdote. She had some kind of orthopedic problem with her foot or knee, but when she visited her doctor he didn't do a full exam or take a proper history. He just said, "Lose weight," then flung her chart into the rack on the door and walked out. Personally, I think that's one ****y H&P, and if it happened to me, I'd have wanted to punch the guy out.

Sure, being overweight doesn't help things, but there are all sorts of problems that can occur--and can be successfully treated--regardless of your weight. For instance, plantar fasciitis: overweight people get it, but so do people of normal weight. (I have it myself.) Don't you think a patient is entitled to better treatment options than "lose weight"? (which, incidentally, will not cure the condition).
 
Wow I didn't realize my little question would be such a big topic of discussion! I'm glad though, it gives me something to work with if I discuss it with her again.... and it appears it's helping others work out the issue as well...

A
 
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The context changes things. Makes my "irony" comment a little less snappy for sure. I can't defend the actions of those involved in those instances and won't try. She was entitled to a medical opinion, and not giving her one was simple neglect. But by the same token, suppose that you control for bp, lipids and blood sugars, are those who are clinically obese "healthy?" I probably had my mind wrapped around the OP's friend, who he claims is +300 lbs. There is no female under seven foot tall who is at a healthy weight at +300 lbs, regardless of what her most basic of labs would say. Her labs might be perfectly normal, but being obese is not what I would consider "healthy." It's a game of actuarial numbers, ones that I feel program directors take into account when they are trying to fill medical training slots with the slate of applicants that maximizes overall success, however they define "success" for their program. That's all I'm getting at. It's the same reason why I would, if offering him my advice, tell the poster elsewhere on here who is asking whether he should make a point of alerting programs to his CF that that might not be a great idea. He might be the healthiest CF patient on earth, but I think human nature will dictate that it would be hard for adcoms to ignore the chances of him not being successful in his training for any number of reasons. Maybe I'm just being cynical. I've been called worse.

I think you're not being quite fair here. Granted, you haven't seen the whole essay, but it gives further details that (assuming they are accurate) suggest that she has a point.

Re "healthy apart from her weight," the author says her blood pressure, lipids and blood sugar are completely normal. That does sound pretty healthy to me. She claims to exercise every day (swims laps in a pool).

As to the "attributing all health problems to her weight," she gives a specific anecdote. She had some kind of orthopedic problem with her foot or knee, but when she visited her doctor he didn't do a full exam or take a proper history. He just said, "Lose weight," then flung her chart into the rack on the door and walked out. Personally, I think that's one ****y H&P, and if it happened to me, I'd have wanted to punch the guy out.

Sure, being overweight doesn't help things, but there are all sorts of problems that can occur--and can be successfully treated--regardless of your weight. For instance, plantar fasciitis: overweight people get it, but so do people of normal weight. (I have it myself.) Don't you think a patient is entitled to better treatment options than "lose weight"? (which, incidentally, will not cure the condition).
 
a) does obesity affect your interview success
No idea. It's not like we have any controlled trials where people apply to med school twice, once while obese and a second time while svelte. But as others have already pointed out, as a society, we do have a bias against ugly people, and obesity is considered ugly by the majority of people in this society. So it's certainly possible.

b) does it affect your med school success.
My guess is that it has very little effect on the first two years, where you're basically being evaluated by how well you memorize material. On the wards....well, again, same as above.

Her fear is that someone would ask her about it in the interview
I think this is unlikely. At any rate, I've never heard of it happening.

or that instructors would look at her differently
Well, physicians are party to the same biases as anyone else, so sure, this is entirely possible. There's a second source of prejudice against the obese that is particular to health care providers though, because morbidly obese patients tend to be among the least desirable patients to care for. Any unpleasant procedure (ex. pelvic exams, inserting a urinary catheter, rectal exam, etc.) is doubly unpleasant when you have to perform it on a patient who is morbidly obese. Even relatively "easy" procedures like phlebotomy or eliciting deep tendon reflexes can become a difficult task if the patient is obese enough. My experience is that it's very common for health care providers (nurses as well as physicians) to feel a little dismayed by walking into a room and seeing an extremely obese patient sitting in there. It's just harder all around to care for them.

Another observation this student made rang very true in my experience: there were practically no fat people besides her in her med school class. In my class, the biggest person is about a size 16, and she stands out.
I think there is quite a bit of self-selection going on here though. You don't see many morbidly obese applicants, either.

Premeds tend to be more similar to one another than they are different in many ways besides their weight. I mean, there aren't very many med students who are in wheel chairs, even though, unlike the obese, it is illegal for the adcom to discriminate against them if they are capable of performing their duties with reasonable accommodations. But the reason we have so few med students in wheel chairs is because so few applicants in wheel chairs apply, not because we're discriminating against them.

It's not exactly fair, but program directors and admissions committees have a strong stake in filling slots with applicants with the greatest chance for success. There are so many applicants these days with good GPA/MCAT/EC's that these marginal issues have to be considered (insert arguments here on the effect of being a married woman of child-bearing age and it's effect on the match process.)
I'm not saying it couldn't happen, but I've been a student adcom for three years now, and I have never heard of an adcom not wanting to admit an applicant because the applicant was obese, even with the obese not being a legally protected group. Interestingly, at one meeting there *was* an adcom who expressed reservations about admitting a candidate with a PhD because they felt this candidate might have trouble fitting in with the younger applicants. Naturally, this view was not terribly popular with yours truly. :d
 
Premeds tend to be more similar to one another than they are different in many ways besides their weight. I mean, there aren't very many med students who are in wheel chairs, even though, unlike the obese, it is illegal for the adcom to discriminate against them if they are capable of performing their duties with reasonable accommodations. But the reason we have so few med students in wheel chairs is because so few applicants in wheel chairs apply, not because we're discriminating against them.

Wheelie applicants unite! ...wait, where's my wheelchair smiley?! This is the closest I could find 🤣
 
1) Most definitely. There are tons of behavioral psych studies showing how weight is used in our decision making and in judging others, and even in assigning wages. Don't think ADCOM members or doctors in general are immune to their inherent human biases.

2) While morbid obesity doesn't necessarily indicate a confidence or self esteem issue, I think your friend may suffer from one if she is considering the weight issue as an important thing to brush up on for an interview. Or maybe she is just an anal pre med gauging all possible questions.

3) It has already been said how her weight may compromise her ability to be a competent doc. I won't add further

4) Personal anecdote one: Weight won't be a significant determining factor. The chief resident in RADONC where I shadowed is somewhere between obese and morbidly obese.

5) Personal anecdote two: I saw an MD being treated today who was 300+ lbs, and multiple docs were commenting on how depressing his life was. Granted, he did lead a depressing life, but the weight was stressed more than it should have been, indicating how docs aren't immune to our behavioral biases.

Personally, I think there is a big difference between being morbidly obese and being a bit heavy as far as admissions should be concerned. But with the health risks, and the compromised physical abilities, of morbidly obese people, I would hope that ADCOMs do discriminate against people as heavy as your friend. They are rationing a scarce resource and need to take the most capable students, not just for now, but for the future.

I know BMI sucks but if your friend is 300 lbs and the average female height (5"4), her BMI is over 50 and she'll on average die 10 years earlier than average, and be at increased risk for all sorts of problems.
 
Who better to counsel the growing population of obese patients than someone who has been there?
...
That being said, I also feel that we need to be role models for our patients and have a responsiblity to lose the weight in our role as health care providers. At the same time, I realize that obesity is a complex medical condition and I would never tell anyone it is "easy" to fix.

I definitely agree with you on this. 👍

I'd also like to bring up the point that even if an overweight physician does not lose enough weight to be in the "healthy" range, as long as they take care of their nutrition and get regular exercise, they would be healthier than a skinny person who does not exercise or take care of their nutrition.
 
I sure think it would be hard to get past the obesity, just for some very logistical issues:
1. Chances are someone who is obese may have significant difficulties bustin' their rump to a code or running a code for that matter. I had a super obese teacher that huffed and puffed through the entire lecture...good thing she was a pharmacist and not a physician.
2. I would probably have bias simply because a lot of times rounds can get crowded with a bunch of students...sometimes it's hard to move even past skinny little nurses to get around the patient's bed.
3. If someone thinks that an obese individual may die 10 years earlier, they might also treat that person as 10 years older (meaning that their overall impact as a physician might be lessened if they practice for 10 years less than a similar "healthy" applicant.

But I totally agree with the above post...wouldn't that be a killer EC line on your AMCAS? Lost 100 lbs. That right there proves the ability to undergo mental and physical sacrifice. I should balloon up right now just so that I can lost 100! err....
 
But I totally agree with the above post...wouldn't that be a killer EC line on your AMCAS? Lost 100 lbs. That right there proves the ability to undergo mental and physical sacrifice. I should balloon up right now just so that I can lost 100! err....

Easy to put on the pounds but an absolute B**ch to get them off.

I'm doing lots of this:
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