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As I write this article, I am on an airplane heading home from New York. There I had the privilege to interact with an approximate 300 incredible human beings who are, were, and/or work with overweight, obese, or morbidly obese people. This was Obesity Help’s third fantastic conference this year. The OH events are dynamic, fun, educational, inspirational, emotional, and uplifting celebrations for those who have chosen to actively deal with their disease of obesity and embark on a lifelong journey of recovery from this chronic, debilitating, and lethal illness. My heart rejoices in the stories of these courageous men and women who have literally lost up to hundreds of pounds and who are doing the work required to maintain a healthy weight. I marvel listening to their stories of leaving behind the physical, social, and emotional pain of their ridiculed, misunderstood, and prejudiced pasts. This is one group of adventurous people who are making the most of their lives in their healthier new bodies, for which they are considerably grateful and for which they have worked incredibly hard.

Six times this year I have presented, in different parts of the country, a continuing education program for medical and mental health professionals who work with the obese population. This includes physicians, nurses, nutritionists, exercise physiologists, and therapists (psychologists, social workers, etc.). Given the fact that a third of the American population is obese (and another third is overweight), it seems fair to assume that most people in the medical and mental health fields encounter patients from this two-thirds of our country’s population in their work on a daily basis. Most of these professionals are required to obtain a certain number of continuing education credits every year. I fully expected to have very large groups in attendance at each of these conferences, as the majority of healthcare and mental health professionals do, indeed, work with obese patients, and have had scarce little training in how to most effectively deal with them. Although the number of participants was low this first year, those who were there provided positive feedback about the program, indicating the need for this information is useful and needed.

I attended a Master’s program in Counseling and a Ph.D. program in Counseling Psychology. I was not taught a single thing about the experience of, or the psychological profile of, the obese population throughout my six years of post-graduate work. I also worked for seven years with medical, nursing, and allied health students at a state medical school. These students similarly receive no, to very little training in understanding how to work effectively with obese patients. But never mind my own experiences. Research clearly indicates that numerous physicians, nurses, and other health care professional feel incompetent and uncomfortable working with obese patients. Additional research indicates that many healthcare professionals have strong negative attitudes and reactions toward the obese and, horrifyingly, continue to describe obese patients as awkward, unattractive, ugly, and noncompliant.

The eight hour continuing education program I present is entitled “Understanding the Obese Patient.? Included in the day’s curriculum are: facts about the complex causes of obesity; education on how to effectively communicate with this population, who has been negatively scrutinized for as long as they have been obese; research on the fact that sugar, in particular, has been shown to be as addictive as illegal drugs of abuse and that many obese people have a psychological, if not physical, addiction to food; and information on the psychological makeup of the obese population. Most importantly, however, attendees are encouraged to return to their jobs with the knowledge, compassion, and understanding that obese patients typically suffer from deep pain associated with childhood, adolescence, and/or adult trauma, abuse, neglect, and discrimination. Food is often used as a coping mechanism for this population. An unhealthy choice to be certain, but one that has protected them from tremendous emotional pain.

Unlike functional alcoholics, drug abusers, gamblers, sex addicts, shop-a-holics, or nicotine addicts (i.e., cigarette smokers) who are able to get by without having their “drug? or soothing behavior on display, the obese patient is unable to hide the shame and pain they carry in their excess pounds. The health care providers clearly see the patient’s obesity. They often ignore it. And sadly, they often criticize and chastise the patient, either overtly to the patient, in their internal dialogue with themselves, or with other “professionals? who share their same ignorance and prejudice against the obese person.

As I was waiting for my flight to New York for the OH Conference/Continuing Education program, I was surprised to receive two emails about the article written by Dr. John Kelly entitled “XXL Patients: Signs That You Should Worry About Performing Surgery on the Supersized.? The first email was from the Obesity Action Coalition (OAC). The OAC is a national non-profit organization dedicated to giving a voice to those affected by obesity. The OAC was formed to build a nationwide coalition of those affected to become active advocates and spread the important message of the need for obesity education. (Please join. Oh, and while I’m at it, please participate with another fantastic organization, Weight Loss Surgical Foundation of America (WLSFA), started by Antonia Namnath!)

The OAC’s Bias Busters campaign brought awareness to the topic of Dr. Kelly’s article. The email I received from them read: “The OAC recently was alerted to an issue of weight bias, and we need your voice and action! An offensive article recently appeared in Outpatient Surgery Magazine_, authored by a physician from the University of Pennsylvania Department of Orthopedic Surgery. In this article, the physician targets individuals affected by presenting 25 derogatory and insulting jokes. In addition, the author also uses insulting language and refers to individuals affected by obesity as “behemoths.? The second email I received in reference to this article was from Tammy Colter, Editor-In-Chief of OH Magazine. By now, I’m pretty sure that most of you reading this article have read Dr. Kelly’s article and many of you have probably written to him, sharing your thoughts with him about his attempts at humor about a not-very-funny subject. (If not, please read it.)

When I got to New York, my “Post Op and A Doc? business partner, Cari De La Cruz, who also assists me in the “Understanding the Obese Patient? continuing education program, greeted me with the same thought I had brewing in my head: “Thank you, Dr. Kelly, for providing the opening to our continuing education program tomorrow.? How could we not? Dr. Kelly had done the very thing we spend a good deal of time discussing: physician’s continued degradation of obese patients. And so we opened the program by reading his article, in its entirety, to the audience. As is always the case, many of the people in the audience not only work with the obese population, but have also suffered from obesity themselves. In fact, the reason I asked Cari to assist me in the continuing education program (besides the fact that she is witty, intelligent, and a word wizard), is that she is an incredible example of a recovering, formerly obese patient who does the hard work each and every day of maintaining her significant weight loss. “I’m twice the woman in half the body,? she eloquently shares. The audience consistently provides positive feedback for having Cari participate in the program. Cari courageously shares her experiences related to the topics we cover, to include the fact that she remains in therapy to address the issues underlying the problems she had with weight. She also shares the voice of many other obese and formerly obese patients with whom she has daily contact through her blog “Bariatric After Life.?

In fact, by the time I got to New York, Cari had already sent an email to Dr. Kelly, which stated, in part, “As someone who works hard to educate medical professionals on positively interacting with obese patients, I will tell you that your article is a textbook example of what ‘not’ to do. As a matter of fact, there’s a good chance it will be added to my PowerPoint presentation tomorrow in New York (just sayin’…). To be fair, I’m pretty sure you wouldn’t say these things to a living, breathing obese patient, but I’m concerned that you even thought it. Unfortunately, our actions usually speak louder than our words, and our behaviors are informed by our beliefs, so you can see the problem: You have inadvertently created the perfect storm for contempt, dissatisfaction, and scorn from your own obese patients.? (Do you see why I refer to her as a word wizard?)

So now, on the way home from the OH Conference, having been invigorated by the people whose lives have been transformed by weight loss, I am reading some of the comments shared by people who have contacted Dr. Kelly. I have no doubt he has gotten the message, loudly and clearly, that he has offended many people in his attempt at humor. The good news is that Dr. Kelly has been acknowledging his behavior and sending personal apologies to many. Impressive!

Rob Portinga (formerfatdudes.com) posted his comments online: “I think we’ve all had situations where we have said something we wished we hadn’t… the proverbial ‘foot in mouth’ scenario. Some of us have a radio audience or the readers of a magazine or newspaper catching us in the act. And others are lucky enough to have only done so in the presence of a small group. If you’re one of the latter and ever tried to stammer out an apology on the spot to a group of say three or four people that heard you say something you regretted the moment it left your lips… well maybe try to imagine what it might be like getting dozens, hundreds, maybe thousands of people calling you to the carpet for something you said. So yeah, in this case… I’m willing to give Dr. Kelly some time. I’m not excusing what he did, I’m not even trying to say anything along the lines of ‘he didn’t really mean it.’ I don’t know him to make such a proclamation. What I am saying is that I believe, given the chance, people can change… and maybe this is our opportunity to give him his chance.?

Following a response from Dr. Kelly to Cari, she wrote back to him: “Dear Dr. Kelly – Thank you for taking the time to write me personally in response to my email (epistle). It earns high marks in my book – especially considering the fact that mine was probably one of A THOUSAND messages, AND you are a busy surgeon. So, thank you. Now, about your article… it was definitely the topic of conversation at the Obesity Help Conference in Long Island this weekend and, yes, Dr. Stapleton (who presents the CEU class) did include it in the course as a discussion opportunity. As you can imagine, people were pretty fired up about it – but (in your defense ;) I told them that you had been kind enough to PROMPTLY reply to my email and apologize for your choice of words. Whether or not that changes anyone’s opinion is out of my control, but I will tell you this: Everyone deserves an opportunity to explain themselves and apologize, if necessary. I do not hold grudges against people who are forthright, honest — and bold! Those are admirable – if not slightly dangerous — qualities. So, thanks again and have a great week. Cari De La Cruz?

Let me tell you what impresses me about the way both Rob and Cari responded to Dr. Kelly. They both did what I hear from obese patients that they want from others: to be treated with dignity, even in confrontation, and to be provided an opportunity to express their side of the story. Rob stated, “I believe, given the chance, people can change… and maybe this is our opportunity to give him his chance.? How awesome is that?! I applaud Rob in the way he held Dr. Kelly accountable for his behavior while offering him the benefit of the doubt. And it is equally true, as stated by Rob, “I think we’ve all had situations where we have said something we wished we hadn’t.? For me personally, I wish it were only a few times that I’ve done that!

The obese patients I work with want the opportunity to be heard and understood. They want others to understand that, although they have responsibility for the foods they chose that contributed to their obesity, there are numerous other factors related to “why? they are or were obese. They want others to realize it is unfair to discriminate against the obese, to be verbally and behaviorally cruel. It is wrong to make false assumptions about the obese based solely on their body size. Obese people want others to take responsibility for their ignorance about the disease of obesity.

I genuinely believe Dr. Kelly was making an attempt to be humorous, as he reportedly dabbles in comedy. Undeniably, his attempt failed. Rather than being in the least bit funny, his remarks were incredibly insensitive and damaging. My hope is that the apologies he is sharing are also genuine and that he is learning lessons that he can put to great use, like helping to inform other medical professionals of the need for compassionate treatment of obese patients. After all, the primary responsibility of physicians, which so many people have reminded Dr. Kelly about, is “_Do no harm.? I’d wager that Dr. Kelly recognizes the harm his words and article have caused. In fact, my understanding is that he has made numerous apologies to individuals and to the bariatric community.

It is tremendous that so many advocates for a better understanding of obesity have responded to Dr. Kelly’s article. I plan on thanking Dr. Kelly for his poor judgment! He has unwittingly brought a great deal of attention to an issue that needs addressing: physicians’ ignorance about obesity and their callous behavior toward the obese. Please note: Just as the majority of obese patients are not “lazy, unmotivated, awkward, unattractive, ugly, and noncompliant,? scores of physicians and other health care providers do implement compassionate care toward the obese, and do provide encouragement and assistance in the patient’s weight loss process.

Over 20 years ago, I began the journey of obtaining a Master’s degree and Ph.D. with a specific goal: to educate physicians and other health care providers about addiction, to encourage them to have compassion in their work with addicts, to acknowledge and treat those with addictions respectfully, to address their own negative biases about addiction, and to lead the country in the direction of recovery from addiction. A decade ago, I expanded that goal to include educating physicians and other health care providers about obesity (which, for many individuals, is a form of addiction).

I can’t help thinking of the people who, after committing an offense of some sort, use the experience for the good of many. I’m hoping Dr. Kelly will join Cari and I in our efforts to provide “Understanding the Obese Patient? to physicians and other health care professionals around the country. Together we can fill the room of attendees who are, as demonstrated by Dr. Kelly, in dire need of this training. I’m just going to go ahead and ask him to do just that! Stay tuned…

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