Some Ob-Gyns Say Obese Patients too High-Risk

VIDEO: University of Vermonts Dr. Robert Macaulay
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Obese pregnant women, already at higher risk for health complications, have had another setback: a survey conducted last week by South Florida's Sun Sentinel revealed that several ob-gyns there refuse to treat overweight and obese women.

Some doctors who admitted they refused obese patients in the survey said that they did not have adequate equipment to treat women over a certain weight. Others said they refuse obese patients because they are too high-risk to treat, and need doctors with special skills.

"I think this is unconscionable," said Dr. Robert Kushner, professor of medicine at Northwestern University's Feinberg School of Medicine. "This is a form of discrimination in the worst way."

Drs. Jeffrey Solomon and Isabel Otero-Echandi, private practice ob-gyns in Plantation, Fla., were among the 15 who admitted they reject new patients who weigh more than 250 lbs, according to the Sun Sentinel.

The office manager said the doctors had no further comment.

Obese pregnant women are at an increased risk of gestational diabetes, preeclampsia and postpartum infection, among other complications.

Turning down obese patients is not illegal. Doctors are allowed to drop or refuse patients if they feel a patient's condition is outside of their skill set, and it is not based on race, sexual orientation or gender.

But Dr. F. Ralph Dauterive, chair of obstetrics and gynecology at the Ochsner Clinical Foundation in Baton Rouge, said that he not only disagrees with doctors who exclude overweight patients from an obstetrics practice, but he rejected the excuse that physicians' medical training would make them unable to care for obese patients.

"The medical risk to the pregnancy is greater, but the obstetrical trained M.D. should be capable of management," said Dauterive. "We have an obligation to care for patients based upon our training. We really do owe that to the community in which we live."

And that community is growing. According to the Centers of Disease Control and Prevention, 26.1 percent of U.S. adults were obese in 2008, up from 25.6 percent in 2007.

Many experts say that's too large a population simply to deny, especially because complicated pregnancies are the ones that require the most preventive and vigilant care.

James Zervios, director of communications for the Obesity Action Coalition, said that this likely happens a lot more than people think.

"We've heard this going on with other doctors in the past," said Zervios. "I find it hard to believe that doctors don't have tables and equipment to accommodate overweight patients with 93 million Americans affected by obesity."

"This goes against the basic principles of health care," continued Zervios. "They're there to improve the quality of life for those they serve."

Because of fear of discrimination and belittling, Zervios said many obese people avoid the doctor altogether, even though a trusting relationship between a doctor and patient would offer a perfect time to discuss necessary lifestyle changes. It's a missed opportunity that could address issues that are affecting one quarter of Americans, said Zervios.

Obese Pregnant Women: Refusal to Treat Could Affect Public Health

"From a public health point of view, what if every specialty trained M.D. chose to only take care of low-risk patients?" said Dauterive. "We would not have enough providers caring for the segment of the population that needs the specialized care the most. Of note, if an obstetrician will only see low-risk patients, then they are basically doing the job of a midwife at a much higher cost, with outcomes that are statistically not better."

But Dr. Brad Imler, president of the American Pregnancy Association, said doctors avoid overweight patients more out of fear of getting sued than because they discriminate.

"Everybody needs an investment in their pregnancy to increase the probability of a healthy baby," said Imler. "But I understand the challenge and concern. Women who are overweight are looking at a greater chance of complications. With our society being prone to litigation that puts doctors in a liable situation, or a position of concern. Either way, neither situation is good for the health of the baby."

"A woman can do everything right during her pregnancy and still have complications," said Imler. "When that happens, most people want someone to be held accountable. That affects public health."

Obstetric experts have been "falling off the map" for years because of high cost and the fear of lawsuits, said Imler. "It is one of the main concerns of ACOG (the American Congress of Obstetrics and Gynecologists)," said Imler. "It's cheaper and they make more money to do straight gynecology."

"I think doctors gladly seek to care for a woman whom he knows needs the care and would seek to provide her with proper education and foster healthy pregnancy in spite of challenges faced with whatever lifestyle factors," said Imler. "That is, as long as, if complications arise, he or she is not going to be sued."