How Obesity Can Impact Otolaryngology Patient Care

When doctors empathize with their patients, those patients say they are more satisfied with their medical care and are more likely to follow physician recommendations. This is seen by patients’ improved blood glucose or blood pressure readings, said Dr. Gudzune. Also, when physicians engage in rapport building with their patients, they report feeling more satisfied with their jobs and are less likely to suffer from burnout or have lawsuits files against them.

“I believe rapport is related to implicit bias,” she said. “A physician might not be making those emotional connections [that] are beneficial both to the patient and to the practitioner.”

How Weight Bias Affects Otolaryngology Patient Care

Among otolaryngologists, excess patient weight plays a role in many medical issues concerning the head and neck region. “We think of ourselves as working with the collarbone and up, but weight affects our disease procedures and how we deal with it from a surgical standpoint,” said Neil Bhattacharyya, MD, professor of otology and laryngology at Harvard Medical School and the associate chief of otolaryngology at Brigham and Women’s Hospital in Boston. “Most of our surgeries are voluntary. I think it’s natural for doctors who want to minimize risks, who might not be as eager or enthusiastic about doing an elective procedure, like a septoplasty” for a larger patient. For patients with an elevated risk like obesity, which can mean higher risks of anesthesia complications or slower wound healing rates—often linked to type 2 diabetes—a physician may be less likely to agree to perform the procedure.

Dr. Bhattacharyya, who has published research in the Laryngoscope linking obesity to higher rates of chronic rhinosinusitis and allergic rhinitis in adults and children, said that obese patients have more difficult airways to manage, because anesthesia is administered in the same airway that otolaryngologists are operating in (2013;123:1840-1844; 2013;123:2360-2363). “It’s not like doing a foot surgery,” he said.

Also, obesity can affect how well a person will heal from a surgical procedure, based on slower wound healing rates associated with diabetes, as well as inflammation factors. “There is mounting evidence that obesity itself is linked to, and can heighten, inflammation. With things like chronic sinusitis, asthma, chronic tonsillitis, and ear infection—all linked to chronic inflammation—an obese individual is probably not going to have as good an outcome, post-surgically, as a thin individual,” he said.

Dr. Bhattacharyya handles many patients with sleep apnea, which can be linked to obesity and treated surgically. He said the question of whether an obese patient should try to lose weight before the procedure or use the operation as a way to jump-start weight loss, becomes “a kind of chicken or egg discussion” among physicians at conferences. “I was more of a believer of doing the surgery before the weight loss, but I’ve seen that largely not be successful,” he said. “People would lose some weight but would gain it back. Now, for people with a body mass index of over 30, I strongly counsel them to lose weight, and [I] make many referrals to see nutritionists and bariatric surgeons. I want to at least explore and fully confront that aspect of their health—not only for obesity’s contribution to sleep apnea but for other health concerns, particularly cardiovascular.”