It is this last notion, “equitably, according to need” that we may sometimes forget. Morbidly obese patients have legitimate and often greater needs, which, in turn, demand and justify a larger share of available staff time and other resources.

‘See excess patient mass as excess patient pain. Consider the plausibility that the morbidly obese patient overeating before you experiences pain daily on a per kilogram basis.’

Stigmatization and staff contempt

While Rubenesque figures are still prized among some Pacific island peoples, obesity tends to be viewed in the most unflattering terms in the Western world. Fat phobia and contempt for obesity are ubiquitous. As a microcosm of our society, the emergency department is not immune to these biases. Morbidly obese patients may engender in us both ridicule and contempt for their lack of self-control and dietary discipline as the root cause of their emergency department visit. When we allow these biases to frame our thinking, however, we cross the line from a helping to a blaming profession, where we serve as judge and jury rather than healer and helper.

Emergency physicians care for countless smokers who are short of breath, drinkers with bleeding varices, and substance abusers who crash cars. Hence, we see (perhaps more than most) the obvious relationships between human behavior and medical consequences. As our specialty’s Cicero, Dr. Gregory Henry, once proclaimed, “If it wasn’t for human vice and self-inflicted illness, I’d be out of a job!”

It may be argued that consistently generating high levels of compassion and empathy is part of the emergency physician’s job description, a job for which we are handsomely paid. However, something much more important is at stake than income when we work 10-hour shifts resenting those perceived as weak, irresponsible, gluttonous patients: our humanity. It is in our best interest to appreciate our own personal need to “like” our patients as much as possible.

When we secretly blame or ridicule them for their body habitus, appetites or food addictions, we invite apathy, disillusionment, resentment, and ultimately, burnout. While one cannot fail to be impressed with the size of some of our “customers,” patient blaming, fat jokes and staff stigmatization are the kryptonite of emergency physicians and should be avoided at all costs.

“Love all, serve all” isn’t just a sign for the Hard Rock Café; it should be our emergency department’s sign too. We do well to see morbidly obese patients as worthy, suffering souls who need our humane and sincere concern and compassion, just like any other patients. Having an unconditional positive regard (UPR) for all patients has long been recognized as a cardinal virtue of excellent emergency physicians.⁹