Delegates to the 2019 Congress of Delegates, held here Sept. 23-25, took action on individual and public health issues that included stigma and bias associated with obesity, family separation, and reproductive health.
General registrant Lauren Oshman, M.D., M.P.H., of Chicago, testifies in a reference committee hearing during the 2019 Congress of Delegates about a resolution she co-authored that addresses stigma associated with obesity in the practice setting.
Stigma, Bias Associated With Obesity
Family physicians who participated in the Reference Committee on Health of the Public and Science hearing on Sept. 23 discussed a resolution submitted by the Illinois AFP that addressed the stigma and bias that patients with obesity often experience.
The resolution, which delegates adopted during the Sept. 24 business session, asked the AAFP to support local, state and national policies that prohibit weight discrimination. It also called for the Academy to offer members educational materials to reduce patients' experience of weight stigma and bias and said those materials should cover topics such as
- reducing weight stigma in the office practice environment;
- patient-centered communication strategies to reduce weight bias; and
- community advocacy opportunities to reduce weight bias in schools, communities and the media.
- Family physicians at the 2019 Congress of Delegates took action on a number of issues debated during the Reference Committee on the Health of the Public and Science hearing.
- Delegates adopted a resolution that addressed stigma and bias experienced by patients with obesity in the practice setting and elsewhere.
- Other measures addressed the separation of families seeking asylum and the conditions in which they are held.
Resolution co-author and general registrant Lauren Oshman, M.D., M.P.H., of Chicago, testified in support of the measure, saying obesity is one of the most prevalent diseases in the United States, affecting about 40% of adults in 2016.
"Despite this, we know the quantity and quality of education on this topic in medical schools and residencies is limited," she said. "This resolution seeks to draw attention to our attitudes, as obesity has been called the last acceptable prejudice."
Oshman noted that one study found 54% of respondents who were categorized as overweight or obese reported stigmatizing comments from their physician.
"This resolution asks us to advocate against weight discrimination and make sure that our educational offerings teach physicians to identify and overcome weight bias in order to connect with our patients," she said.
General registrant Monica Fudala, M.D., of Dundee, Ill., also spoke in support of the resolution. She said she had represented the AAFP at the 2019 Chicago Obesity Summit in May as a member of the Academy's Commission on Health of the Public and Science.
"Thirty-three organizations attended, and there was overwhelming agreement that many barriers exist for physicians to adequately address obesity in this country," she said. "Everyone agreed that one of those barriers was implicit bias of the health care provider."
Fudala said the Obesity Action Coalition provides a great resource for discussing weight with patients who have obesity.(www.obesityaction.org) The resource also calls attention to implicit bias among health care professionals.
"According to one survey of more than 2,400 women, 69% reported that doctors were a source of weight bias," she said. "And 52% said they had been stigmatized by physicians on multiple occasions.
"There are multiple barriers to addressing obesity, but unless we address this implicit bias, we cannot adequately help our patients," Fudala continued.
AAFP Director Sterling Ransone, M.D., of Deltaville, Va., testified that the Board supported the resolution.
"We have very good policy on obesity and on stigma, but we don't currently have one that addresses both together. We feel that this resolution does so in a specific and unique way, and we ask the reference committee to support this as is," he said.
Arizona delegate Andrew Carroll, M.D., of Chandler, speaks in support of a measure addressing U.S. policy on separating families seeking asylum and the conditions in which they are detained, calling it a "tragedy on our southern border."
Family Separation, Detention Center Conditions
A resolution the New Mexico chapter submitted condemned the current U.S. policy of separating families who are seeking asylum and detaining them in substandard conditions.
The Congress adopted a substitute resolution that asked the AAFP to oppose any such policy that separates families seeking asylum and to support providing age-appropriate food, water, personal hygiene and health care to all individuals in detention facilities.
"We asked the AAFP to condemn in the strongest terms possible the current U.S. policies using separation and mass incarceration at our southern border," said resolution co-author and New Mexico alternate delegate Jennifer Phillips, M.D., of Albuquerque. "We believe this creates adverse childhood events and further health problems with children as silent victims."
Arizona delegate Andrew Carroll, M.D., of Chandler, spoke in support of the measure. "We have a tragedy on our southern border. I know this because I live and practice in a border state," he said.
"We will be judged in future history books," Carroll continued. "Let us be remembered for our compassion and our solutions rather than our callousness and xenophobia."
New Mexico delegate Stephanie Benson, M.D., of Las Cruces, speaking in support of the resolution, said she lives and practices 40 miles from the southern border. During the past year, her residency program worked with city and state officials to help treat almost 3,000 asylum-seekers and migrants who had been released from detention centers.
"I assure you that from the times we have visited these facilities and the stories patients have told us, these are not adequate conditions for families or children or infants … or my dog, to be honest with you," she said. "So, I don't see this as a political issue, I see it as a humanitarian one."
The Congress also adopted a substitute resolution that charged the AAFP with actively encouraging administration of annual influenza vaccines to all individuals ages 6 months and older who are confined or held in U.S. immigration detention facilities.
Access to Abortion Care
The reference committee received no fewer than 15 resolutions addressing access to abortion care services, which reference committee members consolidated into just four items for consideration by the Congress.
After much discussion, delegates adopted a substitute resolution that asked the AAFP to support family physicians who have training, experience and demonstrated competence in providing medication and first-trimester aspiration terminations.
Another substitute resolution the Congress adopted asked the Academy to support the safety and efficacy of mifepristone by continuing to advocate that the FDA remove the risk evaluation and mitigation strategy requirement for the drug to conform with current evidence. The measure also asked the AAFP to consider providing education, as appropriate, on early pregnancy loss management in relevant programming at the Family Medicine Experience, as well as at maternity care and women's health conferences on a rotating basis.
Delegates reaffirmed as current policy two measures. One stated that the Academy supports and protects "members who choose to practice medically legal procedures, as well as those who do not, while upholding the patient's right to informed decision-making." The other stated that Academy policy protects family physicians practicing within the bounds of their training, experience and competencies and opposes the criminalization of family physicians legally performing medical procedures.
Other resolutions the Congress adopted included measures tasking the AAFP with
- developing a policy called "Health in All Policies" to incorporate health considerations into decision-making across all sectors and policy areas, and
- supporting efforts to improve access to health care for formerly incarcerated people after their release.
Additional substitute resolutions delegates adopted included requests for the Academy to
- study current research on the relationship between youth use of social media and mood disorders,
- develop resources to raise awareness of family medicine's role in addressing and preventing sexual harassment, and
- investigate the public health effects of environmental toxins and educate members about the findings.
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