- A doctor said a man with joint pain, body aches, and fatigue likely had weight-related arthritis.
- Dr. Mike talks on YouTube about seeing the patient later, and diagnosing him with Lyme disease.
- Weight bias is pervasive in medicine, leading to poorer outcomes.
A popular doctor is speaking out about weight bias in medicine, sharing an example of a young man who he believes had undiagnosed Lyme disease, and that his symptoms went ignored.
For weeks, the man, who has morbid obesity, suffered body aches, joint pain, and fatigue. The man's first doctor chalked it all up to weight-related arthritis, said Dr. Mikhail Varshavski, better known as Doctor Mike on social media, after reviewing the patient's medical records.
But Varshavski says he suspected the man was too young for that diagnosis. After investigating further, he diagnosed the patient with Lyme disease.
Varshavski says he believes the condition could have progressed to damage his heart and even lead to premature death if he had gone undiagnosed longer, describing the case on his YouTube channel.
"A lot of my patients do suffer with their quality of life because they fall into the category of morbid obesity," Varshavski said. "But it's also not right to blame everything that's going on without doing a proper history and physical."
The patient was given over-the-counter medications and creams
After the first doctor's diagnosis, Varshavski says, the patient was sent home to be treated with over-the-counter meds. But the man's pain intensified and he developed a rash.
The patient then went to an urgent care facility, where he received a topical steroid, according to his medical records. While it treated the rash, the patient told Varshavski it didn't ease the joint and muscle pain.
Next, the man returned to his doctor to report he wasn't getting better, and the doctor ordered X-rays, but still told the patient the most likely cause of his symptoms was weight, Varshavski said.
"If you look at the course of illness for this patient — the fact that it was getting worse, there is not only joint pain, but there is also body aches, there is also fatigue setting in, rashes starting to happen — these are multiple systems being involved and that tells me something systemic is going on," Varshavski said.
That something, Varshavaski said, was Lyme disease. He pieced it together using photos of the man's rash and questions about his lifestyle. The patient had a dog, which, the man said, had recently gotten a tick. Ticks can transmit Lyme.
Varshavaski took blood for two tests: ELISA, which tests for antibodies against the bacteria that causes Lyme disease, and the Western Blot, which is used to confirm a positive ELISA test.
Varshavaski also prescribed the man doxycycline, an antibiotic that treats Lyme. Two weeks later, both tests came back positive and the man's symptoms had disappeared.
"Had he progressed to late-stage Lyme disease and had neurologic or cardiac complications, he may have needed a hospital stay for IV antibiotics," Varshavski said. "He could have lost his life as a result of a cardiac arrhythmia."
Weight bias is pervasive in medicine, and contributes to poorer outcomes
A significant majority — nearly three-quarters, according to the latest data from the Centers for Disease Control and Prevention — of Americans are overweight or obese. And yet, clinicians can fall prey to long-held, but false, societal messaging that weight is a key indicator of health.
One study of more than 4,700 medical students across the country found that 74% exhibited implicit weight bias — meaning they weren't aware of their negative attitudes toward bigger-bodied people — and 67% had explicit weight bias, meaning they consciously had more negative feelings when, in this case, presented with photos of obese people.
As a result, people with overweight and obesity can receive inappropriate care, both because doctors may struggle to see beyond a patient's weight, and patients who've been scarred by weight bias may avoid seeking care.
Varshavski recommends patients confront doctors who they believe are over-emphasizing their weight, or find another provider.
"That is your right as a patient," he said. "The relationship between a provider and a patient has to be strong in order for proper health outcomes to occur."
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