Physicians have a problem in seeing past the weight of obese patients, writes Gina Kolata of the New York Times, which may explain why they’re not getting better care.

Sometimes it’s a matter of simple equipment, like when an Ohio patient was told to diet, even though, at 502 pounds, her weight could be monitored on her primary care provider’s scale. She was instead forced to go get weighed at a scale at a local junkyard.

Then there’s more expensive equipment which is often not available. For diagnoses that may require a CT or MRI scan, obese patients may not be able to fit in the machines. While scanners that can fit heavier patients are available, one study in an obesity research journal estimated 90 percent of emergency departments don’t have them.

And in other situations, physicians seemed to have made assumptions based on weight alone. Patty Nece, a 58-year-old resident of Alexandria, Virginia, lost nearly 70 pounds and was aiming to lose more, but needed hip pain checked out by an orthopedist.

“He came to the door of the exam room, and I started to tell him my symptoms,” Nece said. “He said: ‘Let me cut to the chase. You need to lose weight.’”

Nece said the physician never examined her, yet made a diagnosis of “obesity pain.” A different visit turned up the real problem: progressive scoliosis, which isn’t caused by obesity.

For more on efforts to improve care for obese patients, beyond instructions to lose weight, click on the link below: