American Medical News
By — Posted April 1, 2013
How much a physician weighs could have a negative impact on his or her relationship with patients, say researchers with the Rudd Center for Food Policy and Obesity at Yale University in Connecticut. They found that adults are more likely to mistrust doctors they consider overweight or obese than physicians they think are a normal weight.
When a doctor appears to be an unhealthy weight, adult patients are less likely to follow the physician’s advice on health behaviors, such as losing weight. They also are more inclined to change doctors. The findings were published online March 19 in the International Journal of Obesity.
“When we look at weight bias in our culture, it’s a very pervasive and widespread form of stigma,” said lead study author Rebecca M. Puhl, PhD, director of research and weight stigma initiatives at the Rudd Center. “There’s no reason to assume that patients are immune to those biases. We need to pay attention to [these findings], because it’s telling us that patients might be making assumptions about their provider simply based on” appearance.
To help strengthen physician-patient relationships, overweight or obese physicians should discuss their weight during office visits with new patients or when discussing health behaviors such as diet and exercise, said Phyllis A. Guze, MD, a Los Angeles internist and infectious diseases specialist.
Doctors’ efforts to show patients that they’re human and they struggle with health problems just like everyone else could lessen weight bias in the exam room and ultimately enhance the doctor-patient relationship, Dr. Guze said. She is associate vice chancellor of health affairs and executive dean of the School of Medicine at the University of California, Riverside. She also is chair of the American College of Physicians Board of Regents.
During discussions with patients about losing weight, she suggested that doctors start by saying, “I’m overweight, so I really understand how hard it is for you to change your dietary habits. I’m trying to do that, too, but sometimes I’m not successful.”
To further motivate patients, a physician could share personal weight-loss tips, said Arya M. Sharma, MD, PhD, professor of medicine and chair of obesity research and management at the University of Alberta, Canada.
“Overweight or obese doctors need to be aware that their size can have a negative consequence on the doctor-patient relationship,” said Dr. Sharma, a member of the Obesity Society Public Affairs Committee, which provides information on the latest in obesity research, treatment and prevention.
“The best way to deal with these issues is to address them head-on,” he said.
Thirty-three percent of U.S. adults are overweight, and about one in three people 20 and older (about 78 million individuals) is obese, according to the Centers for Disease Control and Prevention. It’s unclear how many of those adults are physicians, but health professionals face many of the same challenges as the public in maintaining a healthy weight.
Among the key factors that contribute to overweight and obesity among doctors is a lack of work-life balance, insufficient time to eat and exercise properly, stress and too little sleep, Dr. Sharma said.
For the International Journal of Obesity study, researchers randomly assigned a national sample of 358 adults to one of three groups. In those groups, participants were asked to complete a questionnaire that assessed their perceptions of physicians who were described as normal weight, overweight or obese.
The survey inquired about the importance of a physician’s body weight and physical appearance when choosing a doctor. Participants also were asked about their perceptions of the compassion and bedside manner of physicians who are normal weight, overweight or obese.
Respondents completed the Fat Phobia Scale, which consists of 14 pairs of adjectives commonly used to describe obese people. The terms included “active versus inactive” and “no will power versus has will power.” The selection of more negative adjectives indicates a more negative attitude toward obese individuals, the study said.
Researchers found that weight bias toward doctors remained consistent regardless of participants’ body weight. The bias was more pronounced among people whose Fat Phobia Scale showed that they have a more negative attitude in general toward obese individuals.
Participants’ perception of physician compassion, which includes the degree to which the adults thought the doctor would listen carefully to them, was the only area where the doctor’s weight did not have an impact.
A key limitation of the study is that the classification of physicians’ weight was not objectively defined by body mass index. Thus, participants’ perception of what constitutes normal weight, overweight and obesity could vary.
But researchers said a patient’s perception of whether a doctor is overweight influences feelings about the physician-patient relationship.
“When we look at the [study] outcomes in terms of not following [physicians’] advice, switching doctors, having less trust — those are all very critical aspects of the patient-provider relationship and of health care quality,” Puhl said.
She said weight stigma needs to be addressed in the public arena and among health professionals. She said federal laws that prohibit weight-based discrimination could be passed. On a smaller scale, doctors could educate their patients about the negative impact of weight bias, and media outlets could take steps to portray weight in ways that are not stigmatizing, Puhl said.
Beyond addressing weight stigma, Dr. Sharma recommends that overweight and obese doctors seek medical care for their health condition. One of the “biggest problems doctors have when they have a health issue is becoming their own patient. It simply doesn’t work,” he said.
Dr. Guze urges overweight physicians to heed the diet and exercise advice they often give their patients, including eating more fruits and vegetables and fewer processed foods.
She also encourages doctors to try to fit small spurts of exercise into their busy days by taking a 10-minute walk around the block or climbing the stairs rather than taking the elevator.
“We are on a pedestal, and I think physicians should be as healthy as they possibly can be,” Dr. Guze said.
But “what the study does highlight is that physicians are human, and obesity is not the easiest [health issue] to address.”