Do Physicians Respect Obese Patients?
A new study seems to solidify fears that physicians are biased against obese patients. In a survey that examined the clinical interactions of 40 physicians with nearly 240 patients, doctors were far less likely to respect patients with high body mass indices (BMI); after adjustment for age and gender, a higher BMI was independently associated with lower physician respect. (Huizinga M, et al. Physician respect for patients with obesity. J Gen Int Med. 2009;24:1236-39)
Although doctors may contend that their bias is generated by frustration (rather than a lack of respect) derived from poor success in treating overweight individuals, it is fairly clear that obese people are stigmatized by American society in general; since physicians are human, they are subject to the same biases that affect other people – despite their best attempts to remain objective and compassionate.
Indeed, even among healthcare providers who specialize in obesity management, weight bias appears to be a relatively pervasive problem. (Schwartz M, et al. Weight bias among health professionals specializing in obesity. Obes Res. 2003;11:1033-39)
Such stigmatization appears to extend beyond doctors’ vexation with addressing the multitude of health problems that are associated with obesity. Unfortunately, physician biases may simply mirror the same coarse prejudices that are visited upon obese persons in other societal settings, such as hiring practices, salary and promotion decisions, media portrayals, and education or housing opportunities. (Puhl R, Brownell KD. Bias, discrimination, and obesity. Obes Res. 2001;9:788-805)
Physicians May See Obese Patients as Unmotivated or LazyMost cases of obesity are due to behavioral problems, rather than specific medical conditions. Simply stated, an imbalance between caloric intake and energy expenditure leads to storage of excess calories as fat. Weight gain can rarely be attributed to Cushing’s syndrome, hypothyroidism, hypogonadism, or other illnesses. (Dickerson L, Carek P. Drug therapy for obesity. Am Fam Phys. 2000;61:2131-38)
Therefore, even when genetic factors play a role in weight gain, physicians often attribute a patient’s persistent obesity to a lack of compliance with recommended lifestyle changes. When doctors spend time educating their overweight patients about the numerous medical issues that accompany obesity (see below), and when those patients not only fail to lose weight but often continue to gain it, doctors may seek explanations for their apparent failure to deal with a significant medical problem.
Sadly, blaming patients for their obesity might be the most convenient means of justifying modern medicine's lack of success at treating a common condition.
Obesity is a Multifactorial ProblemDuring a busy day, many physicians may not have sufficient time – or, perhaps, adequate desire – to delve into an obese patient’s detailed history. The temptation to deal only with immediate problems is great; time constraints and a reticence generated by unsatisfying outcomes from previous encounters with overweight patients compel a clinician to move on to the next patient.
This can only add to the negative perceptions that both obese patients and their physicians retain from these clinical interactions.
But obesity is born of varied underlying causes. Genetic, social, economic, cultural, behavioral, and situational factors all contribute to inappropriate dietary patterns and poor weight control. And many of these factors are rooted in childhood; only a thorough history, conducted in a nonjudgmental environment, will uncover valuable clues that may be nebulous even to the patient.
The Obese Patient Requires More Attention from Medical ProfessionalsBecause obesity is usually not an isolated condition, the overweight patient typically needs more attention from healthcare workers, not less. When communication barriers – particularly those surrounding issues of respect – interfere with productive interactions between a healthcare professional and a patient, no one is well-served.
Indeed, there is a real danger that those medical conditions that frequently attend obesity will be dealt with in a suboptimal fashion; subsequent encounters may become adversarial as doctors chase more issues that, in their minds, would be controlled if only the obese patient was more compliant.
Medical conditions that are commonly associated with obesity – and that are sometimes a source of confrontation between overweight patients and physicians – include:
- type 2 diabetes mellitus
- cardiovascular disease
- large vessel disease (e.g., varicose veins, hemorrhoids, etc.)
- cancer (breast, uterine, prostate, colon, gallbladder)
- menstrual irregularities
- gallbladder dysfunction
- sleep apnea and restrictive lung disease
- thromboembolic disease (clots)
At a time when obese individuals demand more medical care in an atmosphere of potentially shrinking healthcare dollars, a lack of respect and objective compassion for such persons may place many of them at grave risk.