Doctors have less respect for their obese patients than they do for patients of normal weight, a new study by Johns Hopkins researchers suggests. The findings raise questions about whether negative physician attitudes about obesity could be affecting the long-term health of their heavier patients.
As patients had higher body mass index (BMI), physicians reported lower respect for them, according to the study in the Journal of General Internal Medicine. In a group of 238 patients, each 10-unit increase in BMI was associated with a 14% higher prevalence of low patient respect. BMI, calculated from a person’s weight and height, is a shorthand used to determine whether someone is a healthy weight. A person whose BMI is 25 to 29.9 is considered overweight; a BMI over 30 is considered obese.
Mary Margaret Huizinga, MD, MPH, an assistant professor of general internal medicine at the Johns Hopkins University School of Medicine, believes the idea for the research came from her experiences working in a weight loss clinic.
According to Huizinga, by the end of a visit, the patient would be in tears, saying ‘no other physician talked with me like this before. No one listened to me.’
Huizinga is the study’s leader and director of the Johns Hopkins Digestive Weight Loss Center.
“Many patients felt like because they were overweight, they weren’t receiving the type of care other patients received,” Huizinga said in a press release.
Data was collected from 238 patients at 14 urban community medical practices in Baltimore. Patients and physicians completed questionnaires about their visit, their attitudes and their perceptions of one another upon the completion of the encounter. On average, the patients for whom physicians expressed low respect had higher BMI than patients for whom they had high respect.
Previous studies have shown that when physicians respect their patients, patients get more information from their doctors. Some patients who do not feel respected may avoid the health care system altogether, surveys and focus groups have shown. One limitation of the new study, Huizinga pointed out, was that it was unable to link low physician respect directly to poor health outcomes.
“The next step is to really understand how physician attitudes toward obesity affect quality of care for those patients, to really understand how this affects outcomes,” she said. “If a doctor has a patient with obesity and has low respect for that person, is the doctor less likely to recommend certain types of weight loss programs or to send her for cancer screening? We need to understand these things better.”
Ultimately, physicians need to be educated to the fact that obesity bias and discrimination does exist. One good place to start would be in medical school, where Huizinga believes little is taught to reduce or compensate for these negative attitudes.
“Awareness of their own biases can lead to an alteration of behavior and sensitivity,” she said. “They need to watch how they act toward patients.”
