16 April 2013

Patients often biased against fat doctors, too

People are less likely to trust and follow the advice of an overweight doctor, according to a new online survey that suggests "weight bias" may go both ways in the doctor-patient relationship.

"There's lots of work which shows there's a lot of bias from health professionals toward heavy patients," said Sara Bleich, an obesity and health policy researcher at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

 "What's much newer is the other direction," she told Reuters Health.Lead researcher Rebecca Puhl said she was not surprised by the findings but they were still "really concerning" - especially considering how important it is for people to be talking with their doctors about how to maintain a healthy weight.

"Trying to prevent or treat obesity starts with a conversation about weight-related health," said Puhl, the head of research at Yale University's Rudd Center for Food Policy & Obesity in New Haven, Connecticut.

"If a doctor's weight or a patient's weight is going to interfere with that, it's going to make it very difficult to have a productive and positive conversation," she said. "This is an unnecessary and unfortunate barrier."

How the study was done

Puhl and her colleagues surveyed 358 adults about a hypothetical interaction with a normal weight, overweight or obese doctor. People were asked how comfortable they would feel talking with that doctor about health concerns and how credible they believed the doctor to be.

On a scale from 1 to 5, with 5 being highest, study participants ranked their trust level as 4.0 toward a normal weight doctor, 3.4 for an overweight doctor and 3.3 for an obese doctor.

Similarly, they rated their likelihood of following the doctor's advice as 3.9, 3.5 and 3.5, respectively, for a normal weight, overweight and obese physician.

That trend was consistent across survey-takers of all weights, but was stronger among those who scored higher on a general measure of weight bias, the study team reports in the International Journal of Obesity.

Changing stereotypes

Puhl said her team has been working on educational techniques to change doctors' stereotypes of heavy patients. But weight bias doesn't seem to be a one-way problem, she and Bleich agreed."We've shown for a long time that (overweight) patients are often the victim of stigma in the healthcare system, but doctors are not immune from that," Bleich said.

About half of doctors are overweight or obese, she pointed out - so this may affect many doctor-patient relationships.

Or, it could be a significant issue only for the heaviest doctors.The new study points to the need for "really making sure that people have an accurate understanding of the very complex causes of obesity and the complex solutions, so that this is not solely (seen as) an issue of lack of willpower, for example. We need to educate patients as well, and help challenge those stereotypes," Puhl said.

"There are already a number of barriers patients and providers face in their efforts to treat obesity, and we don't want bias to be one of those barriers."


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