Obese patients less respected by doctors, Hopkins study suggests Special
A study, “Physician Respect for Patients with Obesity,” will be published in Nov. in the Journal of General Internal Medicine. Findings indicate that physicians have less respect for obese patients. Lead researcher wishes hypothesis was "wrong."
A team* of researchers at The Johns Hopkins University, led by Mary Margaret Huizinga
, MD, MPH, examined the relationship between physician respect and patient obesity. The study, titled “Physician Respect for Patients with Obesity,” will be published in the November issue of the Journal of General Internal Medicine.
The findings suggest that physicians have lower respect for obese patients. The patients for whom physicians expressed low respect had, on average, higher BMI (body mass index) than patients for whom they had high respect.
In an Oct. 22 press release
issued by Johns Hopkins Medicine, Dr. Huizinga relays what she heard from patients at a weight loss clinic. She states:
Patients would come in and by the end of the visit would be in tears, saying no other physician talked with me like this before. No one listened to me. Many patients felt like because they were overweight, they weren’t receiving the type of care other patients received.
Based upon Dr. Huizinga’s experiences working in a weight loss clinic, documented negative bias toward obese persons by health-care providers, and obesity stigma common within our society, the researchers hypothesized that: physicians would have low respect for patients as body mass index (BMI) increased.
According to the press release, 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.
Data was collected from 238 patients and 40 physicians at 14 urban community medical practices in Baltimore. They were enrolled in a randomized controlled trial of patient-physician communication. Physicians and patients completed questionnaires about the visit, their attitudes and their perceptions of one another upon completion of the encounter.
The findings, to be published next month in the Journal of General Internal Medicine, indicate that patients for whom physicians had low respect had higher BMI and lower age than patients for whom they had high respect. There was no association between physician respect and other patient and physician characteristics.
According to Dr. Huizinga, “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.”
“Ultimately,” according to Dr. Huizinga, “physicians need to be educated that obesity bias and discrimination exist. Awareness of their own biases can lead to an alteration of behavior and sensitivity that they need to watch how they act toward patients.”
Question and Answer with Dr. Huizinga
Based upon the study and its findings, I asked Dr. Huizinga the following questions and she graciously took time to provide the answers.
The study indicates that physicians need to be educated that obesity bias and discrimination exist. What can obese patients do in the meantime? Do you have any specific suggestions/recommendations for obese patients in terms of how they can garner respect from potentially biased/disrespectful doctors?
I believe that all patients have a right to have a respectful relationship with their physician. If they feel that their physician is not being respectful, patients should talk to their physician about their concerns. It may be that the physician does not realize they are presenting a disrespectful attitude to the patient. The other option is to find another physician. Patients should feel comfortable discussing their weight and other healthcare concerns with their physician and if they are not comfortable talking to their physician, I would be concerned that their care could be negatively affected.
Of the 40 physicians analyzed in the study, which specialties were most inclined to be disrespectful toward obese patients? If any specialty (i.e., internal medicine, geriatrics, etc.) was identified, please offer a theory as to why this was the case.
These 40 physicians were all primary care providers. We had internal medicine, family practice and general practice physicians, however, we did not have enough physicians to study differences by specialty.
It was noted that: Further research is needed to understand if lower physician respect for patients with higher BMI adversely affects the quality of care. Do you plan to continue collecting data from the 238 patients in your original study? If so, will you track changes in levels of respect from physicians toward these patients should the patients lose weight?
This study was an analysis of the baseline data of another trial and we are not able to follow these patients further; this is a preliminary study to began to understand this phenomena and to help us design better studies in the future. We would like to study several things in future studies: If a patient’s weight changes, does the physician respect for that patient change? How is care impacted – specifically preventive health screenings and chronic disease management? If care is impacted, what are the primary reasons? What can we do to reduce obesity bias in healthcare and in society in general?
Were you surprised by any of the findings in the study? If so, please elaborate.
This was one study where I wanted my hypothesis to be wrong; however, I was not surprised by the findings. I have seen patients with obesity be treated disrespectfully during my training and I have heard many of my patients relay hurtful stories of care from their physicians.