by Craig Klugman Ph.D.
Most of us know about the health risks of being obese. These include gallstones, type 2 diabetes, high blood pressure, high cholesterol, coronary artery disease, stroke, sleep apnea, gout, arthritis, asthma, metabolic syndrome, cancer, and infertility. But new studies show that being obese can also have a detrimental effect on your relationship with your doctor.
A report in the journal Obesity showed that doctors “are less likely to build emotional rapport with overweight and obese patients” (Gudzune et al 2013). What is emotional rapport? That term means empathy, listening, shared decision-making and focusing on the patient. In other words, if a patient is obese, a physician is less likely to listen to you, to express caring about you, and to look at you as a partner in your medical care. The researchers discovered this finding by audio-taping and analyzing physician-patient conversations. The study also reports that physicians overall were poor in communicating about psychosocial and lifestyle issues, concentrating mostly on biomedical topics.
Before we start requiring all physicians to have training in dealing with patients with obesity, it’s important to note that this study was small—39 primary care physicians and 209 patients who were predominantly ethnic minorities, in one city. Thus whether this finding holds in other geographic locations or across ethnic groups is not known.
This bias against obesity is not a one way street. A 2013 report out of Yale University shows that patients feel less comfortable talking to a physician who is overweight or obese. After all, it is hard to take advice about losing weight and getting exercise from a physician who is tipping the scale on the heavy side. And with nearly 42% of male physicians and 32% of female physicians being overweight or obese (according to the Medscape Physician Lifestyle Report 2012) this bias may come up more often than anyone realizes.
There is no other arbitrary physical characteristic that we accept as a legitimate basis for prejudice except for one’s weight. If this study showed that patients of different skin colors, sexes, or even ages were treated this way, there would be an immediate call for changing how we educate doctors. But there is no moral outcry for discrimination of weight. Ideally there should be no bias in the world and physicians would be looked at for their competency and empathy rather than their weight and all patients would be treated equally with compassion and concern no matter their appearance.
There is not much that can be done about patient bias, especially when they look at the physician as a role model and in many cases find doctors who do not practice what they preach about health, diet, and exercise. But in a physician, such bias is inexcusable. Physicians are trained professionals whose purpose is to help people in need. In medical school and professional education, we teach physicians not to discriminate about patients who are vulnerable simply because they lack power, knowledge, and skills in the physician-patient relationship. The patient should not have a bias as we should all respect all beings, but the physician must not have bias and certainly cannot act upon it even in subtle ways. These studies point out areas of needed work in medical professionalism and communication. Patients deserve help, not scorn and certainly not to be treated differently just because of weight status.