Doctors and Regular People

waiting room

Obesity-hating may be the last socially acceptable form of bigotry, under which people seem to think it’s okay to champion inequality and practice discrimination. When control is in the hands of an airline, or a retail clothing store that refuses to carry extra large garments, this is annoying at the very least. At worst, being the target of discrimination can have life-changing consequences. If someone is on the way to visit a dying parent, and can’t get a seat on a plane, the obstruction is not easy to forgive or forget.

But when medical professionals are involved, matters really become serious, as Childhood Obesity News has been exploring. Would an obese patient knowingly choose a doctor who feels nothing but scorn for obese patients? A doctor’s insensitivity or condemnation can discourage a person from seeking needed medical help, from that human resource or from any other. A patient needs to trust a doctor. When there is no trust, the patient feels less inclined and less obligated to follow good advice.

Attitude counts

When a patient feels stigmatized by a doctor’s attitude, health is threatened. And then there is the whole opposite problem, of the obese doctor who hands out advice about losing weight. This leads to confusion and cognitive dissonance. Doctors earn enormous respect in society because they carry such heavy responsibility. Unfortunately, they also are assigned the duty of setting a good example.

In March, the International Journal of Obesity published research by R. M. Puhl, J. A. Gold, J. Luedicke, and J. A. DePierre, titled “The effect of physicians’ body weight on patient attitudes.” This study acknowledged previous work that revealed the bias felt by many doctors toward obese patients.

The question it asked was, does that go both ways? How do patients feel about flabby doctors who show little sign of following any healthful diet and exercise guidelines themselves? How do they feel about doctors who might even suffer from the same unhealthy, addiction-like dependence on food that is experienced by the patients? The authors wrote:

This study assessed public perceptions of normal weight, overweight or obese physicians to identify how physicians’ body weight affects patients’ selection, trust and willingness to follow the medical advice of providers.

The subjects were 358 grownups who filled out an online test designed to ferret out their underlying anti-fat prejudice, if any, and who responded to a questionnaire about doctors variously described as obese, overweight, or normal weight.

The news is not encouraging. It turns out that a patient has a hard time trusting an oversize doctor, and is less likely to take his or her advice. For some, the matter is weighty enough that they will go out and get a different doctor. And just because the patient herself (or himself) is fat, that doesn’t mean she or he will cut the doctor any slack. A patient is just as capable as any other fool, of engaging in a double standard: one rule for me, but a different rule for the rest of the world.

Here, in official parlance, are the Conclusions:

This study suggests that providers perceived to be overweight or obese may be vulnerable to biased attitudes from patients, and that providers’ excess weight may negatively affect patients’ perceptions of their credibility, level of trust and inclination to follow medical advice.

The aforementioned Rebecca M. Puhl, Ph.D., is Senior Research Scientist at Yale University’s Rudd Center for Food Policy & Obesity. As for the list of publications she has co-authored, just reading through the titles is an educational experience in itself. Here are a few:

  • Weight bias among UK trainee dietitians, doctors, nurses and nutritionists.
  • Obesity stigma: a failed and ethically dubious strategy.
  • Headless, hungry, and unhealthy: a video content analysis of obese persons portrayed in online news.
  • The influence of a defendant’s body weight on perceptions of guilt.
  • Internalization of weight bias: Implications for binge eating and emotional well-being.
  • If you are good you can have a cookie: How memories of childhood food rules link to adult eating behaviors.

Your responses and feedback are welcome!

Source: “The effect of physicians’ body weight on patient attitudes ,” Nature.com, 03/19/13
Source: “Rebecca M. Puhl, PhD,” YaleRuddCenter.org
Image by Robert Couse-Baker.

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