Size Matters: Obese Patients More Likely to Trust Overweight Physicians for Diet Advice

A new study suggests that obese patients are more likely to take diet advice from an overweight physician than a normal weight one.

Researchers found that the reasoning for this may be that obese patients feel that overweight physicians can better perceive weight-related stigmas.

"With respect to overall trust, our results suggest that overweight and obese patients trust their primary care physicians, regardless of their body weight," said Sara Bleich, PhD, associate professor with the Bloomberg School's Department of Health Policy and Management, according to a press release. "However, with respect to trust in weight-related advice, we found that patients more strongly trusted diet advice from overweight primary care physicians as compared to normal BMI primary care physicians. In addition, we found that patient perceptions of weight-related stigma increased with physician BMI. Patients seeing obese primary care physicians, as compared to normal BMI physicians, were significantly more likely to report feeling judged because of their weight."

Researchers used a national cross-section survey of 600 overweight and obese patients to examine overall trust and trust in weight related counseling from primary care physicians. To assess overall health, they asked the following: "Using any number from 0 to 10, where 0 means that you do not trust this doctor at all and 10 means that you trust this doctor completely, what number would you use to rate how much you trust this doctor?"

"While weight-related stigma has been documented among health professionals for decades, as well as lower physician respect towards patients with a higher BMI, our finding that weight-related stigma increases with physician BMI was quite surprising," Bleich notes, according to the release. "Recent changes to obesity coverage among the publicly insured makes understanding primary care physicians' barriers to providing effective obesity care critical. Existing research suggests that primary care physicians face numerous challenges to providing optimal obesity care which include knowledge deficits, negative attitudes and structural barriers. Future research should further examine the impact of physician BMI on obesity care. In particular, why patient-perceived physician stigma is higher among heavier primary care physicians and why the patterns we observed between physician BMI and trust in weight-related counseling differ by the type of counseling."

The results are featured online in the June 2013 issue of Preventive Medicine.

Another study published in the medical journal Obesity also notes similar findings regarding health care. Researchers from John Hopkins recorded discussions between 39 primary care doctors and over 200 patients who had high blood pressure. (Most of the high blood pressure candidates fell into the overweight or obese category.)

Overall, the study showed that the doctors were less likely to engage the overweight or obese patients as opposed to the healthy ones. "It's not like the physicians were being overtly negative or harsh," said the lead author, Dr. Kimberly A. Gudzune, an assistant professor of general internal medicine at the Johns Hopkins School of Medicine, via The New York Times. "They were just not engaging patients in that rapport-building or making that emotional connection with the patient."

However, the researchers of this study also note that overweight or obese patients were more likely to say they heard negative comments from staff.