So this cartoon is cute, in a way, but after completing this review, also strikes me as disturbing. As I will show through this presentation, on the one hand, it doesn’t appear that physicians are explicitly discriminating against overweight or obese patients. However, physicians increasingly express a sense of futility in dealing with obesity, which raises concerns about a self-fulfilling prophecy of sorts.
Prevalence of obesity increasing Providers interacting with increasing numbers of overweight/obese patients Early research found that obese/overweight patients were less likely to seek care, avoid preventative care
Do physicians view obese patients more negatively than normal weight patients and does this affect recommendations for care and physician expectations for success?
GoogleScholar PubMed Search terms: physician bias, physician attitude, obese, overweight Selection Criteria › Study Locus › Type of Study › Sample Demographics › Geography
Grenier et al: Discussing Weight with Obese Primary Care Patients:Physician and Patient Perceptions Year Sample Methods Findings Limitations 2008 456 patients Survey Although physicians and patients had Recall Bias with BMI different perceptions about weight >30, 30 consultation during office visits, patients Limited physicians, reported positive interactions. generalizability due to patients primarily white female primarily sample size female, physicians primarily male
Wadden et al: Obese Women’s Perceptions of their Physicians’Weight Management Attitudes and PracticesYear Sample Methods Findings Limitations2000 259 women Questionnaire Patients were generally satisfied with care Limited with BMI >30 and reported positive experiences, but generalizability reported lower satisfaction with care specific to weight management. Specifically, patients Selection bias expressed difficulty speaking with doctors about weight issues and expressed frustration that doctors failed to understand the difficulties of being overweight.
Galuska et al: Are health care professionals advising obesepatients to lose weight?Year Sample Methods Findings Limitations1999 12,835 adults Telephone Less than half of participants had been told to Recall Bias with BMI >30 Survey lose weight. Patients who were told to lose (BRFSS weight reported that they were trying to lose sample) weight at a rate more than twice that of those who had not been advised to lose weight.
Foster et al: Primary care physicians’ attitudes about obesity andits treatmentYear Sample Methods Findings Limitations2003 5000 primary Questionnaire Physicians attributed obesity to behavioral Polarity of care factors, viewed obese patients more Statements physicians negatively than average weight patients and Ethical/professional expressed limited expectations for successful norms treatment.
Hebl and Xu: Weighing the care: physicians’ reactions to the sizeof a patientYear Sample Methods Findings Limitations2001 122 physicians Mock patient Physicians reported that they would spend Small sample size evaluation form 31.1 minutes with average weight patients. In and follow-up contrast, physicians reported that they would Geographically homogenous sample evaluation spend only 22.4 minutes with obese patients. Physicians reviewing the files of obese Primarily male patients were also more likely to report feeling annoyed with the patient and attribute obesity to behavioral factors
Attribution of obesity to behavioral causes connected to negative attitudes Barriers to discussions about weight and a sense of discrimination persist Low expectations and self-efficacy Talking about weight management positively correlated with patients actively trying to lose weight
Physician training on obesity Clear communication Diverse populations Unintended treatment bias