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Heavy Patients Get Little Respect From Doctors

Study finding shows doctors have to realize obesity is a disease, expert says

FRIDAY, Oct. 23 (HealthDay News) -- Mirroring a societal stigma against the obese, Johns Hopkins researchers report that doctors appear to have less respect for their heavy patients.

"Society, in general, has negative attitudes towards patients with obesity and physicians may be mimicking what is found in society," said lead researcher Dr. Mary Margaret Huizinga, an assistant professor of general internal medicine at Hopkins.

"Obesity bias has been increasing in society, even while race and gender bias has been decreasing," she added.

Huizinga got the idea for the research from her experiences working in a weight-loss clinic. "Many patients felt like because they were overweight, they weren't receiving the type of care other patients received," she said.

The report is published in the November issue of the Journal of General Internal Medicine.

For the study, Huizinga's team asked 40 doctors to complete a questionnaire about their attitudes toward the obese patients they had seen.

The researchers found that, among the 238 patients, each 10-unit increase in body-mass index (BMI) added a 14 percent higher prevalence of low patient respect on the part of their doctor.

BMI is a calculation of weight and height, and is used to determine whether someone is a healthy weight. A BMI of 25 to 29.9 is considered overweight, and a BMI over 30 is considered obese.

How these attitudes affect the doctor/patient relationship isn't clear, Huizinga said. "But focus group studies have shown that patients may refuse to go back to see their physician, and they felt they were treated with a negative attitude," she said.

Other studies have found that negative attitudes toward patients by doctors causes doctors to give their patient less information about their condition, Huizinga said. "That decrease in information may adversely affect the health outcome of patients," she said.

Huizinga believes any solution to this problem will require better education of medical students to identify negative attitudes.

"Patients should also feel comfortable in demanding that they have a respectful relationship with their physician, whether that means talking to their physician about it or finding another physician who they feel more comfortable with," she said. "Acknowledging the problem is the first step."

Respect for patients is a core component of professionalism in medicine, Huizinga said. "I believe that patients have the right to a respectful relationship with their provider. So, just the fact that having a higher weight may mean having lower respect from your physician is not fair -- it's a social injustice," she said.

Dr. Susan Yanovski, co-director of the Office of Obesity Research at the U.S. National Institute of Diabetes and Digestive and Kidney Diseases, said that "a number of studies have shown that health-care providers often have negative perceptions of obese patients. Even health-care specialists who specialize in obesity treatment have been shown to harbor subtle negative attitudes towards obese persons."

The concern is that patients may respond to these biases in ways that may jeopardize their health, for example by avoiding physician visits or preventive screenings, she said.

"Increasing the sensitivity of health-care professionals to their implicit biases and providing them with the skills to interact in a more respectful way with their obese patients has the potential to improve access to care and health outcomes," Yanovski said.

Another expert, Dr. William Walter O'Neill, professor of medicine/cardiology and executive dean of clinical affairs at the University of Miami Miller School of Medicine, said that "this is not surprising. The mind-set for most people is that obesity is a life choice -- that people have a weak will or they just eat too much."

Doctors, he said, have to change their mind-set and acknowledge that obesity is a disease. "We have to start treating the patients not as weak-willed or basic 'pigs,' but as people who have a disease that needs to be treated," he said.

O'Neill said that examining obese patients can be more difficult for doctors because of added folds of skin. And in cases where patients are poorly groomed, body odor can be more of a problem. "Those things make doctors, unfortunately, pull back from doing a thorough job of interviewing and examining the patient as they would with thin people," he said.

Similar attitudes among doctors have been directed at HIV patients, alcoholics and drug users, O'Neill said.

More information

For more information on obesity, visit the U.S. National Library of Medicine.

SOURCES: Mary Margaret Huizinga, M.D., M.P.H., assistant professor, general internal medicine, Johns Hopkins University School of Medicine, Baltimore; William Walter O'Neill, M.D., professor, medicine/cardiology, and executive dean, clinical affairs, University of Miami Miller School of Medicine; Susan Yanovski, M.D., co-director, Office of Obesity Research, U.S. National Institute of Diabetes and Digestive and Kidney Diseases; November 2009 Journal of General Internal Medicine

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