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Overweight Physicians Display Bias in Obesity Care

 |  By cclark@healthleadersmedia.com  
   January 27, 2012

Doctors who are overweight or obese are less likely than physicians of normal weight to diagnose weight problems with their heavy patients or to launch discussions with them about their need to slim down, says a Johns Hopkins report that its authors say is the first of its kind.

The report "indicates that if you're a heavier physician you are biased when it comes to providing obesity care and that may be something physicians do not realize they're doing," lead author Sara Bleich, assistant professor of health policy at Johns Hopkins Bloomberg School of Public Health, explains in an interview.

"When they see patients who look like themselves—in that overweight or obese category—they think, 'This person looks like me and I feel healthy, therefore let me focus on the more extreme'" complaints or issues they may have, such as diabetes and hypertension, rather than the underlying excess weight which may exacerbate their health problems.

Bleich's paper was published in this month's issue of the journal Obesity.

The paper is based on responses to 49 questions in a cross-sectional survey answered by 500 randomly selected primary care physicians—internists and general and family practitioners—who see patients at least 35 hours a week. They were drawn from the Epocrates Honors Panel of 145,000 doctors verified by the American Medical Association's master file, and they received a $25 voucher for their time.

The doctors were not pre-selected for their weight. Instead, they were asked questions about caring for obese patients and at the end, they were asked to give their height and weight, which the researchers converted to a body mass index or BMI score. 

About 38% of the respondents self-reported height and weight indicating an overweight BMI of between 25 and 29.9. The percentage of overweight adults in the nation is 34.4%.  Fifteen percent indicated an obese BMI of at least 30.

"Physicians with normal BMI (body mass index) more frequently report discussing weight loss at lower levels of BMI compared to overweight/obese physicians," Bleich and colleagues wrote in their paper.

"Physicians with normal BMI also have greater confidence in their ability to provide diet and exercise counseling to their obese patients, and perceive their weight loss advice as trustworthy."

Bleich says that the study is unique "because we know [there are] all sorts of barriers when it comes to obesity care. Things like, physicians don't have enough time. Or they have negative attitudes toward overweight patients or they don't have adequate training...and there are insurance barriers," which restrict the amount they get paid for spending extra time counseling patients.

"But what we looked at is that there is something about the physicians themselves that creates barriers when it comes to obesity care because of the way this is such a personal issue."

Bleich says that because this study found that the weight of one's doctor may impact care of overweight patients in that practice, there's a greater need to focus on interventions that improve physicians' health and sense of wellbeing. "We know physicians are in a high-stress job, have high divorce rates, high rates of substance abuse, and depression."

She suggested that electronic medical records could also play a role in reminding physicians to give patients an obesity or overweight diagnosis when different patterns of care would ensue.

"Simple technology changes could make it easier to improve the care that these patients receive, because having the diagnosis is the gateway to getting counseling and treatment to help maintain weight control," she says.

Among some of the results, the survey found:

  • Physicians with BMI scores indicating class 1 obesity, (between 30-34.9) 64% would initiate a conversation with a patient in that same weight category, but of normal BMI physicians, 72% would start that conversation. Among physicians with class 2 BMI weight status, (between 35-39.9) would.
  • For overweight patients, only 5.1 overweight physicians would initiate a conversation about weight loss, but 9.3% of normal weight physicians would begin that discussion with those patients. Likewise for obese patients with BMI between 30 and 34.9, 64% of obese physicians would suggest the need for the patient to lose weight, while among normal weight physicians, 72% would.
  • Among normal weight physicians, 72% and 73% said they should be role models for their patients in maintaining healthy weight and exercising regularly.  But among overweight and obese doctors, 56% and 57% said doctors should be role models.
  • Among normal weight physicians 53% and 56% said they feel competent about counseling patients about diet and about exercise. But among overweight or obese doctors, only 37% and 38% felt confident.
  • Among normal weight physicians, 4% said patients are more likely to trust weight loss advice from an overweight or obese doctor while 79% said patients would be less likely. When overweight and obese doctors were asked that question, 10% said that patients would be more likely to trust their advice while 69% said they would be less likely.
  • When normal BMI doctors were asked about the likelihood patients with weight problems would trust weight loss advice from a normal weight doctor, 75% said it was more likely and 6% said less likely. But when overweight or obese doctors asked about whether patients would trust normal weight doctors' advice, 64% said patients were more likely and 8% said less likely.

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