Are Doctors Nicer To Thin Patients?

"First do no harm" has been the doctor's motto for two thousand years, and there is no evidence that patients in the United States are systematically deprived of essential medical care on the basis of their weight. A fascinating study conducted by researchers affiliated with the medical school at Johns Hopkins University, however, found that doctors are nicer to patients who are thin or of average weight than to overweight and obese patients.

The Johns Hopkins researchers obtained permission to record conversations between 39 primary care physicians and 208 patients who were suffering from high blood pressure. Among the 200 patients, 28 were thin or of a normal weight (having a body mass index of 25 or less), 60 were overweight (having a body mass index between 25 and 30), and 130 were classified as obese (having a body mass index over 30).

The researchers did not detect any differences in the medical treatment the patients were offered. Doctors spent the same amount of time with overweight and normal weight patients, and discussed the same kinds of concerns.

In a conversation with a normal-weight patient who had had surgery on her leg, for instance, the doctor commented "You've still got great legs" when the patient lamented that her surgical scar was still visible and she had to wear ugly shoes. "Clunky shoes are still in," like Crox. "Get something...for spring. That always makes you feel good."

When another normal-weight patient commented that she wasn't having as many hot flashes as in the recent past, the doctor commented, "I am glad you are feeling better now." When a patient expressed frustration over difficulty getting an appointment with a specialist, the doctor answered, "I agree with you. (It's) extremely frustrating when that happens."

The Johns Hopkins researchers used a standardized psychological measurement instrument called the Roter Interaction Analysis System to confirm their impressions that doctors built stronger emotional bonds with thinner patients. There were no incidents of overt unprofessionalism, no insulting or snide remarks, no in-your-face comments on patient obesity, although this may reflect the fact that both the doctors and the patients knew that their conversations were being taped.

And the scientists did find that patients in general received emotional encouragement from their doctors, although overweight or obese patients receive approximately 35% fewer indications of emotional encouragement from their medical care providers. The Johns Hopkins research team did not find, however, that overweight or obese patients received less medical information from their doctors.

Why Building Rapport With Your Doctor Makes A Difference

Of course, if you happen to be overweight, the idea that doctors seem to dislike fat people won't strike you as in any way strange. If you are overweight and you go to see your doctor about a sore throat, chances are that you will also be told you need to lose weight. If you are overweight and you go to the ER with a broken finger, you might just be told you need to lose weight. And if you are overweight and you go to the doctor for weight loss advice, you are told you should have come in earlier.

The simple fact is that people who are overweight or obese often indulge in "doctor shopping" to find a medical provider they are comfortable with, and starting over with a new doctor often involves repeating medical tests and losing continuity of care. Or, worse, overweight patients cannot find a doctor they do not feel is insulting them and stop going in for medical treatment altogether as a consequence of this unfortunate fact.

As a result, the first diagnosis of heart disease may be a finding of sudden death by the medical examiner, the first detection of diabetes may occur after blindness or gangrene, or cancer treatment may not be initiated before the condition has reached its advanced stages. Both doctor shopping and receiving care from a doctor who does not take your concerns seriously and who you avoid seeing as a result can have extremely serious consequences, then. Finding a doctor you can trust and feel respected by is, without hyperbole, a potential matter of life and death.

What can you do if you are overweight and you feel your doctor is cold or disrespectful?

Here are some simple suggestions:

• Seek medical care at clinics that make compassion a priority. The Yale University Medical Center clinics, for example, make sure their doctors have sensitivity training. Similar programs are found in clinics all over the country — but they aren't everywhere.
• If you struggle with your weight, make sure your doctor knows that the measures you are taking. If dieting doesn't work for you (and it usually doesn't), ask the doctor what to do instead. Then consider the advice seriously.
• If you are happy with your size, let your doctor know this, too. Insist that your doctor make recommendations on more measurements than just your weight.
• Don't tolerate overt rudeness, a suggestion that you are lazy, stupid, or gluttonous, for example. On the other hand, don't conflate ill-phrased but well-intentioned remarks into grounds for taking offense, as there is no question that losing weight will indeed improve your health outcomes. 
• Take into account that doctors are people, too, and antipathy to obesity is rooted in American culture. Be the more mature party of your transaction with your doctor. Get the medical advice you need and go on your way.

Or you might just seek out a physician who is himself or herself overweight. In another study, some of the same researchers at Johns Hopkins found at doctors diagnose obesity in 93% of patients who are heavier than they are, but in only 7% of patients who are not. Doctors suggest weight loss for 89% of patients who are heavier than themselves, but in only 11% of patients who are not. When your doctor is overweight, too, they will understand your struggles and this may translate into a friendlier experience.