Doctors’ Anti-Fat Bias Costs Us Dearly
A recently published study compared doctors’ attitudes toward obese patients with the general population’s attitudes toward obesity and found no difference between the two. As the study concluded, “Weight bias among medical doctors is widespread”.
The researchers analyzed voluntary self-assessments by the general public and by doctors – 78% of whom practiced medicine in America. There were a few physician characteristics that bear mentioning:
Male doctors showed stronger anti-fat bias than female doctors;
Younger doctors showed stronger bias than older doctors – the median age of participating doctors was only 34; and
Even obese doctors showed “moderate” bias against their obese patients.
Here’s why these findings are so troubling.
Physician Bias Harms Patient Care
Doctors are supposed to understand both the multitude of reasons why their patients may be obese – which extend far beyond the stereotypical assumptions that they’re lazy and unmotivated (and may even include the medications they‘re prescribed) – as well as the medical consequences of obesity that require special attention, not disdain. (See this CDC report on the role that genetics plays in obesity).
In other words, they’re expected to be professionals – to put their patients’ interests before their own prejudices. Yet many do not.
This study reported that “Only 56% of primary care physicians (participating in their survey) felt qualified to treat obesity”.
I discuss this phenomenon in Our Healthcare Sucks, noting that “Less than 4 in 10 reported they counsel their obese patients about their need to lose weight despite compelling evidence of its benefits and their increased risks with failing to lose excess weight”.
And this obstacle to appropriate medical care is getting worse as the obesity crisis itself worsens. Again from this study:
“Physicians’ stereotypical attitudes of obese people as lazy increased 145% between 1998 and 2005, with younger physicians more likely to endorse this attitude.”
This has consequences for both the affected patients and for the rest of us. Obese patients often avoid medical care because of these discriminatory and humiliating attitudes by doctors and their office staff. According to this study’s results:
“53% of overweight and obese women reported receiving inappropriate comments about weight from their doctors…Obese patients who report perceptions of weight discrimination avoid seeking routine preventive care such as cancer screenings.”
Given that excess body fat contributes to a much higher than average cancer risk, this means these high-risk patients are effectively deprived of screenings they need more than the average patient simply due to their doctors’ ignorance.
And given that an estimated 75% of Americans are expected to be overweight by 2015 – and 40% of them obese – this translates into a growing proportion of patients being subjected to growing anti-fat bias among physicians. This is a formula for worsening healthcare that transcends anything Obamacare can be expected to address.
And it has nothing to do with physician payments or medical malpractice. It has only to do with personal biases that not only interfere with doctors’ professional duty to their patients, but directly negates it. Instead of being advocates for these patients’ healthcare needs, these biases are roadblocks to effective healthcare as surely as not having health insurance.
And because obese patients cost over one-third more than average to treat, this medical neglect impacts everyone’s health insurance premiums.
Bad Attitudes Equal Bad Medicine
Obesity is directly linked to metabolic disorders that lead to at a multitude of chronic diseases that account for 75% of our healthcare costs. These include heart disease, cancer, type 2 diabetes, and dementia/Alzheimer’s Disease.
As the following video from the excellent University of California video series “The Skinny on Fat” outlines, 80% of obese people suffer these metabolic disorders – twice the rate of the non-obese population. This physician ignorance is costing Americans dearly – and not just obese Americans.
And if you’re feeling more ambitious, this longer video of an expert medical panel discusses the cancer-obesity link in greater depth:
As one of the panel participants notes, obesity now exceeds smoking in terms of its cancer risk – and resistance to cancer treatments. You have to go to minute 44 in the second video above for discussion of “skinny fat” – or “metabolically obese thin” population – and their increased cancer risk.
Combined with the medical avoidance caused by humiliating medical attitudes toward obese patients, this adds up to a “whole bowl of wrong” – as the formerly obese Jeff Green character on “Curb Your Enthusiasm” might describe it.
And it’s a whole bowl of medical neglect, inefficiency and unnecessary medical spending that could be averted without complex legislation or regulation, medical coding or malpractice reforms – just a simple attitude adjustment that would realign doctors with their Hippocratic Oath to “Do no harm”.
Is that too much to ask?
UPDATE: One of my Twitter followers, Dr. Kevin Campbell, a North Carolina cardiologist whom I also follow – tweeted about the genetic aspects of obesity, which led to a little Twitter dialogue that went as follows:
@DrKevinCampbell – Study ties obesity-related gene to weaker memory…
@OurH_careSucks – Updated my latest post on docs & obesity to reflect this (see above)…
@DrKevinCampbell – Great article! I wrote something in February focused on MDs setting an example…
@OurH_careSucks – Well said, Dr. C. What if overweight MDs enlisted pts to JOIN THEM in a weight loss program? A twofer!…
@DrKevinCampbell – What a great way to PARTNER with your patients!
Any overweight docs out there who’d like to lead by example? Nobody has a bigger impact on your patients than you.
Tell us what you think by commenting below.