Research already demonstrates that physicians are sometimes uncomfortable talking about weight with their obese patients. Now, a new study shows that the doctors’ weight makes a difference too.
Physicians who pack on the pounds discuss weight loss less frequently with obese patients than doctors who have normal body-mass indexes (18 percent versus 30 percent), according to the report published this week in the medical journal Obesity. And they’re significantly less confident of their ability to provide effective counseling about diet (37 percent vs. 53 percent) or exercise (38 percent vs. 56 percent).
The findings come from an Internet survey of 498 family doctors, internists and general practitioners conducted early last year by researchers at Johns Hopkins Bloomberg School of Public Health. Two-thirds of the physicians were male, almost three-quarters were at least 40 years old and 53 percent were overweight or obese.
The results matter. More than 66 percent of American adults are overweight or obese and their medical costs total $147 billion. If heavy doctors won’t acknowledge that patients have a problem and offer help, that can be a barrier to effective care, says Sara Bleich, lead author of the new study and an assistant professor of health policy at Johns Hopkins Bloomberg School of Public Health.
A notable finding in the study speaks to the problem: 93 percent of physicians of normal weight said they would be more likely to identify an obese patient when that person was as large or larger than they were. By contrast, this was true of only 7 percent of obese or overweight physicians.
“It seems to be the case that doctors are less likely to diagnose the patient until the patient’s weight meets or exceeds their own,” Bleich says. This could be because physicians’ sense of what’s “normal” changes as they put on pounds and see more excessively heavy patients in their practices, she speculates.
Asked what might explain heavier doctors’ reluctance to discuss weight loss, Bleich says, “It could be that they feel that their advice will not hold a lot of weight with their patients, because they themselves are heavy.” Overweight and obese physicians expressed greater confidence in prescribing weight loss medications than other doctors, perhaps because they’ve had personal experience with the medications or with the difficulty of behavior change, she observes.
This isn’t the first time that research has shown a link between physicians’ personal characteristics and their willingness to advise patients on lifestyle issues. “We know that physicians who follow healthy dietary practices themselves are more likely to spend time counseling patients about diet,” says Dr. Robert Kushner, a professor of medicine at Northwestern University Feinberg School of Medicine and clinical director of Northwestern’s Comprehensive Center on Obesity. Other research has shown that physicians who smoke are less likely to help patients quit tobacco use.
Bleich and her co-authors close their study by suggesting that doctors, who also report high levels of stress, substance abuse and depression, need to be encouraged to take better care of their health, both for their own sake and patients. Northwestern is one of the few medical schools to incorporate this in its curriculum: Since 2008, it has offered a mandatory six-week course on healthy living. “Our philosophy is that if doctors understand how to take care of themselves, then they can be a better teacher and guide to their patients,” Kushner says.