Are Overweight Doctors a Problem for the Profession?

Robert M. Centor, MD; Pennie Marchetti, MD; R.W. Donnell, MD; Roy M. Poses, MD

Disclosures

August 02, 2006

In This Article

Pennie Marchetti: Fighting Anti-Fat Bias

Do doctors need to be slim and fit to be effective in the war on obesity? There's no doubt that personal appearance influences patients' perceptions of our abilities.[1] That's why most of us dress up, not down, when we see patients. And there is some evidence that even the obese think fat people are inherently bad and lazy.[2] So it would seem, at a cursory glance at least, that if we expect our obese patients to take our advice seriously, we ourselves should be fit and trim.

But that is an assumption that deserves a closer look. Overweight and obese people are well aware of the pervasiveness of anti-fat bias. How could they not be? Not only must they endure frequent slights from their peers, they also are hammered with almost daily condemnations in the popular press. The message is loud and clear: If you are fat, every negative health problem you experience is your own fault.

The anti-fat bias is not limited to the general public; it also exists among healthcare workers. In one study,[3] almost a quarter of nurses admitted that they were "repulsed" by obese people. In another study,[4] a majority of obesity specialists described obese people as "bad, lazy, stupid, and worthless." How good can a patient-physician relationship be if it's burdened by those kinds of emotions and prejudicial assumptions? Perhaps that's why obese women get fewer preventive pelvic exams than their thinner counterparts.[5] On the other hand, heavier healthcare professionals are less likely to categorize the obese in negative terms.[4] So, it's fair to conclude that, absent the barrier of disdain, they are able to build better relationships with obese patients.

Do you have degenerative arthritis of the knees? "Lose weight," we tell patients. Blood pressure high? "Lose weight." Plagued by indigestion? "Lose weight." Feeling tired? "Lose weight." Sometimes, doctors are even more forceful. I have had more than one patient return to me in despair and humiliation after being told by a specialist, "I won't even touch you until you've lost 50 pounds." While the recommendation to lose weight in these cases is medically sound, the blunt delivery makes the doctor's underlying bias all too clear. We may be saying "lose weight," but the obese patient hears, "Become thin. Become a better person," especially if it's a thin, fit physician uttering the admonition.

There's no evidence that obese patients are any more compliant with recommendations given by fat doctors, but they may read less implicit condemnation in that advice than they do when it comes from a thinner doctor. Empathy is a very important tool in the doctor's bag, and there's no doubt that a doctor who understands firsthand how difficult it is for some of us to maintain an ideal body weight has more empathy with his patient's struggles. That's not to say that physicians need to be fat in order to provide good care to the obese. It's just that being fit and slim does not automatically make one a better physician, any more than it makes one a better person.

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