Can Overweight Doctors Really Help Patients Lose Weight?

Neil Chesanow

Disclosures

December 08, 2016

In This Article

Bias Against Overweight Patients

Few issues in medicine are more contentious than the obesity epidemic and what to do about it. According to the National Institute of Diabetes and Digestive and Kidney Diseases, two thirds of adults in the United States aged 20 years or older are overweight (body mass index [BMI] 25-29.9 kg/m2) or obese (BMI ≥ 30 kg/m2).[2]

Although political correctness has affected social etiquette in many areas of life—from gender identity to sexual, racial, and religious identity—bias against overweight people is a continuing social prejudice, Dr Puhl observes.

Research shows that healthcare professionals are not exempt from bias against overweight patients. In one study, almost one quarter of nurses admitted that they were "repulsed" by obese people.[3] In another study, a majority of obesity specialists described people who were obese as "bad, lazy, stupid, and worthless."[3]

But is being overweight or obese a character flaw, a disease, a genetic condition, or a metabolic issue? Each of these perspectives has its adherents.

A study of contestants on the NBC reality television show "The Biggest Loser," in which obese people attempt to lose as many pounds as possible, shed new light on the issue.[4] One contestant, who weighed 430 pounds in 2009, set a program record—dropping 239 pounds in just 7 months. But in subsequent years, despite herculean attempts to keep the weight off, he regained over 100 pounds. Most contestants who were studied, who collectively lost hundreds of pounds, regained much, if not all, the weight—or ended up weighing even more than when they began—despite their best efforts to stay slim.

The reason, the investigators discovered, was not a lack of willpower but a quirk of resting metabolism, the mechanisms of which are still not well understood.[4] The contestants, when obese, were burning the normal number of calories for people of their weight. But after years of dieting, their metabolisms had slowed to the point where their bodies were not burning a sufficient number of calories to maintain their hard-won slimness. As the years went by, their metabolisms slowed even more, causing their weight to climb. It was as if their bodies were dragging them, against their will, back to their original weight.

Still, ingrained prejudices are slow to change, even in the wake of scientific evidence that refutes the assumptions on which the prejudices are based. When it comes to negative attitudes about people who are overweight, physicians are no exception.

In Medscape's 2016 Lifestyle Report, in which over 15,000 physicians in 25 specialties took part, 40% admitted that they had biases toward specific types or groups of patients.[5] Of these, 56% of male doctors and 48% of female doctors said the factor most likely to trigger bias in patients was the patient's weight.[5]

Moreover, according to survey responses, 14% of emergency physicians; 11% of family doctors, orthopedists, and psychiatrists; and 9% of internists, pediatricians, and ob/gyns said that their biases affected their treatment of patients.[5]

Obese Patients Have Biases Too

Medicine may be an elite profession, but its practitioners are prone to the same mental and physical health problems as nonphysicians. Doctors have similar rates of depression,[6] suicide,[6] alcohol abuse,[7]and drug abuse[7] as the general population.[8]

The incidence of physicians who are overweight or obese is also similar. One study found that 51% of family doctors, internists, and general practitioners are overweight or obese—not quite the two thirds of the rest of the population that needs to slim down, but close enough.[9] In Medscape's Lifestyle Report, 49% of family doctors, 43% of internists, and 41% of pediatricians who took part reported being overweight or obese.[5]

If doctors are sometimes biased against their overweight and obese patients, what of patient attitudes toward physicians who are carrying extra pounds? Surveys show that patients whose doctors are overweight or obese are significantly more likely to change physicians than patients who have doctors described as being of normal weight—regardless of the weight of the patient.[1] Doctors with "tight-white-coat syndrome" may be viewed as less credible and trustworthy than normal-weight doctors, these surveys show, and patients are less likely to follow their medical advice.[10]

George Fielding, MD, for one, knows this from firsthand experience. Dr Fielding, a bariatric surgeon at New York University's Langone Medical Center, once weighed 330 pounds.[1]"People would come in for consultations and say they would do [lap band or gastric bypass surgery], and then they didn't come back," he recalls. "I knew they were probably thinking, 'Wow, he's fat! Is he any good?'"

In Medscape's Lifestyle Report, 45% of general surgeons reported being overweight or obese.[10]

"Patients seem to hold doctors to a stricter standard," Dr Puhl says. "If you're a health professional, people think you shouldn't be struggling with your weight."

Nor are many normal-weight doctors inclined to give their heavier colleagues a pass. Doctors should be role models, some of them insist.

"Now, I understand that expecting physicians to control their weight may seem draconian," conceded Robert M. Centor, MD, professor of medicine at the University of Alabama at Birmingham, in an essay on whether overweight doctors are a problem for the profession.[11] "However, for those who believe that this is good advice for patients, the failure to act personally on such advice is at best hypocritical and at worst disingenuous."

Dr Centor is not alone in this belief, even though a high correlation exists between doctors who are overweight or obese and physician burnout.[10] Many doctors can't find enough hours in the day to see patients and spend time with their families, let alone make time to shop for and prepare healthy meals and exercise with any regularity.

In fact, trying to squeeze exercise into a chronically overfull schedule can be a catch-22, ultimately leading to weight problems for an overworked physician.

"Count calories and exercise" is appealingly simple advice, notes family doctor Robert W. Donnell, MD, a staff physician at Mercy Clinic in Rogers, Arkansas, who has struggled with his weight.[12] But it's not as easy as it sounds. "The Institute of Medicine recommends at least an hour a day of moderately vigorous physical activity, but for busy doctors, the benefits of exercise come at a high price. With only so many hours in the day, something has to give, and often it's sleep. Ironically, recent research has implicated sleep deprivation as a contributor to obesity. Thus, a compulsive schedule of exercise conceivably could produce diminishing returns if sleep deprivation counters the benefits."

Doctors who are overweight often internalize the criticisms of their normal-weight colleagues all too well, as an Internet survey of 498 family doctors, internists, and general practitioners demonstrated.[8] Respondents who were overweight or obese, the survey found, discussed weight loss less frequently with obese patients than doctors with a normal BMI (18% vs 30%). In addition, the heftier doctors were significantly less confident in their ability to provide effective counseling about diet (37% vs 53%) or exercise (38% vs 56%).

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