Can Overweight Doctors Really Help Patients Lose Weight?

Neil Chesanow

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December 08, 2016

In This Article

Where Overweight Doctors May Have an Edge

Yet the same survey also showed that "obese physicians had greater confidence in prescribing weight-loss medications and were more likely to report success in helping patients lose weight," says Dr Bleich, who led the team of investigators that conducted it. "Given that so many people are obese, all doctors, regardless of their personal weight, should provide their patients with sound advice."

Despite what some patient surveys show, overweight doctors may have even more influence than normal-weight doctors in getting overweight patients to change their eating habits, Dr Bleich maintains. Far from viewing them as hypocrites, "heavier patients tend to trust heavier doctors when it comes to diet-related advice," she says.

This may be because overweight doctors may show greater empathy than some of their normal-weight colleagues for patients who have weight problems. Lack of physician empathy is a major complaint on patient surveys, regardless of a doctor's weight.[13]

Given the anti-fat bias among doctors and nurses, "how good can a patient-physician relationship be if it's burdened by those kinds of emotions and prejudicial assumptions?" wonders Pennie Marchetti, MD, a family doctor in Hudson, Ohio, who has struggled with her weight.[14] Focusing too much on a patient's weight may harm the doctor/patient relationship, and doctors may miss the chance to discuss more serious problems that a patient may have.

Female patients who are overweight or obese, in particular, bear the brunt of "fat-shaming" on the part of physicians. One half of the women in one survey said they had cancelled or postponed their next visit with the doctor until they could shed a few pounds.[9] "Perhaps that's why obese women get fewer preventive pelvic exams than their thinner counterparts," Dr Marchetti speculates.[14]

"On the other hand," she says, "heavier healthcare professionals are less likely to categorize the obese in negative terms. So it's fair to conclude that, absent the barrier of disdain, they are able to build better relationships with obese patients."[14]

"There's no evidence that obese patients are any more compliant with recommendations given by fat doctors," Dr Marchetti hastens to add, "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 or her patient's struggles."[14]

The 'White Coat Effect'

Regardless of whether or not doctors are overweight, many do not broach the subject of healthy lifestyle changes with their overweight or obese patients, for a variety of reasons, Dr Bleich notes. Doctors may not know what advice to give, she points out. Nutritional counseling, for example, isn't commonly taught in medical school. Or doctors may not want to embarrass a patient by bringing up her weight. Or they may be concerned that a discussion about lifestyle changes will take too long for a 10- or 15-minute visit. Or they may believe that such discussions are a waste of time. After all, lifestyle regimens are a lot harder to adhere to than medication regimens, which many patients also fail to follow.

But don't discount the power of a doctor's authority—what Dr Bleich terms the "white coat effect." "Just hearing what you should do from the doctor, regardless of the doctor's weight, has a motivating effect on the patient," she asserts.

This was confirmed in study by investigators at the University of Georgia.[15,16] It found that patients were motivated to lose weight after their doctors advised them to do so—even when the patients weren't prepared to hear the message. A doctor's recommendation was associated with a 10-lb weight loss among women and a 12-lb weight loss among men. Although the study didn't show that this advice definitely produced the desired result, it was linked to greater odds of weight loss.

One reason a doctor's recommendation may lead to greater weight loss is that a doctor is able to assess multiple factors—such as diet, exercise and medical history—to determine whether a patient is at risk for obesity, says Joshua Berning, PhD, the study's lead author.[16] "Oftentimes, we have a sense of complacency with our own health," Dr Berning says. "A good physician can help us understand what kind of health trajectory we are on and how we can improve it." But, he adds, "the problem is that doctors often don't take time to talk with their patients about weight."

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