Do Overweight Patients Get the Cold Shoulder?

Doctor with Stethoscope Holding Red Measuring Tape.

Could how much you weigh determine how nice your doctor is to you?

A new study published online in the journal Obesity says yes. In fact, the study suggests that doctors make fewer efforts to bond with patients who are overweight or obese compared to their normal-weight counterparts. This lack of empathy may ultimately hurt the doctor-patient relationship, making it even harder for patients to lose weight.

In the small study, researchers at Johns Hopkins University in Maryland analyzed audio recordings of 208 patient encounters, evaluating how often doctors demonstrated empathy, concern and reassurance. They focused particularly on small statements such as “I’m glad you’re feeling better” or “I can see how frustrated you are.” While the study’s authors did not encounter doctors being more critical or rude toward their heavier patients, they did note a distinct lack of such small efforts to connect emotionally.

The effects of decreased empathy for overweight and obese patients may go beyond hurt feelings. Studies have long shown that the more empathetic the doctor, the better patient satisfaction and healthcare outcomes are. This is especially important for patients who are at greater risk for health problems and who could benefit from lifestyle and behavior changes – categories into which overweight and obese patients often fit. Additionally, other studies have specifically shown that patients are more likely to exercise and change their diet when their doctors show more empathy.

The reasons underlying the study’s findings remain unclear. Prior studies have suggested that primary-care physicians have more negative feelings toward overweight and obese patients. Experts have suggested that physicians may simply share a larger societal bias against overweight people, or may feel frustrated along with their patients by how difficult and slow it is to lose weight.  Another hypothesis is that physicians feel overwhelmed by the increased health risks and coexisting medical conditions that often accompany obesity.

But it’s not only patients who benefit from empathy – doctors have much to gain themselves. Being more empathetic in patient interactions can result in fewer malpractice cases and decrease the rate of physician burnout, which may affect up to 40% of doctors.

The study also yielded some other encouraging results. Doctors still made an effort to build positive rapport, including employing humor and compliments, with all their patients regardless of weight. In addition, the amount of time spent with each patient did not depend on weight, and doctors made equal efforts to gather patient histories and provide education and counseling to all patients.