The Weight of CareExploring the Influence of Physician Bias

on Patient Care

Overview

Background Methodology Results Findings Implications Conclusion Questions

Background

Prevalence of obesity increasing Providers interacting with increasing

numbers of overweight/obese patients Early research found that obese/overweight

patients were less likely to seek care, avoid preventative care

Research Question

Do physicians view obese patients more negatively than normal weight patients and does this affect recommendations for care and physician expectations for success?

Methodology

GoogleScholar PubMed Search terms: physician bias, physician

attitude, obese, overweight Selection Criteria

› Study Locus› Type of Study› Sample Demographics› Geography

Results

Grenier et al: Discussing Weight with Obese Primary Care Patients: Physician and Patient Perceptions

Year Sample Methods Findings Limitations

2008 456 patients with BMI >30, 30 physicians, patients primarily female, physicians primarily male

Survey Although physicians and patients had different perceptions about weight consultation during office visits, patients reported positive interactions.

Recall Bias

Limited generalizability due to primarily white female sample size

Results

Wadden et al: Obese Women’s Perceptions of their Physicians’ Weight Management Attitudes and PracticesYear Sample Methods Findings Limitations

2000 259 women with BMI >30

Questionnaire Patients were generally satisfied with care and reported positive experiences, but reported lower satisfaction with care specific to weight management. Specifically, patients expressed difficulty speaking with doctors about weight issues and expressed frustration that doctors failed to understand the difficulties of being overweight.

Limited generalizability

Selection bias

Results

Galuska et al: Are health care professionals advising obese patients to lose weight?

Year Sample Methods Findings Limitations

1999 12,835 adults with BMI >30 (BRFSS sample)

Telephone Survey

Less than half of participants had been told to lose weight. Patients who were told to lose weight reported that they were trying to lose weight at a rate more than twice that of those who had not been advised to lose weight.

Recall Bias

Results

Foster et al: Primary care physicians’ attitudes about obesity and its treatment

Year Sample Methods Findings Limitations

2003 5000 primary care physicians

Questionnaire Physicians attributed obesity to behavioral factors, viewed obese patients more negatively than average weight patients and expressed limited expectations for successful treatment.

Polarity of Statements Ethical/professional norms

Results

Hebl and Xu: Weighing the care: physicians’ reactions to the size of a patient

Year Sample Methods Findings Limitations

2001 122 physicians Mock patient evaluation form and follow-up evaluation

Physicians reported that they would spend 31.1 minutes with average weight patients. In contrast, physicians reported that they would spend only 22.4 minutes with obese patients. Physicians reviewing the files of obese patients were also more likely to report feeling annoyed with the patient and attribute obesity to behavioral factors

Small sample size Geographically homogenous sample Primarily male

Findings

Attribution of obesity to behavioral causes connected to negative attitudes

Barriers to discussions about weight and a sense of discrimination persist

Low expectations and self-efficacy

Talking about weight management positively correlated with patients actively trying to lose weight

Implications

Physician training on obesity

Clear communication

Diverse populations Unintended

treatment bias

Questions?