Overcoming Pain

Why people experience chronic pain, and the power they have to de-intensify it

Trusting the Obese and Uninterested

Obese and empty of empathy: the reality of the overweight doctor-patient myth.

In a recent blog, I discussed the research findings that primary care physicians tend to develop less emotional rapport with overweight and obese patients, and the consequence that this lack of emotional connection makes the prospect for successful behavioral change, such as that which can lead to weight loss, all the more difficult to achieve.

In another recent—and perhaps more interesting--study, overweight and obese patients were more likely to feel stigmatized by primary care physicians who were themselves obese than by doctors of normal weight. Has that little glimmer of hope that an obese patient might have for a life-altering doctor-patient relationship as he or she observes that extra-extra-large white coat struggling through the door into the cramped confines of the examination room been dimmed?

These overweight and obese patients still trust their primary care physicians, regardless of their body weight. However, patients trust diet advice coming from overweight and obese physicians more, according to the research scheduled to appear in the journal Preventive Medicine:

• Among the 600 obese and overweight women surveyed, 32% who visited obese primary care physicians reported that they felt judged by the physician because of their weight, in contrast to the 14% who saw the physicians of normal weight and 17% who saw overweight physicians.

• However, 87% of women with appointments with overweight primary care physicians trusted the dietary advice provided, as opposed to the 77% cared for by physicians of normal weight, and the 82% of patients visiting obese physicians.

Using a 10-point scale in which higher numbers indicated greater trust, patients reported high levels of trust in their primary care physicians, regardless of the doctor's body weight. Specifically, the mean scores were:

• 8.6 points for normal weight PCPs

• 8.3 points for overweight physicians

• 8.2 points for obese doctors

The authors of the research concluded that high levels of trust in advice given regarding weight from primary care physicians, particularly overweight providers, may be due to the patient perceiving a shared weight identity, and a sense that there will follow a more fulfilling communication regarding health problems relating to excess weight.

So, what is going on here? It may be that overweight physicians have experienced society’s negative reaction towards those who are not slim, leading to negative attitudes that impact their patients. With an increasingly obese patient pool in this country, it is imperative that these and other barriers to effective treatment of patients be realized, and remedied.

Mark Borigini, M.D., is a board-certified rheumatologist who has devoted his career to treating illnesses that cause chronic pain and disability.

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