Patients less likely to trust and listen to overweight doctors

I was having a conversation with someone this week which centred around this photo which has done the rounds in the blogosphere.

Dean Ornish Mark Sissons

Essentially, this has been used by proponent of low-carb/primal/paleo eating and lifestyle who, as a rule, reject the notion that a healthy diet is one that is largely or completely devoid of animal products and low in fat.

While I generally support the former diet over the latter, it’s sometimes important to remember that our health and how we look is not always completely down to our lifestyle. Genes usually play some part, of course. During my conversation about this, we talked about elite marathon runners (Mark Sisson was a marathoner in his earlier life). It’s easy to perhaps look at a lean runner and imagine that he or she is lean because of all the running they do. However, just as plausible is the idea that someone is able to become an elite runner because they are naturally lean.

However, I also made the observation that, in general terms, we can easily make a judgment about someone’s lifestyle and even character based on how they look. The photograph above is perhaps an example of this. As is any negative feelings or judgment any of us have had on seeing a very obese person struggling to walk or making their way in a mobility scooter.

I know from experience that the reason someone is struggling with excess weight may possibly be in spite of their best efforts. For a start, someone attempting to eat a low-fat diet may be unwittingly driving themselves down a road to accumulating fat. Also, it is possible that someone can have a hormonal issue, such as undiagnosed or inadequately-treated low thyroid function, that leaves them prone to excess weight whatever steps they take.

Again, not everyone can be expected to understand these views, and the end result, again, is that many of us will simply make judgements based on what pre-formed ideas about the cause of the obesity being gluttony or laziness or both.

I am only too aware of this myself, because as someone who expressed opinions publicly on weight control, I do feel under some pressure not to be obese. I was once lecturing in Zurich, Switzerland, and a member of the audience raised the issue of ‘food reward’, and the fact that there is a form of potato chip/crisp in Switzerland that he feels is very rewarding for him, and that he can have trouble stopping eating once he’s started. I suggested I might try this snack, but he jokingly cautioned me against this saying “If you did that, you may not be able to do your job.” I asked him why, and he said “Because you would get fat and then no-one would take you seriously.” And although this communication was light-hearted and in good spirit, I think he had a point.

And this conversation came back to me today when I read a pieces of research in which the relationship between a doctor’s weight and their people’s attitudes to them were assessed [1].

Here’s a summary of the study’s findings and conclusions:

Respondents reported more mistrust of physicians who are overweight or obese, were less inclined to follow their medical advice, and were more likely to change providers if the physician was perceived to be overweight or obese, compared to normal-weight physicians who elicited significantly more favorable reactions.

This study suggests that providers perceived to be overweight or obese may be vulnerable to biased attitudes from patients, and that providers’ excess weight may negatively affect patients’ perceptions of their credibility, level of trust and inclination to follow medical advice.

Interestingly, this study found that when individuals exhibited more ‘weight bias’, perceiving a doctor as normal weight was associated with higher trust, more compassion, more inclination to follow advice, and less inclination to change doctors.

As I said, the way someone looks and their weight may have essentially nothing to do with their lifestyle and is not necessarily a reflection of their character. But this does not seem to stop individuals making such judgments. On the plus side, there is usually much someone can do to improve their health situation. For the most part, I think there’s great potential in the idea of we doctors getting our own houses in order and ‘looking the part’. This will likely benefit us not just personally, but professionally too.

References:

1. Puhl RM, et al. The effect of physicians’ body weight on patient attitudes: implications for physician selection, trust and adherence to medical advice. International Journal of Obesity advance online publication 19 March 2013; doi: 10.1038/ijo.2013.33

Thanks to Asclepius for making us aware of this relevant cartoon strip:

dilbert strip

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31 Responses to Patients less likely to trust and listen to overweight doctors

  1. Maura 22 March 2013 at 1:52 pm #

    We want our doctor to appear as ‘do as I do and not as I say’, and it is also imperative that a Govt Minister for Health should walk the talk otherwise they become a target of redicule

  2. John Walker 22 March 2013 at 2:02 pm #

    I recently failed a hospital admission screening, due to a high “BMI”. The admissions nurse tried four or five online BMI sites, and came up with four different figures for my ‘stats’. It was pointless arguing that fact alone pointed to the uselessness of that index, and besides I still do look obese. In the end, I was told I should lose a further 6 lbs to get my BMI down to sub-40. I was eating to Dr. Briffa’s recommendations from ‘Waist Disposal’, so I know I was losing weight at the time. Since then (about one month ago), I have lost a further 21 lbs. (Although from where I don’t know, as my clothes still ft the same! ) My BMI though has dropped from 42.9 to 39.5 so hopefully I shall now be able to have my second knee replacement. I need only add that the person telling me to lose weight was no stripling herself. No, not at all! It makes one wonder why the experts cannot see the link between healthy eating and the epidemic of obesity in this country, and why they cling to this ridiculous index, worked out simply as a risk assessment gauge, by an Insurance company. Not even Medical in origins then!

  3. Gay McWhinnie 22 March 2013 at 2:05 pm #

    I live in France and have been shocked at the number of doctors who smoke – one can sometimes smell it on their breath when they are taking your blood pressure, etc.
    My former GP even had his cigarettes, a lighter and an ash tray on his desk!!
    Not much confidence in him – certainly regarding trying to get people to stop smoking.

  4. Asclepius 22 March 2013 at 2:07 pm #

    Whilst I’d be happy for an obese doctor to ADVISE me to lose weight, I would certainly question advice as to HOW to lose weight if s/he were obese him/herself. If the advisor were obese then I would consider the advice too complicated that even s/he couldn’t follow it or think that the advice simply didn’t work.

    I know several people currently on weight-loss diets and they follow the usual diet of low fat/diet food and exercise religiously. They’ve sustained this diet for several years and are STILL obese, and STILL trying to lose the fat. I’ve asked a few of them when do they think they will finally achieve their goals? Next year? The year after? Another five years from now?

  5. Asclepius 22 March 2013 at 3:04 pm #

    Serendipity: http://www.dilbert.com/strips/comic/2013-03-22/

  6. Galina L. 22 March 2013 at 5:17 pm #

    I think overweight doctor who knows what it takes to loose weight and especially to keep it off is much better than some naturally thin one who would probably believe that anyone plumper than him is a lazy glutton who sustains himself/herself with junk 24/7.

  7. PAT SCOTT VINCENT 22 March 2013 at 5:59 pm #

    YEARS OF DIETING HAVE NEVER WORKED FOR MY HUSBAND. I EXPECTED WHEN WE MARRIED THAT MY HEALTHY FOOD METHODS WOULD DEAL WITH HIS PROBLEM. VIRTUAL STARVATION WILL TAKE OF A SMALL AMOUNT OF WEIGHT BUT IT WILL NOT LAST. WE EAT ALMOST THE SAME FOOD BASED UPON LOW CARBOHYDRATE DIET. i WEIGH 11 STONE, HE WEIGHS ABOUT 21. IF I LISTED WHAT WE EAT DAILY YOU WOULD BE SURPRISED AT OUR SIZE, ESPECIALLY HIS.

    MY FEAR IS THAT IF HE WERE ILL, MEDICAL PEOPLE WOULD SIMPLY ASSUME THAT HE WAS A GREEDY PIG AND HE MIGHT NOT GET THE ATTENTION HE NEEDED. HE HAS NOT SEEN A DOCTOR FOR SO LONG I CANNOT REMEMBER WHEN.

  8. Gerda Flöckinger C B E 22 March 2013 at 6:02 pm #

    My position now is that I no longer trust doctors anyway – at least not enough to blindly follow advice without careful thought and research, nor to taking unknown substances with their too frequent – but too often unmentioned – side-effects.
    As to trusting slim doctors over fat ones, I can’t see that as an issue though statistically obviously there are figures which appear to indicate that such attitudes now prevail though I would probably want to question the sample as to who the questioned actually were. That might perhaps be useful as some guide of validity of the opinion.
    Personally I would always prefer to have an intellectually and culturally orientated doctor rather than to have to think about whether there is any weight problem present.
    A thousand years ago when I still had a highly dedicated and cultured National Health doctor he had terrible weight problems which he fought against tooth and nail and invariably lost because at the time too little was known about the best ways to do this, but that most certainly did not alter my view of him as a doctor.
    In 2008 – at the age of 80 after seeing myself full-length in the mirror – I decided to get some discipline into my life, get rid of the exceedingly ugly overweight and the cellulite I had accumulated, and instead to work out a programme of exercise and diet for myself.
    My girth went down first, the weight loss took longer but followed, the improvement of muscle tone was – and still is I think – remarkable. The weight loss resulting from the changes I had made was fairly slow but steady over a period of maybe a couple of years.
    So far I have lost 23 lbs which have stayed lost.
    And I have ceased to crave foods altogether. I think the sugar craving had been the worst of all, particularly when associated with chocolate in its many forms. Though I can still manage to admire pretty confections from a distance without being interested in more intimate experience of them.
    Luckily I have digestive problems which – whilst being annoying – give me number of useful food limitations and have managed to put a cap on my extremely boring greed. However there were certain prohibitions I placed on myself from the start – as sugar, chocolate in any form, potatoes, pasta, fine-milled grains, cheese except in minute quantities, virtually all – and particularly smoked – meats and fish – and tannins.
    I still don’t know the G.I off by heart, I eat of the higher count substances, though sparingly and not constantly, but I am extremely careful in having adequate vitamins and minerals in what I do eat and as supplements where I think it is necessary.
    I do suspect that there are certain vegetables which are highly important for human health, and I still think it may be dangerous to omit all grains regardless of their contents. And that in order to feel well and be well does require considerable thought and certainly application, and that there are no easy answers to any of this that to simplify too much can actually be highly dangerous in the longer term.

  9. eddie watts 22 March 2013 at 7:55 pm #

    nice to see so many comments from people on other blogs i frequent (asclepius and Galina L)! i’ve wandered over from gnolls.org, nice to see some interesting stuff on here.

    anyway i think asclepius has hit the nail on the head: if they advise someone to lose weight that is fine, but the question has to be asked of how and also “is that what you’re doing? so…why is it not working for you?”

    i don’t think it is rude to be honest.

  10. donald 22 March 2013 at 10:02 pm #

    Surprised to hear John mention Thyroid as a possible reason for obesity , I thought that was very rare , I recall reading a GP saying he had not seen a case of thyroid related obesity in 20 yrs practice.

  11. Galina L. 22 March 2013 at 11:54 pm #

    @Donald,
    Hashimodo (the most frequent reason for an under-active thyroid) is on the rise together with other autoimmune issues, it gets routinely under-diagnosed (I really twisted my Canadian doc’s arm for a test when I was 35 years old), why it could not contribute to the obesity epidemic?

  12. Megan 23 March 2013 at 5:28 am #

    Interesting. I am overweight yet admit to such a bias, but not only towards obese doctors (and nurses) but also towards very thin ones! I am far more likely to take notice of a health care professional with a “normal” shape – one I aspre to!

  13. donald 23 March 2013 at 8:38 am #

    Hi Galina ,
    sorry to hear that , I presented to my UK doctor with symptoms that could indicate thyroid issue & was tested there & then , had a (negative) result in days.
    Hashimodo is officialy listed as a “rare disease” Hashimoto’s Thyroiditis: Rare Disease

    Hashimoto’s Thyroiditis is listed as a “rare disease” by the Office of Rare Diseases (ORD) of the National Institutes of Health (NIH). This means that Hashimoto’s Thyroiditis, or a subtype of Hashimoto’s Thyroiditis, affects less than 200,000 people in the US population.

  14. Carol AKA CarbSaner 23 March 2013 at 1:27 pm #

    Why isn’t Scott Adams president?

  15. Galina L. 23 March 2013 at 1:59 pm #

    Donald, people with low thyroid are normally not tested for the thyroid anty-bodies. How would they know? I have experience with health care systems in Russia, Canada and US. I asked my US doc why was it so, and he answered that it would make no difference in a treatment, so what was a point to get unusable info?

  16. Dr John Briffa 23 March 2013 at 2:08 pm #

    Galina L and Donald

    I see Hashimoto’s thyroiditis (and other forms of hypothyroidism) regularly in my practice, and hypothyroidism is a quite common cause of excess weight in my experience.

    In my view, those who say these issues are rare are:

    1. people with no clinical experience

    2. people with clinical experience who see patients vastly different to the ones I see (unlikely)

    3. people with clinical experience who don’t often consider and test for Hashimoto’s or perhaps thyroid disease generally (see Galina’s comment above)

    4. people who believe that all overweight people must be lazy and/or greedy and that hormonal issues (including thyroid disease) are largely an ‘excuse’

    Donald – do any of these apply to you, do you think?

  17. Dr John Briffa 23 March 2013 at 2:16 pm #

    Asclepius

    Thanks for that – very funny and very relevant!

    I’ve put the strip at the bottom of the post.

  18. Paul 23 March 2013 at 2:48 pm #

    One definition of insanity is, “undertaking the same task over and over again, but expecting a different result”.

    So, with a 95% failure rate of dieting, one would question whether the ‘eat less, move more’ mantra has any place in weight loss advice.

    It follows that an obese health care professional who suggests such advice yet for whom it has clearly not worked on a personal level (and probably on several occasions), and who would have seen many patients who have failed, is clearly insane.

    ‘Insane’ is an entirely rational conclusion for a patient to arrive at if being ‘advised’ by an overweight GP, or nurse.

  19. Donald 23 March 2013 at 4:47 pm #

    Hi John
    Hopefully none of them ! I claim no medical experience , I tend to be sceptical of both “sides” of an argument initially & try & do my own research on reputable websites both independent & government/official body backed . In this instance I commented based on the writings of a GP who , with hindsight appears to fit category 3. On Further research it seems the incidence is somewhat higher than my initial research led me to believe , my error.Apologies. I found this online which gives a higher incidence than the first article & I am happy to accept your word that you believe it to be underdiagnosed. http://emedicine.medscape.com/article/120937-overview#a0156
    Can you clarify one thing for me please , when my GP took a blood sample & told me (2 days later) that it was normal would such a test normally pick up Hasimoto’s , or should I be requesting a further test ? (50 yr old male , primary symptom marked decrease in cold tolerance in last two years)

  20. Galina L. 23 March 2013 at 5:08 pm #

    Donald, it is great that you are looking for the second opinion. As I understand, there is a disagreement even between medical professionals about what it normal when it comes to the thyroid test results. In my case symptoms were present even with normal lab results after I started to take synthroid until I changed my medication for natural pig-derived thyroid (it contains T3).
    May be you would find that blog interesting – http://www.stopthethyroidmadness.com/

  21. Dr John Briffa 23 March 2013 at 5:14 pm #

    Donald

    If you have no medical experience then you have no clinical experience, probably, so it sounds likes 1. applies.

    I don’t know what your GP tested for so I can’t comment on whether or not the test would normally pick up Hashimoto’s. The condition is normally diagnosed when what’s called ‘thyroid autoantibodies’ are present.

  22. donald 23 March 2013 at 5:24 pm #

    Thanks Galina & John
    I do think (1) should be split in to 2 subgroups ,(a) people who take little interest in their health and are unable or unwilling to learn , you only need to look at junk food sales to see how big this group is, & (b) people who try & live healthily & are actively interested in health & desire to learn more , I hope I & most (if not all) your blog readers are type 1b !
    Fair comment re test , I was just curious as to whether thyroid antobodies are routinely tested for by British GP’s .

  23. Dr John Briffa 23 March 2013 at 5:28 pm #

    Donald

    By ‘clinical experience’ I mean clinical experience as a health practitioner.

    Thyroid autoantibodies are not routinely checked for in my experience, which is part of the problem, I think.

  24. Galina L. 23 March 2013 at 6:07 pm #

    Just some clarification, I don’t want to tell that every other person who can’t tolerate cold has a Hashimodo decease, my message is that all that is not a very clear issue. Many people may have low-thyroid symptoms after a successful weight-loss. I noticed a tendency on a blogosphere to blame LC and paleo diets for low-thyroid symptoms, while it is just a part of our body normal reaction to resist the weight loss.
    We can’t relay on doctors alone to sort out all health issues. We have to learn how to manage our health and properly listen to our bodies.

  25. donald 23 March 2013 at 10:03 pm #

    Absolutely Galina , I found the web link you sent very interesting but I would always consult my GP as well in such matters . That is the point I was attempting to make by splitting type 1 into two sub types , obviously all type 1 are people without clinical experience as a health practioner , however , if there are two patients with undiagnosed Hasimoto’s Thyroiditis , they both see a type 3 practioner then , to me it highly likely that a type 1(b) patient will have a better health outcome than a type 1(a).
    Today has been very educational !

  26. Craig 24 March 2013 at 3:53 pm #

    The original image you posted of Mark Sisson is typical of the kind of vitriol that is spat between each camp of nutritional advice. Though the image you posted is light-hearted, there really does exist this desire to discredit the other camp through things like body image, or how they died.

    It’s why people say that Dr. Atkins died of heart disease – As if to discredit the diet he spent years advocating (http://lowcarbdiets.about.com/od/atkinsdiet/a/dratkinsdeath.htm).

    It’s sad… Some people can do fine on grains and carbohydrates. There is more merit in athletes using them. But for the general population, eliminating or limiting carbohydrates is sound advice that will cause no harm.

  27. Chloe 25 March 2013 at 9:00 am #

    Many people are overweight despite ‘knowing’ what they should be eating – I know lots of very overweight dietitians, for example. Other issues come into play, emotional, social, stress-related issues.

    I’m a hypnotherapist and am very aware that if I were to be overweight, or bite my nails for example, it would cause people to lose faith in me.

    Many people see the isdea of cutting out bread from their diet as too ‘out there’ and unrealistic. Hopefully soon low carb eating will be more mainstream and less far outside of people realms of what is realistic for them.

  28. Tom 25 March 2013 at 12:22 pm #

    I’m a doctor that used to be overweight (“obese” in fact, according to BMI). After a year and a half eating lower carb/paleo I am now a relatively lean BMI 26 (perfectly healthy for someone who is quite muscular), and have gone from squeezing into size 38 trousers to enjoying shopping for 34 inch waists.
    Losing weight has been bittersweet for me: mostly sweet as I feel more confident, healthier etc. but it has outlined the prejudice overweight people are subject to. I feel my patients – in fact, pretty much everyone – gives me more attention, respect and so on.
    I fully agree that you don’t want to take advice on weight loss from someone who is obese. But assumptions go way beyond that; getting labelled as fat and lazy, greedy and so on, when in fact I am very much the same guy I was two years ago. We (low carb/primal eaters) of all people should be sympathetic to our overweight friends, colleagues and healthcare providers as we know that they may be trying really hard, but as they have been grievously misinformed about the likely cause of their weight problem and how to manage it effectively, are not seeing results and are becoming disheartened and depressed.
    Let’s keep it positive and try to correct people’s misinformation, rather than criticise and mock; they will have had plenty of that already.

  29. Jon Wade 27 March 2013 at 10:06 pm #

    It works both ways. When I was studying health sciences with the OU we discussed how doctors sometimes treat overweight patients differently – they feel that they will not make a real effort to follow a prescription etc.

    Seems to be some level of mistrust with overweight people – could it be evolutionary? Fat people must be eating more than their fair share and not to be trusted in the group?

  30. fluff 1 May 2013 at 1:39 am #

    No I don’t think its evolutionary. It is the Western culture and media who successfully program people to think a certain way. When i was a little girl, innocent, my smiling chubby grandma was the loveliest thing in the world, her weight was not an issue to me, nor anyone else. Our Dr wasn’t thin either by today’s standards. I have weight on due to multiple endocrine problems, unfortunately my son gets picked on for my obesity. People are ignorant and cling to the last ‘ism’ they are allowed.
    I read comments under newspaper articles and marvel at people’s harshness and lack of empathy, they usually represent the ‘popular’ attitude programmed into them :(.
    Sadly looks seem to be everything now, even respect and ability to do a job has been brought into looks. Very sad.

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