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Doctors have weaker emotional rapport with obese, overweight patients: study

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New research from Johns Hopkins finds physicians are less likely to form an emotional connection with patients who are overweight, which could negatively affect the quality of care.

The study, which appeared in the journal Obesity, looked at nearly 40 primary care doctors – along with more than 200 of their patients – and determined that doctors were significantly more likely to show empathy, concern and understanding to patients who were of a normal weight.

That could be a problem, said lead author Dr. Kimberly Gudzune in a press release. The John Hopkins assistant professor of medicine said not "establishing a rapport with your patients" could make them "less likely to adhere to your recommendations to change their lifestyles and lose weight." Said Gudzune:

Some studies have linked those bonding behaviors with patient satisfaction and adherence, while other studies have found that patients were more likely to change their dietary habits, increase exercise and attempt to lose weight when their physicians expressed more empathy. Without that rapport, you could be cheating the patients who need that engagement the most.

The researchers didn't find any indications that patients' weight affected how doctors questioned the patients, the medical advice and counseling they dispensed or the treatment regimens they discussed.

More than mere niceties

Even so, that rapport isn't a superficial pleasantry. Dr. Sharon Orrange, an internist and associate professor at the Keck School of Medicine of USC, said the study's findings "should really be a heartache to everyone who works in medicine."

"Hopefully this isn't a mystery to anyone," said Orrange. "When it comes to [patients'] either heeding your advice, taking medications you prescribe, following up on lab results, coming to see you for a three-month follow-up – they are only going to do that if you establish a connection with them."

A lack of that sort of connection breeds noncompliance, she explained, because a lot of patients have a hard time listening to someone they don't trust. That's especially true in underserved areas like South Los Angeles, where regular medical care isn't a given.

"It is a tall order to ask somebody with less social support, with a lower socioeconomic status, to follow the rules," said Orrange. "To change their diet, to exercise, to surround themselves with people who love them, to take their medications. It's a much taller order for people who don't have social support or financial well-being. So the connection is even more important."

Orrange called the Johns Hopkins results "discouraging," but was hopeful that medical providers are getting better. She did note that generally, "physicians and patients alike have negative attitudes toward obese patients."

"What I think is at the core of this is that physicians feel that obesity is an easily modified, easily changeable risk factor, and they feel frustrated that patients don't just wake up one day and lose weight," she said. "I don't agree with that attitude but I think that's where it comes from."

The reality of weight bias

A 2012 report from the Yale Rudd Center for Food Policy & Obesity highlighted the issue of weight discrimination, which the report said "affects millions, at a steadily increasing rate":

  • It cited statistics that report that 1 in 3 doctors list obesity "as a condition to which they respond negatively." Some associate it with "noncompliance, hostility, dishonesty, and poor hygiene."
  • Another study indicated that doctors often view people who are overweight as "lazy, lacking in self-control, non-compliant, unintelligent, weak-willed, sloppy and dishonest."
  • In a survey of nearly 2,500 overweight women, more than 2 in 3 said they'd experienced bias because of their weight – and more than half of those women said it'd happened more than once.

Last November, Rebecca Puhl, the Rudd Center's director of Research and Weight Bias Initiatives said in an interview that the problem is exacerbated by the media's negative portrayal of people who are overweight and the fact that in most places, weight isn't a legally protected class.

There's also a prevalent notion that preventing obesity is rooted in personal responsibility.

"That kind of approach, unfortunately, really creates a lot of blame on people who are obese," Puhl said at the time. "And that blame translates to pervasive stigma."

The latest data from the L.A. County Department of Public Health indicates that about 1 in 3 adults in South Los Angeles are obese.

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