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Overweight, obese patients more likely to jump from doctor to doctor

Rude comments from medical staff, unsolicited weight-loss advice from doctors or improperly-sized medical equipment can drive patients living with obesity to switch providers, said researchers.
Rude comments from medical staff, unsolicited weight-loss advice from doctors or improperly-sized medical equipment can drive patients living with obesity to switch providers, said researchers.
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Patients who are obese and overweight are more likely to repeatedly switch primary care providers, according to a new study, which can present a problem to the health of those patients.

A recent study published in the journal Obesity says "doctor shopping" may be more common among these patients because they tend to have more negative experiences with the health care system. That could mean inconsiderate comments about their weight from medical staff, unsolicited weight-loss advice from their health providers or improperly-sized office equipment.

South Los Angeles has the second-highest obesity rate in the county: 1 in 3 adults are obese. Dr. Derrick Butler, the associate medical director at T.H.E. Clinic, said providers should "treat it as a medical issue."

"Patients know they're obese," he said. "They walk outside, they see it, feel it; they look at the TV and see they're not thin. The provider needs to understand that and, I think, be matter-of-fact."

In doing so, said Butler, a health provider can "destigmatize" obesity.

"It's not something that's wrong with you, but a physiological reason for the way you are," he said. "You have to understand that there are health risks associated with it, then have a patient buy into a partnership."

It's important that patients who are overweight or obese make a habit of regularly going to the same doctor, because a lack of steady, routine care can contribute to other dangerous conditions. Butler ticked some of them off: diabetes, high blood pressure, joint pain, back pain, high cholesterol.

Patients who frequently switch providers are also less likely to find themselves in medical homes, which means they're less likely to get coordinated care. Their primary care doctor may not know what medications were prescribed to them at a different clinic, for example, which could affect how they prescribe medication.

"When patients bounce around, you completely lose that coordination," explained Butler. "You lose that doctor-patient relationship, so they never get empowered because they're always having to start over with a different doctor."

That's not good, he said, especially because weight-loss is such "a long process."

"It's not like you see one doctor, and all of a sudden you're on the road to weight loss," Butler said. "You're talking a process of up to three years to really achieve significant, consistent weight loss or addressing that issue."

Dr. Kimberly Gudzune, an assistant professor at Johns Hopkins University School of Medicine, led the study. She and her colleagues looked at nearly 21,000 patients in a BlueCross BlueShield database; of those, they found that more than 1 in 5 had seen at least three doctors within a two-year period. The odds of a patient switching doctors increased by 19 percent if they were overweight and by 37 percent for those who were obese.

"There’s something going wrong in these doctor-patient relationships that make these switches so frequent for this group of people," she said in a statement. "The real problem here is that the health of overweight and obese patients who doctor shop is being compromised."

The obese patients are also 85 percent more likely than normal-weight patients to visit the emergency room, but were not found more likely to be fully hospitalized – which means their health issues probably could have been taken care of in a primary care setting.

Dr. Gudzune was careful to note that her research didn't conclusively determine why overweight patients switch doctors so often. But regardless of the reasons, patients at unhealthy weights need to have reason for hope.

"Maybe they've never been approached in a way that makes them feel empowered," said T.H.E. Clinic's Butler. "If they can make some incremental gains toward weight-loss, the buy-in can get better and better because they see results."