Physician Respect for Patients with Obesity
Mary Margaret Huizinga, MD, MPH
, Lisa A. Cooper, MD, MPH
, Sara N. Bleich, PhD
Jeanne M. Clark, MD, MPH
, and Mary Catherine Beach, MD, MPH
Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA;
Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;
Welch Center for Prevention,
Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA;
Department of Epidemiology, Johns Hopkins
Bloomberg School of Public Health, Baltimore, MD, USA.
INTRODUCTION: Obesity stigma is common in our
society, and a general stigma towards obesity has also
been documented in physicians. We hypothesized that
physician respect for patients would be lower in
patients with higher body mass index (BMI).
METHODS: We analyzed data from the baseline visit of 40
physicians and 238 patients enrolled in a randomized
controlled trial of patient-physician communication. The
independent variable was BMI, and the outcome was
physician respect for the patient. We performed Poisson
regression analyses with robust variance estimates,
accounting for clustering of patients within physicians,
to examine the association between BMI and physician
ratings of respect for particular patients.
RESULTS: The mean (SD) BMI of the patients was 32.9
. Physicians had low respect for 39% of the
participants. Higher BMI was significantly and nega-
tively associated with respect [prevalence ratio (PrR)
0.83, 95% CI: 0.73–0.95; p=0.006; per 10 kg/m
increase in BMI]. BMI remained significantly associated
with respect after adjustment for patient age and
gender (PrR 0.86, 95%CI: 0.74–1.00; p=0.049).
CONCLUSION: We found that higher patient BMI was
associated with lower physician respect. Further research
is needed to understand if lower physician respect for
patients with higher BMI adversely affects the quality of
KEY WORDS: obesity stigma; physician respect and body mass index.
J Gen Intern Med 24(11):1236–9
© Society of General Internal Medicine 2009
tigma against persons with obesity is pervasive in our
Persons with obesity earn less money, face
discrimination from individuals and institutions, and experi-
ence insults on a frequent basis.
Obesity stigma is harmful
and has been associated with low self-esteem, depression and
Despite the increasing commonness of
obesity, obesity stigma is increasing even as other disparities
are decreasing or have remained unchanged.
the highest levels of obesity are more likely to experience
Negative bias towards persons with obesity has been well
documented in health-care providers, including physicians, for
the last 40 years.
In a survey of physicians, obesity was
identified as a characteristic that elicited negative feelings,
and other studies have found that physicians associate
negative terms, such as ignorant, lazy and incompetent, with
In addition, physicians have reported ambivalence
towards the treatment of obesity.
However, none of these
studies have documented physician attitudes towards specific
patients with obesity. Several studies have documented
health-care avoidance in patients with obesity, and in some
studies, participants cited individual and institutional biases
as the reason for avoidance.
There is also evidence that
obesity is associated with decreased preventive services,
especially cancer screenings.
Few studies have studied
physicians’ attitudes and beliefs towards specific patients,
especially with regards to the patient’s weight.
Respect for all patients, which involves positive regard, is a
core component of professionalism in medicine.
who have more respectful attitudes towards patients share
more medical information and have greater positive affect
during encounters compared to patients for whom they have
In a study of obese females, participants
indicated a desire for a respectful relationship with their
physician and would avoid health-care visits if such a
relationship did not exist.
While a general bias towards
obesity has been documented in the literature, little is known
about the respect a physician has for a patient with obesity
and how that may impact the patient’s care. In this study, we
examine the relationship between physician respect and
patient obesity. We hypothesized that physicians would have
low respect for patients as body mass index (BMI) increased.
Study Design and Setting
Data for this study were obtained from the baseline visit of the
Patient-Physician Partnership Study, a randomized controlled
trial of physician and provider interventions to improve
Forty physicians and
238 of their patients with height, weight and measure of
physician respect available were included in this analysis.
Physicians were recruited from 14 urban community practices
Received March 16, 2009
Revised July 28, 2009
Accepted August 18, 2009
Published online September 18, 2009