Obesity affects one-third of the adult U.S. population, including physicians, and is estimated to cost $147 billion annually. How does the Body Mass Index (BMI) of the physician affect the relationship with patients and the care provided? According to a study in Obesity magazine, “Understanding physician body weight as a possible barrier to obesity care is critical given the important role physicians can play in helping patients manage or lose weight.”

First off, there is little research available examining the impact of physician obesity on the care of obese patients, and the few studies available are all a decade old. Despite the timing of those research studies, the information they contain remains applicable today. The fact that there are limited studies points to the importance of examining this timely issue when obesity is at epidemic proportions.

The complexity of obesity as a disease

Beyond simple calories: Obesity is a multifactorial chronic disease.

Genetic factors: Children have a fifty percent risk of obesity with one obese parent, seventy-five percent if both parents are obese.

Multiple drivers: Biological, genetic, environmental, hormonal, mental health, and trauma factors all play a role in obesity and must be addressed.

Systemic barriers: Food deserts (areas with little access to healthy food options), socioeconomic limitations, and cultural norms also play a role.

Why this matters: Understanding the complexity of obesity helps reduce the stigma for both patients and providers.

Bias against physicians with obesity

Professional stigma: Weight bias from colleagues and within the medical community is well documented. Medscape Medical News recently published an article examining the bias and stigma experienced by obese physicians. Three physicians were interviewed and discussed experiencing bias from both directions. Their colleagues often view obese physicians as less credible and fail to recognize the complexity of obesity.

Patient perceptions: Their patients sometimes assume their obese provider cannot help them if the physician is struggling with the same issues. A study in Obesity magazine showed patients had less confidence in obese providers, were less likely to follow medical advice from the provider, and were more likely to change providers if their provider was obese.

The “physician heal thyself” expectation: There are unrealistic standards applied to physicians’ personal health. One of the physicians interviewed by Medscape stated: “In medicine there is an implicit expectation that knowledge equates to immunity — that we should be exempt from chronic conditions. This bias is prevalent within the system, among colleagues, and even within ourselves.” That expectation can weigh very heavily on the shoulders of a physician with a high BMI.

Career impacts: Obesity can have a negative impact on physicians’ professional advancement and peer relationships.

Clinical impact: how physician weight stigma affects patient care

Diagnostic hesitance: Another study in Obesity showed that normal BMI physicians, as opposed to physicians with a high BMI, were more likely to discuss obesity with their clients, provide weight counseling, and give an obesity diagnosis.

Missed opportunities: The physicians who were overweight or obese often waited to discuss weight with their patients until the patient’s BMI was greater than the provider’s BMI. This can result in delayed interventions and referrals due to provider discomfort.

Reduced treatment confidence: One of the physicians interviewed in the Medscape Medical News article said, “I felt like a fraud or a hypocrite talking to my obese patients about health risks while being obese myself.”

Moving forward: practical solutions

Self-awareness without self-judgment: Physicians need to honestly look at their lifestyle and make changes they would recommend to their patients. Taking time for self-care will yield significant dividends not only in physical health but also in mental and emotional well-being for the physician. The result can be a more trusting relationship between doctor and patient when they see their provider taking their own advice.

Evidence-based protocols: Providers need to stop focusing on just BMI. Physicians need to be trained to focus on muscle strength, metabolic flexibility, inflammation reduction, and blood sugar stability. These factors tell far more about long-term health than just weight. The positive changes that may result from this broader focus can lead the way in the creation of evidence-based protocols for obesity treatment.

Education and training: In one study in Obesity magazine, only thirty-six percent of physicians reported very good or good obesity-related medical training in medical school or residency. The need for more in-depth training for medical students and residents about the complexities of obesity is obvious, considering the obesity epidemic we are experiencing in the U.S.

Integrative approach: Because obesity is a complex disease, referral to an integrative or functional health practitioner may be appropriate. Not every physician is trained in integrative medicine, so knowing when it is appropriate to refer is crucial. The time it takes to dig deep for success is time most providers do not have, as they are focused on comorbidities such as diabetes, hypertension, and heart disease. Physicians on a weight loss journey may also benefit from an integrative approach to their personal health if they are struggling to make positive changes.

Challenging current culture: The three physicians interviewed by Medscape all challenge our culture’s current oversimplification of the obesity epidemic as a willpower issue. If colleagues link obesity to patient willpower, the interviewed physicians say they would remind their colleagues that no one chooses to be obese. Willpower fails when fighting biology. We would not have an epidemic if willpower worked.

Shifting clinical approaches: Physicians who are successful in lowering their BMI find that their clinical approach has changed. The first physician interviewed by Medscape shared that knowing the struggle of weight loss allows her to approach the issue with more compassion. She would like to see colleagues approach obesity with compassion rather than scare tactics or reprimands. Another interviewee, who personally lost 150 pounds, said his approach has undergone a complete transformation. He now approaches obesity as a neurohormonal disease influenced by processed foods, environment, and metabolic dysfunction. He now emphasizes education, compassion, and not willpower. The last interviewee emphasizes metabolic health instead of weight loss. He emphasizes building lean muscle mass, optimizing protein intake, stabilizing blood sugar levels, improving sleep quality, and managing stress.

Conclusion

Addressing weight bias from all angles will help improve obesity care. Improving physician well-being by encouraging a healthy lifestyle and/or weight loss may have a secondary effect of enhancing physician care for obese patients. Physicians who have lowered their BMI may have more confidence in the care they provide for obesity and may discuss weight loss with patients earlier, potentially preventing unnecessary complications. Patient trust and compliance are likely to increase when physicians practice what they preach, maintaining a healthy weight themselves while providing care for their patients with obesity.

June Pomeroy is a nurse.