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Registered nurse June Pomeroy discusses her article, “How physician obesity affects patient care.” June explores the complex realities of weight bias within the medical field, examining how a physician’s own struggle with obesity can impact patient care. She highlights the professional stigma physicians face and the documented bias from patients, which often leads to reduced treatment confidence and delayed diagnoses for obesity. June digs deep into why obesity is a complex chronic disease (not just a willpower issue) and discusses how the health care system fails both patients and providers by lacking adequate training on obesity. This conversation covers the critical need to move beyond BMI, focusing instead on metabolic health and compassion to improve patient care and challenge systemic weight stigma. Learn how addressing physician bias and wellness can transform the way we treat obesity.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome June Pomeroy; she’s a registered nurse. Today’s KevinMD article is “How physician obesity affects patient care.” June, welcome to the show.

June Pomeroy: Thank you so much for having me.

Kevin Pho: All right, let’s start by briefly sharing your story, and then we’ll jump right into your KevinMD article.

June Pomeroy: Okay. I’m an RN and I’ve worked many years at the bedside in the hospital. As I’ve gotten older, those 12-hour shifts can be very brutal. I wanted to be able to do something else with my nursing degree where I could still teach and make a difference in people’s health. So I’ve transitioned over to being a freelance health writer, and that’s a great way for me to still use my knowledge and to help people.

Kevin Pho: All right, so you talk about how physician obesity affects patient care. So before talking about that article, what led you to write about this topic in the first place?

June Pomeroy: I was working on my continuing education requirements for my degree, and I’m from Michigan, and Michigan now requires implicit bias education. When I was completing that implicit bias module, I was really struck by the numerous biases that there are: race, nationality, gender identity, ethnicity, religion, age, socioeconomic status, and disability. The one that really caught my attention was weight bias. Because I have struggled with obesity my whole life, that’s very personal for me.

Obesity affects one-third of the adult population in the U.S., and of course that includes physicians, and it costs an estimated $147 billion annually. Medscape Medical News recently published an article that examined the stigma and the bias experienced by obese physicians. That was the article that really piqued my interest and I decided I really wanted to write something about this because it’s very important. There are a lot of obese physicians just like the rest of the population.

Kevin Pho: All right, so tell us what your article is about for those who didn’t get a chance to read it.

June Pomeroy: Okay. One thing that surprised me was how few studies there are about this. The studies that I found that actually looked at physician obesity and the effect that that had on the care they provided for their patients were mostly ten years old. The information and the studies are still very valid, but it just points out that we are really not looking at this really important issue that needs to be examined.

Another thing that was really pointed out in the research that I did was the multifactorial chronic nature of obesity. There are so many drivers for obesity: biological, genetic, environmental, hormonal, mental health, and trauma factors. Those all play a big role in obesity and have to be addressed. There are a lot of systemic barriers. There’s very little access to healthy food options in food deserts and socioeconomic limitations. Cultural norms also play a big role.

The startling statistic for the genetic component was the fact that children have a 50 percent risk of obesity if they have one obese parent, but they have a 75 percent risk if both parents are obese. We know the statistic of one-third of adults are now obese. So that really points out what can happen in generations to come. It’s just going to continue on.

My article really focused on the professional stigma that obese physicians face. Their colleagues often view them as less credible if they are obese, and their colleagues will fail to really recognize the complexity of obesity. There are also career impacts: a negative impact on professional advancement and peer relationships. There’s this “physician heal thyself” expectation that because the physician has the knowledge, then they shouldn’t have these issues that other people have. That’s a really heavy weight on the shoulders of physicians that do have a high BMI.

Then there’s the patient perception. Patients assume that their obese provider can’t help them if the physician is struggling with the same issues. One of the studies that I found in Obesity magazine pointed out that patients had less confidence in their obese providers. They were less likely to follow the medical advice of that provider, and they were more likely to change providers if their provider was obese. So that was kind of a sad statistic.

The clinical impact showed that normal BMI physicians, as opposed to physicians with a higher BMI, were more likely to discuss obesity with their patients and to provide counseling and to actually give them an obesity diagnosis. So there’s definitely some missed opportunity there where obese physicians often waited to discuss weight loss with their patients until the patient’s BMI was higher than the physician’s own BMI. So that can result in delayed interventions and referrals due to the physician just not being comfortable giving that counsel when they’re obese themselves.

Then there’s also the reduced treatment confidence. One of the physicians interviewed in the Medscape article stated that she felt like a fraud, or she felt like a hypocrite when she was talking to her obese patients about health risks while she was obese herself.

So a couple of the things that I sort of saw as lessons or ways that clinicians can actually make improvement is to have self-awareness without self-judgment. The physicians need to just honestly look at their lifestyle and make the changes that they recommend for their patients. Taking time for self-care will just pay huge dividends in physical, mental, and emotional health. The result from that can be a more trusting relationship between doctor and patient when they see that the physician is taking their own advice.

So a couple of the things that really need to potentially change is there needs to be evidence-based protocols. Physicians and providers need to stop focusing solely on BMI. They need to be trained to focus on things like muscle strength, metabolic flexibility, inflammation reduction, and blood sugar stability. Those factors tell far more about long-term health than just weight. That broader focus then can lead the way for the creation of evidence-based protocols for treating obesity.

Another thing that I found very surprising, it was in another obesity study, that only 36 percent of physicians reported that they had very good or good obesity-related medical training in medical school or residency. So it’s obvious that there needs to be better training before they ever become physicians or while they’re in their education process because the obesity epidemic is definitely here in the U.S.

Another thing is to have them not be afraid of an integrative approach. Because obesity is so complex, referral to an integrative or a functional health provider may be appropriate. Most physicians just aren’t trained to have that integrative or functional approach, and they also don’t have the time to actually dig deep to have the success. They’re so focused on the comorbidities of diabetes, hypertension, and heart disease. We know how packed full their schedules are. They’re only given a short period of time to see each patient and they just don’t have the time to do the deep dive that sometimes needs to happen in order to really be successful. A referral might be appropriate for the patient, but also for the physician themself.

Kevin Pho: Let me jump in there. So, a lot to unpack there. So in the beginning you said that there are studies that show that physicians who are obese sometimes delay treatment for their patient’s obesity and also can contribute to their own burnout because they have that “physician heal thyself” expectation. So during your years at a bedside, have you personally seen cases like this that kind of support some of the studies that you’re seeing? Any personal experience or observations that you’ve seen?

June Pomeroy: Well, most of my time was in pediatrics, so I did not do a lot of adult medicine. But you know, we definitely had obese children come in for various things. There definitely could be that undertone of “things need to change” and giving the parents a sermon of what they needed to be doing for their children. There definitely was that undertone there. Yes.

Kevin Pho: And you quoted that physician from the Medscape article who felt like a fraud discussing obesity while being obese. Right. What are some ways that we can support physicians who are struggling with their weight so they can confidently provide care without that sense of hypocrisy?

June Pomeroy: I think one of the big things is just not to focus on just the “calories in, calories out.” Just try to start making those healthy habits of getting some exercise. Those things are all a big ask when you’ve got a full-time job and a very, very busy life, which most people do. But focus on those things that will actually make a change: making sure their blood sugar is stable, cutting back on those carbs if your blood sugar is starting to rise, paying attention to their own health, checking their lab work, and seeing what’s going on physically. Are there things that need to be tended to? There’s quite a long list of things that they can be doing besides just cutting those calories.

Kevin Pho: And one of the things that you also mentioned was referrals to integrative or a functional practitioner. What are some of the things that they do that can help with physicians and their weight?

June Pomeroy: Oftentimes they use a team approach. You know, they will have a nutritionist on board because sadly many physicians have very little nutritional training. Even though they may have the general idea, really have a nutritionist on their side to help them do a deep dive into what they’re eating, because food definitely is medicine. We are what we eat and what we absorb. So that would be very important.

And another big thing is to look at their hormone levels. Especially for women, hormone levels play such a huge role in whether or not you’re able to lose weight easily, especially when you get to the perimenopause and menopause years. That can be such a challenge. To really have someone that can test those hormone levels and see what needs to happen to replace them can be very helpful.

Kevin Pho: In your article, you talk about how physicians who successfully lost weight changed their clinical approach, shifting from scare tactics to a compassion-based approach. What do you mean by a compassion-based approach?

June Pomeroy: Just again, not scolding. Saying, “I understand how difficult this is. I’ve walked in your shoes. What can we do to help? What’s standing in the way?” Get a real feel for what that patient lives with. Do they even have access to healthy food options? Try to find out more about walking in that patient’s shoes. What are their barriers to being healthy? Try to take it from that aspect instead of “you need to do this, you need to do that.” Step back and try to listen and figure out what’s going on and what’s the bigger picture.

Kevin Pho: So of course obesity cuts across the entire health spectrum. During your years as a nurse, have you seen these issues also affect the nursing profession as well?

June Pomeroy: Yes. I mean, there were times when I was really quite heavy and it was difficult to work a 12-hour shift when you have to be carrying around a lot of extra weight and then you worry about your back lifting patients. Nursing can be very strenuous and it definitely can affect you greatly. At the end of your shift, you are just exhausted from not only doing patient care but carrying your own body weight with you. It’s definitely a challenge.

Kevin Pho: Did you face some of these weight-based implicit biases during your career as a nurse?

June Pomeroy: I can’t say that I really did because when I got really large then I got busy and did something about it and lost a lot of weight. So, you know, I never let it get to the point where it prevented me from doing my job, but it sure added another layer of burden to it.

Kevin Pho: Yeah. So could you share some of the techniques that you used on yourself for those others in the health professions who may have been in a similar position?

June Pomeroy: The biggest thing that I’ve done in the last decade or so is I have really cut my carbohydrate intake because there’s always that concern of memory loss as you get older. I’ve done a lot of research on going to a ketogenic type lifestyle. Just really getting those carbs out of there. I was able to lose almost 70 pounds and keep it off. And that has been just huge for my life. But yeah, cutting those tasty carbohydrates has made a huge difference in my life.

Kevin Pho: We’re talking to June Pomeroy; she’s a registered nurse. And today’s KevinMD article is “How physician obesity affects patient care.” June, let’s end with some take-home messages that you want to leave with the KevinMD audience.

June Pomeroy: Yes. Some of the biggest things is, I love what one of these physicians said after he had lost weight, that he just really wanted to emphasize metabolic health. And I love that he emphasizes building lean muscle mass, optimizing your protein intake, stabilizing your blood sugar, addressing sleep quality, and regulating stress. Those things all sound like a real win-win to me.

If we can address the weight bias from all angles, then there will be an improvement in obesity care and improving the physician’s well-being. By encouraging a healthy lifestyle or weight loss, that can have a secondary effect of really improving the care that that physician gives to his obese patients. Physicians that have lowered their BMI will probably have more confidence in the care that they provide and they may discuss weight loss earlier with their patients. And probably the most important one would be that the patient’s trust and compliance are likely to increase if the physician actually practices what he preaches and is able to maintain a healthy weight himself while he’s providing obesity care for his patients.

Kevin Pho: June, thank you so much for sharing your perspective and insight. Thanks again for coming on the show.

June Pomeroy: Thank you.