Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Behavior and Psychology

The effect of physicians’ body weight on patient attitudes: implications for physician selection, trust and adherence to medical advice

Abstract

Background:

Research has documented negative stigma by health providers toward overweight and obese patients, but it is unknown whether physicians themselves are vulnerable to weight bias from patients.

Purpose:

This study assessed public perceptions of normal weight, overweight or obese physicians to identify how physicians’ body weight affects patients’ selection, trust and willingness to follow the medical advice of providers.

Methods:

An online sample of 358 adults were randomly assigned to one of three survey conditions in which they completed a questionnaire assessing their perceptions of physicians who were described as normal weight, overweight or obese. Participants also completed a measure of explicit weight bias (Fat Phobia Scale) to determine whether antifat attitudes are associated with weight-related perceptions of physicians.

Results:

Respondents reported more mistrust of physicians who are overweight or obese, were less inclined to follow their medical advice, and were more likely to change providers if the physician was perceived to be overweight or obese, compared to normal-weight physicians who elicited significantly more favorable reactions. These weight biases remained present regardless of participants’ own body weight. Inspection of interaction effects revealed opposing effects of weight bias between the obese/overweight and normal-weight physician conditions. Stronger weight bias led to higher trust, more compassion, more inclination to follow advice, and less inclination to change doctors when the physician was presented as normal weight. In contrast, stronger weight bias led to less trust, less compassion, less inclination to follow advice and higher inclination to change doctors when the physician was presented as obese.

Conclusions:

This study suggests that providers perceived to be overweight or obese may be vulnerable to biased attitudes from patients, and that providers’ excess weight may negatively affect patients’ perceptions of their credibility, level of trust and inclination to follow medical advice.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Puhl R, Heuer CA . The stigma of obesity: a review and update. Obesity 2009; 17: 941–964.

    Article  Google Scholar 

  2. Puhl RM, Brownell KD . Bias, discrimination, and obesity. Obesity Res 2001; 9: 788–905.

    Article  CAS  Google Scholar 

  3. Brownell KD . Introduction: The Social, Scientific, and Human Context of Prejudice and Discrimination Based on Weight. Weight Bias: Nature, Consequences, and Remedies. Guilford Press: New York pp 1–11 2005.

    Google Scholar 

  4. Brown I . Nurses’ attitudes towards adult patients who are obese: literature review. J Adv Nursing 2006; 53: 221–232.

    Article  Google Scholar 

  5. Huizinga MM, Cooper LA, Bleich SN, Clark JM, Beach MC . Physician respect for patients with obesity. J Gen Intern Med 2009; 24: 1236–1239.

    Article  Google Scholar 

  6. Huizinga MM, Bleich SN, Beach MC, Clark JM, Cooper LA . Disparity in physician perception of patients’adherence to medications by obesity status. Obesity 2010; 18: 1932–1937.

    Article  CAS  Google Scholar 

  7. Puhl RM, Brownell KD . Confronting and coping with weight stigma: an investigation of overweight and obese adults. Obesity 2006; 14: 1802–1815.

    Article  Google Scholar 

  8. Price JH, Desmond SM, Krol RA, Snyder FF, O’Connell JK . Family practice physicians’ beliefs, attitudes, and practices regarding obesity. Am J Prev Med 1987; 3: 339–345.

    Article  CAS  Google Scholar 

  9. Schwartz MB, Chambliss HO, Brownell KD, Blair SN, Billington C . Weight bias among health professionals specializing in obesity. Obes Res 2003; 11: 1033–1039.

    Article  Google Scholar 

  10. Flegal KM, Carroll MD, Kit BK, Ogden CL . Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. J Am Med Assoc 2012; 307: E1–E7.

    Article  Google Scholar 

  11. Manson J, Willett W, Stampfer M, Colditz GA, Hunter DJ, Hankinson SE et al. Body weight and mortality among women. N Engl J Med 1995; 333: 677–685.

    Article  CAS  Google Scholar 

  12. Ong L, de Haes J, Hoos A, Lammes F . Doctor-patient communication: a review of the literature. Social Sci Med 1995; 40: 903.

    Article  CAS  Google Scholar 

  13. Hash RB, Munna RK, Vogel RL, Bason JJ . Does physician weight affect perception of health advice. Prev Med 2003; 36: 41–44.

    Article  Google Scholar 

  14. Rogers LQ, Gutin B, Humphries M, Lemmon CR, Waller JL, Baranowski T et al. A physician fitness program: enhancing the physician as an ‘exercise’ role model for patients. Teaching Learning Med 2005; 17: 27.

    Article  Google Scholar 

  15. Pipe A, Sorensen M, Reid R . Physician smoking status, attitudes toward smoking, and cessation advice to patients: an international survey. Patient Educ Counsel 2009; 74: 118.

    Article  Google Scholar 

  16. Zhu D, Norman IJ, While AE . The relationship between health professionals’ weight status and attitudes towards weight management: a systematic review. Obesity Rev 2011; 12: e324–e337.

    Article  CAS  Google Scholar 

  17. Bleich SN, Bennett W, Gudzune K, Coope L . Impact of physician BMI on obesity care and beliefs. Obesity 2012; 20: 999.

    Article  Google Scholar 

  18. Smith DR, Leggat P . An international review of tobacco smoking in the medical profession: 1974–2004. BMC Public Health 2007; 7: 115.

    Article  Google Scholar 

  19. Hull S, DiLalla L, Dorsey JK . Prevalence of health-related behaviors among physicians and medical trainees. Acad Psychiatry 2008; 32: 31–38.

    Article  Google Scholar 

  20. Frank E, Breyan J, Elon L . Physician disclosure of healthy personal behaviors improves credibility and ability to motivate. Arch Fam Med 2000; 9: 287–290.

    Article  CAS  Google Scholar 

  21. Feller DB, Hatch R . Do physicians take care of their health? Physicians’ personal health behaviors, good or bad, can influence their patients. Psychiatr Ann 2004; 34: 762.

    Article  Google Scholar 

  22. Combs A, Snygg D . Individual Behavior: A Perceptual Approach to Behavior. Harpers & Brothers: New York, 1971.

    Google Scholar 

  23. Yanover T, Thompson J . Weight ratings of others: the effects of multiple target and rater features. Body Image 2010; 7: 149–155.

    Article  Google Scholar 

  24. Kinnersley P, Stott N, Peters T, Harvey I, Hackett P . A comparison of methods for measuring patient satisfaction with consultations in primary care. Fam Pract 1996; 13: 41–51.

    Article  CAS  Google Scholar 

  25. Bacon JG, Scheltema KE, Robinson BE . Fat phobia scale revisited: the short form. Int J Obesity 2001; 25: 252–257.

    Article  CAS  Google Scholar 

  26. Enders CK . Applied Missing Data Analysis. Guilford: New York, 2010.

    Google Scholar 

  27. Rubin DB . Multiple Imputation for Nonresponse in Sample Surveys. Wiley: New York, 1987.

    Book  Google Scholar 

  28. National Heart L, and Blood Institute. How are overweight and obesity diagnosed? 2011, http://www.nhlbi.nih.gov/health/health-topics/topics/obe/diagnosis.html (retrieved 21 December 2011).

  29. Ubink-Veltmaat LJ, Damoiseaux RAJM, Rischen RO, Groenier KH . Please, let my doctor be obese. Diabetes Care 2004; 27: 2560.

    Article  Google Scholar 

  30. O'Brien KS, Puhl RM, Latner JD, Azeem SM, Hunter JA . Reducing anti-fat prejudice in preservice health students: a randomized trial. Obesity 2010; 18: 2138–2144.

    Article  Google Scholar 

  31. Daníelsdóttir S, O’Brien KS, Ciao A . Anti-fat prejudice reduction: a review of published studies. Obesity Facts 2010; 3: 47–58.

    Article  Google Scholar 

  32. Kuczmarski MF, Kuczmarski RJ, Najjar M . Effects of age on validity of self-reported height, weight, and body mass index: findings from the Third National Health and Nutrition Examination Survey, 1988–1994. J Am Diet Assoc 2001; 101: 28–34.

    Article  CAS  Google Scholar 

  33. Puhl RM, Andreyeva T, Brownell KD . Perceptions of weight discrimination: Prevalence and comparison to race and gender discrimination in America. Int J Obesity 2008; 32: 992–1000.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This research was supported by a grant from the Rudd Foundation.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to R M Puhl.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Puhl, R., Gold, J., Luedicke, J. et al. The effect of physicians’ body weight on patient attitudes: implications for physician selection, trust and adherence to medical advice. Int J Obes 37, 1415–1421 (2013). https://doi.org/10.1038/ijo.2013.33

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ijo.2013.33

Keywords

This article is cited by

Search

Quick links