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Are Doctors Nicer to Thin Patients?


Doctors are supposed to do no harm and therefore, you could assume, treat all patients with equal concern. But your white coat may be nicer to you if you’re thin, a new study to be published in Obesity suggests.

Researchers at Johns Hopkins University obtained permission to record discussions between 39 primary care physicians and more than 200 patients who had high blood pressure. Of the 200 patients, 28 were of normal weight (having a BMI of under 25), 60 were overweight (BMI of 25 to 30), and 120 were obese (having a BMI of 30 or greater).

There was no distinguishable difference in the overall type of care each patient received, but when researchers analyzed the transcripts of each visit, they noticed there one big discrepancy: Doctors were noticeably nicer to patients who were of normal weight or thin.

“It’s not like the physicians were being overtly negative or harsh,” the lead author, Kimberly A. Gudzune, M.D., M.P.H., an assistant professor of general internal medicine at the Johns Hopkins School of Medicine, told the New York Times. “They were just not engaging patients in that rapport-building or making that emotional connection with the patient.”

Dr. Gudzune also said that in conversations with thin patients, doctors would empathize more, saying things like "I'm glad you're feeling better" to a patient who experienced hot flashes or "That can be frustrating" when another patient complained of how long it took to schedule an appointment. Those types of expressions were noticeably absent from the conversations the physicians had with the overweight or obese patients, according to Dr. Gudzune.

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"Doctors are people too and prone to the prevailing influences in our culture," says David Katz, M.D., director of the Yale-Griffin University Prevention Research Center. "If we want to banish obesity bias—and we should—we need to address it culture-wide. Doctors will address this better when our culture addresses it better: with more understanding and an emphasis on what truly helps."

At a biological and cultural level, we're hardwired to favor physical appearances associated with reproductive success, and that implies certain proportions, Dr. Katz says. Historically, he adds, this may suggest that those who were heavier were working less and had more goods than their thinner counterparts, which may be where the current notions that overweight people are overweight because they're lazy or because they want to be may have originated. "But that simply doesn't pertain to a modern, obesogenic environment," he says.

Additionally, the problem of doctor bias is compounded by the fact that doctors are trained to deal with medical problems that have specific solutions. "Doctors don't like anything that doesn't yield to medical knowledge," he says. "We're frustrated by what we can't fix. And to date, we have not been very good at fixing obesity."

And while these differences in treatment may seem minor, studies suggest that patients are more likely to follow their doctor's advice when they believe their doctor empathizes with them. If you feel as though you're not receiving the best care and you suspect it's because of your weight, approach your doctor about it and see if he or she is receptive to you.

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"If you believe you have a relationship with your doctor that's worth saving, then you should be honest," Dr. Katz says. "If you feel like you're experiencing doctor bias, you could say, 'The way you are dealing with this is not helping me. Can we approach this differently together?'"

And if your doctor brushes you off or isn't responsive, it's time to find a new doctor, Dr. Katz suggests.

"Ultimately, each one of us has to share in the responsibility of this," he says. "We can control what we do with our feet and our forks every day. But there's a big difference between sharing in the responsibility and being to blame for the problem. It's not about individual willpower. It is far bigger than that, and shame is not helpful or justified."


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