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Heavy Patients Trust Diet Advice From Overweight Docs Most: Study
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"In general, heavier patients trust their doctors, but they more strongly trust dietary advice from overweight doctors," said study leader Sara Bleich, an associate professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health, in Baltimore.
The research is published online in the June issue of the journal Preventive Medicine.
Bleich and her team surveyed 600 overweight and obese patients in April 2012. Patients reported their height and weight, and described their primary care doctor as normal weight, overweight or obese.
About 69 percent of adult Americans are overweight or obese, according to the U.S. Centers for Disease Control and Prevention.
The patients -- about half of whom were between 40 and 64 years old -- rated the level of overall trust they had in their doctors on a scale of 0 to 10, with 10 being the highest. They also rated their trust in their doctors' diet advice on the same scale, and reported whether they felt judged by their doctor about their weight.
Patients all reported a relatively high trust level, regardless of their doctors' weight. Normal-weight doctors averaged a score of 8.6, overweight 8.3 and obese 8.2.
When it came to trusting diet advice, however, the doctors' weight status mattered. Although 77 percent of those seeing a normal-weight doctor trusted the diet advice, 87 percent of those seeing an overweight doctor trusted the advice, as did 82 percent of those seeing an obese doctor.
Patients, however, were more than twice as likely to feel judged about their weight issues when their doctor was obese compared to normal weight: 32 percent of those who saw an obese doctor said they felt judged, while just 17 percent of those who saw an overweight doctor and 14 percent of those seeing a normal-weight doctor felt judged.
Bleich's findings follow a report published last month in which researchers found that obese patients often "doctor shop" because, they said, they were made to feel uncomfortable about their weight during office visits.
Bleich's research didn't delve into reasons for feeling judged, but she said obese doctors could feel stigmatized themselves and have negative attitudes about excess weight.
As for patients trusting diet advice more from an overweight doctor, Bleich speculated that "it has to do with this shared identity." Patients may think an overweight or obese doctor knows what they are going through.
"There could be any number of possible explanations" for the findings, said Richard Street, professor of communications at Texas A&M University, who conducts research on patient-doctor communication.
What the research found, he said, is a link between weight status of the patient and the doctor and their trust level. "In a study like this, there is no causal relationship tested," he said.
The findings, however, are the opposite of what one physician who sees overweight patients said he observes.
Dr. Peter Galier, a doctor at the UCLA Medical Center in Santa Monica, Calif., said his patients often tell him they don't have faith in dietary advice from an overweight doctor.
A doctor in the best position to gain his patient's trust in diet advice, Galier said, might be a doctor who is now normal weight but has overcome a weight issue. Galier is normal weight, and when he initially counsels patients about weight, he said, some look at him as if to ask what he would know about weight struggles.
Then he shares with patients that he has lost a substantial amount of weight, and continues to have ups and down. "I'll get more attention from patients when I tell them I know [from experience] that it's hard," he said.
Because overweight doctors may not be comfortable talking about weight loss, patients may have to start the conversation, Bleich said. "Ask for help," she said, including a referral to a dietitian if needed.
SOURCES: Sara Bleich, Ph.D., associate professor, health policy and management, Johns Hopkins Bloomberg School of Public Health, Baltimore; Peter Galier, M.D., associate clinical professor, medicine, David Geffen School of Medicine, University of California, Los Angeles, and physician, UCLA Medical Center, Santa Monica, Calif.; Richard Street, Ph.D., professor, communications, Texas A&M University, College Station; June 2013 Preventive Medicine