Doctors less empathetic for obese patients

JOHNS HOPKINS (US) — Physicians build much less of an emotional rapport with overweight and obese patients than with patients of normal weight, a study suggests.

The study was small—involving 39 primary care doctors and 208 patients—but has potentially significant implications, because bonding with doctors is important for good health outcomes. Earlier studies showed that patients of more empathetic physicians are more likely to adhere to recommendations and respond to behavior-change counseling.

“If you aren’t establishing a rapport with your patients, they may be less likely to adhere to your recommendations to change their lifestyles and lose weight,” says Kimberly A. Gudzune, an assistant professor at the Johns Hopkins University School of Medicine. “Without that rapport, you could be cheating the patients who need that engagement the most.”


Gudzune and colleagues found that patient weight did not influence the quantity of physicians’ medical questions or their medical advice, counseling, or treatment regimen discussions.

But the doctors were significantly more likely to express empathy, concern, and understanding with patients of normal weight than with overweight and obese patients, regardless of the medical issue discussed.

Obese patients may be particularly vulnerable to poorer physician-patient communications, because studies show that physicians may hold negative attitudes toward these patients. Some physicians have less respect for their obese patients, which may come across during patient encounters.

“If patients see their primary care doctors as allies, I think they will be more successful in complying with our advice,” says Gudzune, whose practice focuses on weight-loss issues.

“I hear from patients all the time about how they resent feeling judged negatively because of their weight. Yes, doctors need to be medical advisors, but they also have the opportunity to be advocates to support their patients through changes in their lives.”

For the study, published online in the journal Obesity, researchers studied recordings of visits by patients with high blood pressure to doctors in Baltimore between 2003 and 2005. They found no difference related to body mass index, a ratio of height to weight, in terms of time spent with each patient or in weight counseling.

But when the recordings were analyzed for expressed words of empathy, concern or encouragement, the differences popped out. The researchers found more evidence of empathetic words and phrases—showing concern, reassurance, and legitimation of patients’ feelings—in interactions with patients of normal weight. An example of showing empathy would be a doctor who says: “I can see how frustrated you are by your slow progress; anyone would be.”

Physicians should be mindful of any negative attitudes, make an effort to bond, and then spend time with overweight and obese patients discussing psychosocial and lifestyle issues, Gudzune says. If they do, physicians may find their obese patients more responsive to weight-loss counseling.

“Patients want information and treatment, but they also need the emotional support and attention that can help them through the challenges that accompany weight loss and the establishment of a healthy lifestyle.”

The research was supported by grants from the National Institutes of Health’s National Heart, Lung, and Blood Institute and the Health Resources and Services Administration.

Source: Johns Hopkins University