Obese patients lose less weight if doctors judge them

Doctors shouldn't come across to overweight patients as judgmental, but shouldn't avoid the subject of weight either, says Kimberly Gudzune. “Many doctors avoid the conversation . . . but that is not in the patients' best interest." (Credit: "stethoscope on scale" via Shutterstock)

Overweight and obese people who feel their physicians are judging them are more likely to try to shed pounds, but less likely to succeed, a study shows.

The findings, reported online by the journal Preventive Medicine, suggest that primary care doctors should be aware that patients can sense their negative attitudes.

“Negative encounters can prompt a weight loss attempt, but our study shows they do not translate into success,” says study leader Kimberly A. Gudzune, assistant professor of general internal medicine at the Johns Hopkins University. “Ideally, we need to talk about weight loss without making patients feel they are being judged. It’s a fine line to walk, but if we can do it with sensitivity, a lot of patients would benefit.”


For obese patients, losing 10 percent or more of body weight is typically enough to reduce blood pressure, cholesterol, and diabetes risk. The US Preventive Services Task Force recommends that health care providers counsel obese patients to lose weight; the Centers for Medicare and Medicaid Services now cover some behavioral counseling related to weight loss. But Gudzune and her team suspected negative attitudes and weight stigma might limit the effectiveness of advice from primary care providers.

Did you ever feel judged?

To test that idea, the researchers conducted a national Internet survey of 600 adults with a body mass index of 25 or more who regularly see primary care doctors. The participants were asked, “In the last 12 months, did you ever feel that this doctor judged you because of your weight?” Twenty-one percent of participants believed they had been judged.

Further, 96 percent of those who felt judged reported attempting to lose weight in the previous year, compared to 84 percent who did not. But only 14 percent of those who felt judged and who also discussed weight loss with their doctor lost 10 percent or more of body weight, while 20 percent who did not feel judged and also discussed shedding pounds lost a similar amount.

Having a weight loss conversation clearly helped people lose more weight, the study found. Only 9 percent of those who felt judged but did not discuss weight loss with their doctor lost more than 10 percent of their body weight, while 6 percent of those who neither felt judged nor discussed weight loss with their doctor lost that amount.

Overall, just two-thirds of participants reported that their doctors brought up weight loss.

Doctor training

“Many doctors avoid the conversation because they don’t want to make anyone feel bad, worrying they’ll create a rift with their patients if they even bring it up. But that is not in the patients’ best interest in terms of their long-term health,” Gudzune says.

Gudzune, whose own practice focuses on obesity, says that doctors may need to be taught how to talk about the topic in ways that make patients feel understood and supported.

She says it is also helpful to start with smaller weight loss steps, such as a 10 percent reduction in weight. A larger long-term goal of, say, losing 70 or 100 pounds can be a setup for frustration and failure when tackled all at once.

“We don’t want to overwhelm them,” she says. “If we are their advocates in this process—and not their critics—we can really help patients to be healthier through weight loss.”

The National Heart, Lung and Blood Institute supported the research.

Source: Johns Hopkins University