Perceived judgment about weight can negatively influence weight loss: A cross-sectional study of overweight and obese patients
Introduction
The U.S. Preventive Services Task Force has issued a recommendation that healthcare providers counsel obese patients to lose weight (McTigue et al., 2003, Moyer, 2012). Recent evidence from a meta-analysis found that behavioral weight loss interventions can be effective in the primary care setting and lead to improved control of obesity-related conditions including hypertension (LeBlanc et al., 2011). Primary care provider (PCP) advice on weight loss has also been shown to have a significant influence on patients' engagement in weight loss efforts (Rose et al., 2013).
Yet, the pervasiveness of negative provider attitudes and weight stigma could limit the effectiveness of PCP advice and behavioral counseling for obese patients. Physicians have been shown to have less respect for obese patients (Huizinga et al., 2009), and obese individuals commonly report stigmatizing experiences during interactions with the healthcare system (Puhl and Brownell, 2001, Puhl and Brownell, 2006, Puhl and Heuer, 2009). Obese patients have reported avoiding or delaying medical services such as gynecological cancer screening due to negative experiences (Amy et al., 2006). Evidence also suggests that PCPs engage in less emotional rapport building during visits with overweight and obese patients (Gudzune et al., 2013a), which may negatively influence the patient–provider relationship and decrease the effectiveness of behavior change counseling. Obese patients may be less receptive to weight loss counseling and be less likely to lose weight if they perceive negative attitudes from their PCP; however, we are aware of no studies that have examined this question.
Our primary objective was to evaluate whether overweight and obese patients who perceive being judged by their PCPs about their weight report differences in weight loss attempts and weight loss success as compared those who do not perceive judgment. We hypothesized that patients, who perceived being judged by their PCP, would be less likely to achieve clinically significant weight loss. Our second objective was to evaluate whether greater weight loss success occurs among patients who receive weight loss counseling from a provider perceived to be free of weight-related judgment as compared to other scenarios. We hypothesized that patients who report that their PCP discussed weight loss and did not perceive being judged about their weight would lose more weight than those patients who reported receiving counseling but perceived being judged.
Section snippets
Design and participants
We conducted a cross-sectional, internet-based survey of a nationally representative sample of 600 overweight and obese U.S. adults about physician factors that influence patient trust (Bleich et al., 2013). Experts in obesity and patient–physician relationships reviewed the survey instrument for content, which was then pretested for length and comprehension and revised with the assistance of Social Science Research Solutions. The survey was administered online through the Authentic Response
Results
We screened 1380 panel members who responded to the survey invitation, and excluded 335 participants who had not seen their PCP in the last year, 396 who did not have a BMI ≥ 25 kg/m2, 6 who were currently pregnant, and 43 who had incomplete survey responses. Our final sample included 600 participants. Mean age was 47.4 years, 48% were female, 76% were white, and mean BMI was 31.5 kg/m2. In the last 12 months, 66% reported that their PCP discussed weight loss, 83% attempted weight loss, and 15%
Discussion
Over 20% of overweight and obese patients perceived judgment from their current PCPs because of their weight. Prior studies have described the pervasiveness of healthcare providers' negative attitudes towards patients with obesity (Puhl and Brownell, 2001, Puhl and Brownell, 2006, Amy et al., 2006, Huizinga et al., 2009, Puhl and Heuer, 2009), and this study confirms that patients' perceive judgment from their PCPs. We found that respondent perceptions of being judged were associated with
Conclusion
PCPs may need to consider additional training in preparation for the new Medicare benefit covering intensive behavioral counseling for weight loss. While seeking additional training on basic weight management will be essential to address knowledge deficiencies previously identified in this area (Block et al., 2003, Jay et al., 2008), our findings suggest that PCPs should consider adding communication skills training to this experience. Building communication skills helps improve PCPs' capacity
Conflict of interest statement
The authors declare no conflicts of interest.
Acknowledgments
KAG and SNB were supported by trainee awards from the National Heart, Lung, and Blood Institute's (NHLBI) Center for Population Health and Health Disparities (P50HL0105187). NHLBI also provided support through the following grants: KAG (K23HL116601); WLB (K23HL098476); LAC (K24HL083113); and SNB (K01HL096409).
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