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Weighing the care: physicians' reactions to the size of a patient


OBJECTIVE: To examine how the weight of a patient affects both the attitudes that physicians hold as well as the treatments that they intend to prescribe.

DESIGN: In a six-cell randomized design, physicians evaluated a medical chart of a male or female patient, depicted as either average weight, overweight or obese, who presented with a migraine headache.

SUBJECTS: A total of 122 physicians affiliated with one of three hospitals located in the Texas Medical Center of Houston completed the experiment.

MEASUREMENTS: Using a standard medical procedure form, physicians indicated how long they would spend with the patient and which of 41 medical tests and procedures they would conduct. They also indicated their affective and behavioral reactions to the patient.

RESULTS: The weight of a patient significantly affected how physicians viewed and treated them. Although physicians prescribed more tests for heavier patients, F(2, 107)=3.65, P<0.03, they simultaneously indicated that they would spend less time with them, F(2, 107)=8.38, P<0.001, and viewed them significantly more negatively on 12 of the 13 indices.

CONCLUSION: This study reveals that physicians continue to play an influential role in lowering the quality of healthcare that overweight and obese patients receive. As the girth of America continues to increase, continued research and improvements in the quality of such healthcare deserve attention.

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  1. Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL . Overweight and overweight in the United States: prevalence and trends 1960–1994 Int J Obes Relat Metab Disord 1998 22: 39–47.

    Article  CAS  Google Scholar 

  2. Mokdad AH, Serdula MK, Dietz WH, Bowman BA, Marks JS, Koplan JP . The spread of the obesity epidemic in the United States 1991–1998 JAMA 1999 282: 1519–1522.

    Article  CAS  Google Scholar 

  3. Must A, Strauss RS . Risk and consequences of childhood and adolescent overweight Int J Obes Relat Metab Disord 1999 23: S2–S11.

    Article  Google Scholar 

  4. Pi-Sunyer FX . Health implications of overweight Am J Clin Nutr 1991 53: 1595S–1603S.

    Article  CAS  Google Scholar 

  5. Allison DB, Fontaine KR, Manson JE, Stevens J, VanItallie TB . Annual deaths attributable to obesity in the United States JAMA 1999 282: 1530–1538.

    Article  CAS  Google Scholar 

  6. DeJong W, Kleck RE . The social psychological effects of overweight. In Herman, CP, Zanna MP, Higgins ET (eds). Physical appearance stigma and social behavior: the Ontario Symposium Erlbaum: New Jersey 1986 65–87.

    Google Scholar 

  7. Hill AJ, Williams J . Psychological health in a non-clinical sample of obese women Int J Obes Relat Metab Disord 1998 22: 578–583.

    Article  CAS  Google Scholar 

  8. Rothblum ED . The stigma of women's weight: social and economic realities Femin Psychol 1992 21: 61–73.

    Article  Google Scholar 

  9. Allon N . The stigma of overweight in everyday life. In: Wolman BB, DeBerry S (eds). Psychological aspects of overweight: a handbook Van Nostrand Reinhold: New York 1982 130–174.

    Google Scholar 

  10. Weiner B . Judgements of responsibility: a theory of social conduct The Guilford Press: New York 1995.

    Google Scholar 

  11. Pingitore R, Dugoni BL, Tindale RS, Spring B . Bias against overweight job applicants in a simulated employment interview J Appl Psychol 1994 79: 909–917.

    Article  CAS  Google Scholar 

  12. Roehling MV . Weight-based discrimination in employment: psychological and legal aspects Pers Psychol 1999 52: 969–1016.

    Article  Google Scholar 

  13. Canning H, Mayer J . Obesity: an influence on high school performance? Am J Clin Nutr 1967 20: 352–354.

    Article  CAS  Google Scholar 

  14. Hebl MR, Heatherton TF . The stigma of obesity: the differences are black and white Pers Soc Psychol Bull 1997 24: 417–426.

    Article  Google Scholar 

  15. Pérusse L, Chagnon YC, Weisnagel J, Bouchard C . The human obesity gene map: the 1998 update Obes Res 1999 71: 111–129.

    Article  Google Scholar 

  16. Stunkard AJ, Harris JR, Pedersen NL, McClearn GE . The body-mass index of twins who have been reared apart New Engl J Med 1990 322: 1483–1487.

    Article  CAS  Google Scholar 

  17. Wiese HJC, Wilson JF, Jones RA, Neises, M . Obesity stigma reduction in medical students Int J Obes Relat Metab Disord 1992 16: 859–868.

    CAS  PubMed  Google Scholar 

  18. Young LM, Powell B . The effects of overweight on the clinical judgements of mental health professionals J Health Soc Behav 1985 26: 233–246.

    Article  CAS  Google Scholar 

  19. Price JH, Desmond SM, Krol RA, Snyder FF, O'Connell JK . Family practice physicians' beliefs attitudes and practices regarding overweight Am J Prev Med 1987 36: 339–345.

    Article  Google Scholar 

  20. Bretytspraak LM, McGee J, Conger JC, Whatley JL, Moore JT . Sensitizing medical students to impression formation processes in the patient interview J Med Educ 1977 47–54.

  21. Blumberg P, Mellis LP . Medical students' attitudes toward the obese and the morbidly obese Int J Eat Disord 1985 4: 169–175.

    Article  Google Scholar 

  22. Maddox G, Liederman V . Overweight as a social disability with medical implications J Med Educ 1969 44: 214–220.

    CAS  PubMed  Google Scholar 

  23. Wee CC, McCarthy EP, Davis RB, Phillips RS . Physician counseling about exercise JAMA 1999 282: 1583–1588.

    Article  CAS  Google Scholar 

  24. Galuska DA, Will JC, Serdula MK, Ford ES . Are health care professionals advising obese patients to lose weight? JAMA 1999 282: 1576–1578.

    Article  CAS  Google Scholar 

  25. Fontanarosa PB . Patients, physicians, and weight control JAMA 1999 282: 1581–1582.

    Article  CAS  Google Scholar 

  26. Harris MB, Harris RJ, Bochner S . Fat four-eyed and female: stereotypes of obesity, glasses and gender J Appl Soc Psychol 1982 126: 503–516.

    Article  Google Scholar 

  27. Ajzen I, Fishbein M . Attitude-behavior relations: a theoretical analysis and review of empirical research Psychol Bull 1977 84: 888–918.

    Article  Google Scholar 

  28. Eagly A, Chaiken S . The psychology of attitudes HBJ 1993.

    Google Scholar 

  29. Snyder M, Tanke ED, Berscheid E . Social perception and interpersonal behavior: on the self-fulfilling nature of social stereotypes J Pers Soc Psychol 1977 35: 656–666.

    Article  Google Scholar 

  30. Adams CH, Smith NJ, Wilbur DC, Grady KE . The relationship of overweight to the frequency of pelvic examinations: do physician and patient attitudes make a difference? Women Health 1993 202: 45–57.

    Article  Google Scholar 

  31. Abe R, Kumagai MK, Hirosaki A, Nakamura T . Biological characteristics of breast cancer in overweight Tohoku J Exp Med 1976 120: 351–359.

    Article  CAS  Google Scholar 

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The authors thank Dr Clifford Dasco and Dr David Lairson for comments on earlier copies of this manuscript. This study was supported by two mini-grants from the University of Texas-Houston School of Public Health and from funding by Rice University.

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Correspondence to MR Hebl.

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Hebl, M., Xu, J. Weighing the care: physicians' reactions to the size of a patient. Int J Obes 25, 1246–1252 (2001).

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