Patients less likely to trust and listen to overweight doctors

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I was having a conversation with someone this week which centred around this photo which has done the rounds in the blogosphere.

Dean Ornish Mark Sissons

Essentially, this has been used by proponent of low-carb/primal/paleo eating and lifestyle who, as a rule, reject the notion that a healthy diet is one that is largely or completely devoid of animal products and low in fat.

While I generally support the former diet over the latter, it’s sometimes important to remember that our health and how we look is not always completely down to our lifestyle. Genes usually play some part, of course. During my conversation about this, we talked about elite marathon runners (Mark Sisson was a marathoner in his earlier life). It’s easy to perhaps look at a lean runner and imagine that he or she is lean because of all the running they do. However, just as plausible is the idea that someone is able to become an elite runner because they are naturally lean.

However, I also made the observation that, in general terms, we can easily make a judgment about someone’s lifestyle and even character based on how they look. The photograph above is perhaps an example of this. As is any negative feelings or judgment any of us have had on seeing a very obese person struggling to walk or making their way in a mobility scooter.

I know from experience that the reason someone is struggling with excess weight may possibly be in spite of their best efforts. For a start, someone attempting to eat a low-fat diet may be unwittingly driving themselves down a road to accumulating fat. Also, it is possible that someone can have a hormonal issue, such as undiagnosed or inadequately-treated low thyroid function, that leaves them prone to excess weight whatever steps they take.

Again, not everyone can be expected to understand these views, and the end result, again, is that many of us will simply make judgements based on what pre-formed ideas about the cause of the obesity being gluttony or laziness or both.

I am only too aware of this myself, because as someone who expressed opinions publicly on weight control, I do feel under some pressure not to be obese. I was once lecturing in Zurich, Switzerland, and a member of the audience raised the issue of ‘food reward’, and the fact that there is a form of potato chip/crisp in Switzerland that he feels is very rewarding for him, and that he can have trouble stopping eating once he’s started. I suggested I might try this snack, but he jokingly cautioned me against this saying “If you did that, you may not be able to do your job.” I asked him why, and he said “Because you would get fat and then no-one would take you seriously.” And although this communication was light-hearted and in good spirit, I think he had a point.

And this conversation came back to me today when I read a pieces of research in which the relationship between a doctor’s weight and their people’s attitudes to them were assessed [1].

Here’s a summary of the study’s findings and conclusions:

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Respondents reported more mistrust of physicians who are overweight or obese, were less inclined to follow their medical advice, and were more likely to change providers if the physician was perceived to be overweight or obese, compared to normal-weight physicians who elicited significantly more favorable reactions.

This study suggests that providers perceived to be overweight or obese may be vulnerable to biased attitudes from patients, and that providers’ excess weight may negatively affect patients’ perceptions of their credibility, level of trust and inclination to follow medical advice.


Interestingly, this study found that when individuals exhibited more ‘weight bias’, perceiving a doctor as normal weight was associated with higher trust, more compassion, more inclination to follow advice, and less inclination to change doctors.

As I said, the way someone looks and their weight may have essentially nothing to do with their lifestyle and is not necessarily a reflection of their character. But this does not seem to stop individuals making such judgments. On the plus side, there is usually much someone can do to improve their health situation. For the most part, I think there’s great potential in the idea of we doctors getting our own houses in order and ‘looking the part’. This will likely benefit us not just personally, but professionally too.


1. Puhl RM, et al. The effect of physicians’ body weight on patient attitudes: implications for physician selection, trust and adherence to medical advice. International Journal of Obesity advance online publication 19 March 2013; doi: 10.1038/ijo.2013.33

Thanks to Asclepius for making us aware of this relevant cartoon strip:

dilbert strip


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