By Jennifer Shine Dyer, MD, MPH
Do Obese Patients Preempt Their Own Preventive Care? A study published recently in JAMA evaluated the quality of preventive medical care provided by physicians to obese patients. This study was undertaken to address previous studies in which physicians openly admitted to having negative attitudes toward obese patients, with many expressing dissatisfaction in caring for these patients.
The study authors looked at 8 prevention performance measures: eye exams; glycated hemoglobin (A1c) testing; lipid screening; influenza vaccination; pneumococcal vaccination; mammography screening; cervical cancer screening; and colorectal cancer screening. Results demonstrated that the delivery of these preventive tests was identical in patients with normal weight and in those who were obese, suggesting that any potential obesity discrimination by physicians does not affect the quality of medical care.
Physicians’ negative views of obesity stem from both societal disapproval of being overweight and a body of medical science suggesting associated health risks. Public scrutiny of obesity developed quite suddenly at the end of the 19th century, after long serving as a mark of prosperity. As one popular magazine put it in 1914, “Fat is now regarded as an indiscretion and almost a crime.” That view grew stronger over the years (diminishing only during The Great Depression and World Wars). The rise of the diet industry, which now accounts for more than $50 billion in spending per year, is a testament to Americans’ concern with their weight. A steady stream of reports provides further evidence of widespread antipathy toward overweight people, affecting everything from personal esteem to college admissions to hiring decisions.
Although social disapproval of obesity set in during the early 1900s, sustained medical concern did not develop until the 1950s. As a consensus on the associated medical issues emerged, public officials began to devote resources to publicize the dangers of obesity in the 1970s, and medical professionals were enlisted to help fight the battle.
More recently, however, public health efforts have begun to shift the blame for obesity on the food industry. In 1999, Eric Schlosser’s surprise best seller, Fast Food Nation, argued that the industry targets children, reshapes their eating habits, and essentially “sponsors” an epidemic (“no other nation in history has gotten so fat so fast”). Similar views are echoed in other movies and commentaries, and perhaps physicians have been swayed by these arguments, thus seeing patients as “victims” of these societal trends.
Whatever a clinician’s perspective on obesity might be, the state of the obese patient is a vulnerable one. Being sick and sitting in a doctor’s office, wearing only a paper gown, can be intimidating for any patient. Add to that a negative attitude from the provider, whether real or perceived, and I’m not sure that obese patients would actually seek preventive care anyway. This potential problem was not assessed in the recent JAMA study, raising questions about the validity of the conclusions because these patients are precisely the ones most affected by clinicians’ “disapproval.”
In the end, whether obese patients are victims of the food industry, victims’ of negative clinician attitudes, or ‘victims of their own personal indiscretions, weight bias remains an important force that deserves further study. The JAMA study’s conclusion that the quality of preventive care is not diminished is good news. However, this may not be the full story because an important population was not included, ie, those who did not seek care due to perceived discrimination. Future studies need to address this critical issue.
- Chang VW, Asch DA, Werner RM. Quality of care among obese patients. JAMA. 2010;303:1274-1281.
- Kersh R, Morone J. The politics of obesity: seven steps to government action. Health Aff (Millwood). 2002;21:,142-153.
- Smith D. Demonizing fat in the war on weight. New York Times. May 1, 2004. Available at: http://www.nytimes.com/2004/05/01/arts/01FAT.html Accessed April 27, 2010.
- Schlosser E. Fast Food Nation: The Dark Side of the All-American Meal. New York: Harper Perennial; 2002.