Dr. Sabin studies the biases of healthcare providers and how they may affect patient care, using insights collected through a virtual laboratory based at Harvard University, where people can take online tests that uncover bias against weight, race, and other topics. “It’s a rapid-fire process, where people can’t stop and think about what they want to say,” she said. The database has more than 300,000 responses from the general public, and Dr. Sabin has studied the responses of those who self-identify as medical doctors (though medical specialties were not specified). A physician can show explicit bias, openly admitting he or she does not want to treat an obese patient, as well as implicit bias, a prejudice the physician does not realize he or she holds.
Explore This IssueMarch 2014
“Anecdotally, it’s pretty obvious that overweight or obese is a problem in healthcare,” said Dr. Sabin, who published her findings in 2012 (PLoS One. 2012;7:e48448). (Overweight people are those who have a body mass index number of 25 to 29.) “Looking at the data, physicians recorded very strong thin-versus-fat preferences, a very strong anti-bias. These are attitudes they might not be aware they have. It’s not a surprise, as these attitudes are very prevalent in society.”
In reviewing studies about weight bias, Dr. Sabin said that patients have reported feeling disrespected by health professionals because of their weight and that women have been subjected to inappropriate comments about their weight by their doctors. As a result, she said patients don’t always seek timely care, and tend to avoid seeing a physician. “It’s a real snowball effect,” she added.
Physicians Miss Out, Too
Patients aren’t the only ones who are hurt by weight bias; physicians are, too. Kimberly Gudzune, MD, MPH, an assistant professor of medicine at The Johns Hopkins University School of Medicine in Baltimore, has studied how physicians interact with their patients by reviewing audiotapes of doctor-patient discussions that represent established patients coming in for routine care from their primary care doctors.
In her research, published in 2013, she found three kinds of communication: biomedical (asking questions about medical problems and symptoms and giving advice), psychosocial (asking about how life is going), and rapport building (the doctor expressing empathy or partnership, or disclosing personal details) (Obesity. 2013:21:1328-1334). While biomedical and psychosocial communication was the same among all patients and doctors, regardless of the patient’s weight, “there was significantly less rapport-building between physicians and their overweight or obese patients,” said Dr. Gudzune. “This suggests they are not building the core of the relationship.”