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Perceived judgements

Obese patients feel judged by physicians

Counselling may be more effective if patients do not perceive judgment

Overweight and obese people who feel their physicians are judgmental of their size are more likely to try to lose weight but are less likely to succeed, according to results of a study by Johns Hopkins researchers.

The findings, reported in the journal Preventive Medicine, suggest that primary care physicians should lose the negative attitudes their patients can sense if the goal is to get patients with obesity to lose 10 percent or more of their body weight (an amount usually sufficient to reduce blood pressure, cholesterol and diabetes risk).

"Negative encounters can prompt a weight loss attempt, but our study shows they do not translate into success," said study leader, Dr Kimberly A Gudzune, an assistant professor in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine. "Ideally, we need to talk about weight loss without making patients feel they are being judged. It's a fine line to walk, but if we can do it with sensitivity, a lot of patients would benefit."

Gudzune and her team suspected the pervasiveness of negative provider attitudes and weight stigma may be limiting the effectiveness of advice from primary care providers for these patients.

To test that idea, the researchers conducted a national Internet-based survey of 600 adults with a BMI >25 who regularly see their primary care doctors. The participants were asked, "In the last 12 months, did you ever feel that this doctor judged you because of your weight?"

Overall, 21% perceived that their primary care physician judged them about their weight. Respondents who perceived judgment were significantly more likely to attempt weight loss [odds ratios (OR) 4.67, 95% confidence interval (CI) 1.96–11.14], although they were not more likely to achieve ≥10% weight loss [OR 0.87, 95%CI 0.42–1.76].

Among patients whose primary care physicians discussed weight loss, 20.1% achieved ≥10% weight loss if they did not perceive judgment by their primary care physicians, compared to 13.5% who perceived judgment.

Ninety six percent of those who felt judged did report attempting to lose weight in the previous year, compared to 84 percent who did not.

Having a weight loss conversation clearly helped people lose more weight, the study found. Only 9 percent of those who felt judged but did not discuss weight loss with their doctor lost more than 10 percent of their body weight, while 6 percent of those who neither felt judged nor discussed weight loss with their doctor did.

Overall, just two-thirds of participants reported that their doctors brought up weight loss.

"Many doctors avoid the conversation because they don't want to make anyone feel bad, worrying they'll create a rift with their patients if they even bring it up. But that is not in the patients' best interest in terms of their long-term health," said Gudzune.

She added that doctors may need to be taught how to talk about the topic in ways that make patients feel understood and supported. It may also be helpful to start with smaller weight loss steps, such as a 10 percent reduction in weight. A larger long-term goal of losing 70 or 100lbs can be a setup for frustration and failure when tackled all at once.

"We don't want to overwhelm them and if we are their advocates in this process - and not their critics - we can really help patients to be healthier through weight loss.”

The US Preventive Services Task Force has recommended that health care providers counsel obese patients to lose weight, and the Centers for Medicare and Medicaid Services now covers some behavioural counselling related to weight loss.

Other Johns Hopkins researchers who contributed to this study were Wendy Drs L Bennett, Lisa A Cooper and Sara N Bleich.

The research was supported by trainee awards from the National Institutes of Health's National Heart, Lung and Blood Institute's Center for Population Health and Health Disparities, as well as by other NHLBI grants.

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