Heavier Docs Less Likely to Tackle Patient Weight

[Guest guest]

A physician's body mass index (BMI) may have an impact on how he or she

cares for overweight and obese patients, according to a nationwide survey.

Physicians with normal BMIs were more likely to engage their patients in

weight-loss conversations compared with those who were overweight or obese

(30% versus 18%, *P*=0.010), reported Sara Bleich, PhD, and colleagues from

the s Hopkins Bloomberg School of Public Health and Medical

Institutions in Baltimore.

The study, published online in *Obesity*, also found normal weight

physicians had more confidence in their ability to provide counseling on

diet (53% versus 37%, *P*=0.002) and exercise (56% versus 38%, *P=*0.001)

compared with their overweight or obese colleagues.

Physician body weight may be a barrier to obesity care. Understanding how a

doctor's BMI influences his or her treatment decisions regarding weight

management is critical, given the important roles practitioners play in

helping their patients lose or gain weight, the authors stated.

They conducted a cross-sectional survey of general practitioners, family

practice physicians, and general internists, recruiting doctors from The

Epocrates Honors panel, an opt-in group of 145,000 American Medical

Association-verified U.S. physicians.

Participants were given a 49-item questionnaire that covered how they

recorded an obesity diagnosis, initiated weight-loss discussions, rated

self-efficacy for providing counseling, and prescribed weight reduction

medication when indicated.

The researchers also looked into differences in outlook on modeling healthy

behaviors and whether physicians believed that patient trust of a doctor's

advice might be less if given by an overweight or obese doctor.

All of the 500 physicians who responded were given a $25 incentive for

completing the survey. After excluding two practitioners who were

underweight, there were 498 responses used in the analysis.

The results showed that normal-weight physicians were more likely to

believe that doctors should model weight-related behaviors, such as

maintaining a healthy weight (72% versus 56%, *P*=0.002) and exercising

regularly (73% versus 57%, *P*=0.001) compared with their overweight or

obese counterparts.

Those with healthy weights also said they believed that overweight or obese

patients would be less likely to trust advice given by a physician who also

was overweight or obese (79% versus 69%, * **P*=0.03).

A physician's self-impression also seems to be a factor in weight loss

counseling. Doctors were more likely to record a diagnosis of obesity (93%

versus 7%, *P*<0.001) or start a weight loss conversation (89% versus 11%, *

P*≤0.001) if they perceived the patient's body weight met or exceeded their

own. These factors remained significant even after adjustment for

covariates.

However, obese and overweight physicians had higher self-efficacy when

prescribing weight-related medications (26% versus 18%, *P*=0.043). They

also were more likely to think they were successful in helping their

patients lose weight, although the actual percentage was very low (5%

versus 2%, *P*=0.034). These remained significant following multivariate

analysis.

Limitations of the study included the use of a cross-sectional analysis,

which only allowed for the finding of associations rather than the

establishment of causal relationships. Self-reporting may have lead to an

underestimation of those in the overweight/obese group. The authors also

noted that use of body images of different patient sizes, rather than BMI

percentages, may have been interpreted differently by responding physicians.

" Physician self-efficacy to care for obese patients -- regardless of their

BMI -- may be improved by targeting physician well being and enhancing the

quality of obesity-related training in medical school, residency or

continuing medical education, " they concluded.

*Primary source: *Obesity

Source reference:

Bleich SN, et al " Impact of hysician BMI on obesity care and beliefs " *

Obesity* 2012; DOI:

10.1038/oby.2011.402.<http://www.nature.com/oby/journal/vaop/ncurrent/full/oby20\

11402a.html>

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