Let's say your doctor tells you need to drop a few pounds, but one look says he needs to do the same. What if you catch your doctor smoking or knocking back a few beers? Do patients who think their doctors are unhealthy take their medical advice seriously? One study suggests they might not.

Many Americans have a strong bias against people who are overweight or obese, and most physicians consider patients who are overweight or obese as less healthy than they should be, even when other health measures are normal.

Bias Affects Both Doctors and Patients

New research in the International Journal of Obesity suggests that the bias works both ways: in a recent online survey of 358 adults, subjects were asked about their perceptions of physicians who were described as either normal weight, overweight, or obese. Subjects also completed a measure of explicit weight bias (called a Fat Phobia Scale) to determine their attitudes towards weight and size.

Study participants reported more mistrust of overweight or obese physicians than normal weight physicians; they were also less inclined to follow these doctors' medical advice, and more likely to change doctors. Oddly enough, the subject's body weight had no effect on patient perceptions; if the doctor was described as obese, patients didn't find him as credible as a normal weight physician, even if the patients themselves were overweight.

Talking the Talk, and Walking the Walk

So what if your doctor has other unhealthy behaviors like smoking, or a junk food habit? Specific studies haven't investigated this, but we do know that trust is a key component in every doctor-patient relationship. That trust is built on a number of factors including:

  • The doctor's communication style
  • Time spent with the patient during appointments
  • How (or whether) the doctor listens and understands what the patient is trying to communicate
  • The doctor's non-verbal communication cues

And when a doctor communicates, "Do as I say, not as I do," that sends a strong message to patients about how important they think a specific activity, piece of medical advice, or habit actually is. "That's why it is so important for a doctor to be congruent," says Liesa Harte, MD, a physician in Austin, TX. "It is hypocritical for a doctor to ignore her own health issues." But it also demonstrates what many patients often forget: Physicians are human too.

Liesa Harte, MD, reviewed this article.



R M Puhl, J A Gold, J Luedicke and J A DePierre. "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. Web. 19 March 2013; doi: 10.1038/ijo.2013.33