INTRODUCTION
Stigma toward obese persons is pervasive in North America. Obese individuals are vulnerable to harmful weight-based stereotypes, including perceptions that they are lazy, lacking in willpower, indisciplined and unintelligent. (1,2) These stereotypes give way to stigma, prejudice and discrimination in multiple domains of living, including the workplace, health-care facilities, educational institutions, the mass media and even in close interpersonal relationships. (1,3) Of concern, these negative stereotypes have emerged consistently in the health-care setting, with multiple studies documenting biased attitudes toward obese patients by physicians, nurses and other health-care professionals. (4–9)
Stigma toward obese persons is pervasive in North America. Obese individuals are vulnerable to harmful weight-based stereotypes, including perceptions that they are lazy, lacking in willpower, indisciplined and unintelligent. (1,2) These stereotypes give way to stigma, prejudice and discrimination in multiple domains of living, including the workplace, health-care facilities, educational institutions, the mass media and even in close interpersonal relationships. (1,3) Of concern, these negative stereotypes have emerged consistently in the health-care setting, with multiple studies documenting biased attitudes toward obese patients by physicians, nurses and other health-care professionals. (4–9)
Although considerable research has illustrated negative stigma by physicians toward overweight and obese patients (see Puhl and Heuer 1 for a review), 1 little research to date has examined whether physicians themselves could be vulnerable to weight bias from patients. That is, to what degree do patients hold stigmatizing attitudes toward physicians who are overweight or obese? Given that two-thirds of American adults are either overweight or obese, (10) many health care providers also struggle with overweight and obesity (11) and may be perceived differently by their patients compared to thinner physicians. This notable gap in research is important to address for several reasons. The provider–patient relationship is pivotal for risk reduction, disease prevention and ultimately disease outcomes for the patient. (12)
When addressing health behaviors like smoking, exercise, diet and alcohol usage, the provider–patient interaction is key for identifying risk factors and disease, and for counseling patients on appropriate treatment actions. (13) Yet, the degree to which these interactions are effective and successful could be related to actual or perceived health-related behaviors of doctors themselves. For example, evidence suggests that physicians with lower resting heart rates are more likely to counsel their patients on exercise (14) and non-smoking physicians are more likely to counsel their patients on smoking cessation. (15) Some research shows that health professionals of a ‘normal weight’ are more confident in their weight management practices, perceive fewer barriers to weight management for their patients, and have more positive expectations for patient health outcomes. (16)
Similarly, a recent study found that physicians with a body mass index (BMI) in the ‘normal-weight’ range have greater confidence in their abilities to provide diet and exercise counseling to their obese patients compared to physicians with higher BMI, and believe that overweight/obese patients would be less likely to trust weight loss advice from overweight/obese doctors. (17) Personal health behaviors of physicians have also been associated with patients’ perceptions of their decreased credibility. (18) For example, one study found that even if physicians talk to their patients about reducing unhealthy behaviors, patients are less likely to listen to physicians who are perceived as unhealthy. (19) In addition, experimental research has found that physicians who disclose health, diet and exercise habits are perceived as more believable, healthier and more motivating by patients compared to physicians who do not disclose health behaviors. (20) However, the degree to which a physician’s body weight may affect patient perceptions and reactions to physicians remains poorly understood, and has received very little research attention. Of the limited research that has been published in this area, one study found that non-obese physicians are perceived to be better at providing health advice than obese physicians, (13) and another study illustrated that patients listen more strongly to the health advice of a non-obese physician, as compared to an obese physician. (21)
However, questions remain regarding the impact that a physician’s body weight has on patients’ perceptions of trust and credibility of the physician, their comfort level in discussing personal health behaviors, the degree to which they would follow advice to improve health behaviors and even their selection of providers. The present study aimed to assess public perceptions of normal weight, overweight or obese physicians to better understand how these perceptions affect the doctor–patient relationship, including physician selection, physician trust and following medical advice. It was hypothesized that participants would assign more negative ratings on these characteristics to physicians who were described as being overweight or obese compared to physicians described as being normal weight. These questions were examined in an experimental paradigm via an online self-report survey of the general population. This study additionally examined whether certain participant characteristics (for example, gender, age, body weight and race) affect their responses and perceptions of physicians’ weight and the doctor–patient relationship.