In this study we found that as patients had higher BMI, physicians reported lower respect for them. A ten-unit higher BMI was associated with a 14% higher prevalence of low physician respect. This association was unchanged after adjustment for patient and physician demographics.
These findings are in agreement with prior studies that show obesity elicits negative attitudes from physicians.5–7
Our study adds to this literature and shows that individual patients are the recipients of lower physician respect related to higher BMI, independent of other patient and provider characteristics. This is an important distinction and provides further evidence that the care for individuals may be affected by negative attitudes about obesity.
Respect is a central concept to the practice of medicine, yet the term respect may hold a variety of meanings. Respect generally refers to “positive regard” and has been further conceptualized as the “recognition of the unconditional value of patients as persons,”16
and it therefore has been argued that this recognition should be independent of personal characteristics and accorded equally to all.16
Yet we acknowledge that respect is conceptualized by many as a sort of admiration, which is dependent upon a subjective assessment of a person’s worthiness of respect. It is possible that it is this sense of “admiration respect” that physicians were using when they rated their levels of respect for patients in our study, especially because the wording of the question gave physicians permission to rate people at different levels. Nevertheless, without a deliberate intention on the part of the physician to disentangle their own assessments of a person’s admirability, one form of disrespect can easily lead to another, leading to an injustice in the amount of value accorded to the lives of individuals based on their weight.
In addition to the primary injustice of the lower respect with higher BMI, there may be further consequences of this finding that should also be explored. Physician respect is associated with a greater amount of information given by the physician at the patient encounter.17
Focus groups and surveys have found that patients desire a respectful relationship with their physician and may avoid the health-care system if such a relationship does not exist.9,12
We postulate that physician respect may play a role in patients with obesity avoiding the health-care systems and receiving less preventive care and less education about their health documented in other studies, but more studies are needed to determine specifically what additional consequences may occur as a result of lower respect.12,14,15,20
Future research should explore the impact of physician negative attitudes associated with obesity on the health-care processes and outcomes for patients. In addition, deeper understanding about the development of this bias in health-care professionals is needed. Negative bias towards obesity has been documented in medical students,21
yet little is currently offered in medical education to reduce or compensate for these negative attitudes. One of the first steps in promoting equity is to recognize the problem and to help physicians develop insight into their own biases.
There are several limitations to our study. It is cross-sectional, and, as such, we cannot comment on the causal nature of this association. We are also unable to link low physician respect for patients to health outcomes. However, this study remains an important first step in describing and understanding the association between physician respect and patient BMI. A social desirability bias is possible as physicians may not want to report low respect for patients. We attempted to limit this bias by asking physicians to compare the patient to the “average patient.” It is unlikely that this social desirability bias would be differential by BMI. There are many reasons why physicians might have developed a lowered respect for patients, and we are unable to explore all of the possibilities in this study leading to residual confounders. In addition, we are underpowered to explore possible mediators and moderators of this relationship.