Many physicians treat obese patients with less respect according to a study out of Johns Hopkins University.

Lead researcher Dr. Mary Huizinga witnessed first-hand physicians making hurtful comments that discouraged obese people from seeking medical help and dispensing frightening statements to patients by linking obesity and death during medical school.

“While I was training at Vanderbilt, I noticed the way some doctors approached the issue of weight was inappropriate and disrespectful,” said Huizinga, the director of the Johns Hopkins Digestive Weight Loss Center. “I was with this cardiologist who told a woman that she was going to die if she didn’t lose weight and then just walked out of the room.”

The findings stir up many questions involving the level of care offered to obese patients.

“Obese patients didn’t want to come in because they were embarrassed,” Huizinga said. “They would come in for an earache and be lectured on their weight.”

The report, published in the November issue of the Journal of General Internal Medicine, examined survey responses from 238 patients and 40 doctors in the Baltimore area. The average body mass index of the patients was 32.9; a person with a BMI of 30 or higher is considered obese. Normal weight for adult men and women falls between 18.5 and 24.9 BMI. An individual is underweight if they are below a BMI of 18.5.

The study showed that with each 10-unit increase in body mass index, a doctor’s respect level dropped by 14 percent. Physicians rated their respect level for obese patients in comparison to “the average patient” using a 5-point scale.

Huizinga argued that it was impossible to establish a “beneficial relationship” between doctor and patient without respect. She contended that doctors require more training in how to approach patients and overcome cultural prejudice.

“Physicians are humans and they are part of a society that values being fit and thin and [which] has a bias against people who are overweight,” Huizinga said. “So, we definitely need more training on how to interact with patients.”

“Nutritional and behavioral training is essential to any medical student’s curriculum,” agreed Linda Van Horn, professor and interim chair of Northwestern University’s Department of Preventive Medicine.

“Behavioral lessons not only teach you how to give bad news, but also how to really talk to a patient,” she said. “Nutrition education lets a doctor say, ‘This is what we can do to help you.’ ”

Van Horn also recommended that the typical approach of medicine, marked by a doctor dictating a course of action to a patient, be replaced by a partnership.

Huizinga remarked that communication is essential when dealing with overweight and obese patients.

“A message that physicians and patients lose is an obese person only needs to lose five percent of their weight to benefit their health,” she said. “They may not be at their ideal size but the patient will be a lot healthier.”

Van Horn insisted that physicians have a duty to be as informative as possible toward obese patients, since many come in looking for a “quick fix,” such as bariatric surgery.

“Patients will actually gain weight to be eligible for bariatric surgery,” she said. “Doctors need to tell them that the surgery is not a walk in the park and intended as a life-saving procedure.”

According to the Mayo Clinic's Web site, complications from weight loss surgery may include kidney stones, hypoglycemia, vitamin and mineral deficiency, hernias, blood clots in the legs, long-term digestive problems and, in extreme cases, death. A study published in the October issue of the Archives of Surgery reports that super obesity increased the possibility of death following bariatric surgery.

Huizinga and Van Horn agreed that one of the greatest obstacles facing the treatment of obesity besides physician behavior is lack of insurance.

“It’s frustrating as a medical doctor that a lot of obesity treatment is not reimbursed by insurance,” Huizinga said. “The initial consultation is covered, but if I send a patient to a nutritionist or exercise specialist the insurance companies won’t pay for it.”

Van Horn lamented that contemporary medical culture focuses on intervention instead of prevention, causing insurance companies to avoid covering visits with a lifestyle coach or medication.

Huizinga observed that in order to change the health care system’s outlook regarding obesity, society must identify it as a disease rather than an expression of an individual’s weakness.

“We blame people for being overweight,” she said. “We think they’re at fault.”