PROBLEM: Stemming the rising levels of obesity is complicated. We at least (are starting to) know enough not to shame individuals for their weight. Doctors see us at our most vulnerable, and we certainly don't want to think that internal biases affect the way they treat us.
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METHODOLOGY: In a small study, researchers at Johns Hopkins University analyzed recordings made of 39 primary care physicians in Baltimore during routine visits with 208 of their patients with high blood pressure. They measured how much time the doctors spent discussing medical information, like tests and symptoms, psychological and lifestyle factors, like the state of the patients' social lives and the amount of diet and exercise they got, and "rapport building" -- how they engaged with the patients on a more personal level.
RESULTS: For the most part, the doctors appeared to be very egalitarian with their patients. There were no significant between-patient differences in any of their basic doctoring and counseling. And while there were no differences in how positive or social their interactions were, the doctors built less emotional rapport with their patients.
This meant they said less things to convey "empathy, legitimation, concern, reassurance, partnership, and self-disclosure" during the course of the patient visit. Moreover, in response to the question, "How well do you know this patient?," doctors reported having less familiarity with their overweight and obese patients.
IMPLICATIONS: That the doctors didn't spend any more time on medical or lifestyle information with their overweight patients is problematic in itself. Overweight patients in this study were more likely to suffer from multiple conditions at once, and would probably benefit from emphasis on lifestyle changes.
But studies have shown that patient adherence to such advice improves when their relationships with their doctors include "elements of emotional rapport including empathy, reassurance, listening, shared decision making, and patient centeredness" write the authors. These things matter more than other, more superficial types of rapport; the type in which the doctors engaged equally for all patients. If doctors aren't connecting with their patients -- and it's unclear why they appear not to be -- it might be harder for those messages to sink in.
"Physicians build less rapport with obese patients" is published in Obesity.
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