Overcoming Weight Bias to Gain Trust

Practicing what you preach is good advice for everyone. And results of an online survey published in the International Journal of Obesity, indicate that adage is particularly good advice for physicians.

The survey found that patients are less likely to trust and follow the advice of an overweight physician. Specifically, on a scale of 1 to 5, with 5 being the highest level of trust, those responding to the survey ranked their trust level as 4 toward a normal weight physician, 3.4 for an overweight physician, and 3.3 for one who is obese.

Lori Mosca, MD, MPH, PhD, professor of medicine at Columbia University Medical Center and director of preventive cardiology at New York Presbyterian Hospital, is not at all surprised by the survey results.

“There is a weight bias in our culture, and what I think that study says [is] that physicians are not exempt,” Mosca says. “And from a financial perspective, [patient bias] can impact a physician’s bottom line, in how patients are referred to them, or perceived by [patients] to be healthy.”

Turn negative into positive

Mosca, an active proponent of healthy lifestyles, and author of Heart to Heart: A Personal Plan for Creating a Heart-Healthy Family (HCI, 2005), says the results of the online survey clearly indicate the potential impact physicians can have on their patients by adopting healthy lifestyles.

That’s a positive thing — even if physicians don’t give the appearance of living a healthy lifestyle.

“Physicians are not God, and I think our patients recognize that,” Mosca explains. “And if we’re struggling with weight problems we could turn that into a positive, and share it with our patients. ‘Yes, I’m not at my ideal weight yet, but here’s what I’m doing, and we’re going through this together.’ Empathy with a patient can actually build trust rather than decrease trust.”

Mosca says that taking the time to converse and build a rapport with a patient can produce very positive results.

“I’ve seen data in the past showing that physicians are still the number one source of trust in information for patients regarding nutrition,” Mosca says. “That’s a window of opportunity for us. And even if we spend a brief one minute in our encounter with a patient on nutrition, that can have an impact similar to a patient seeing a dietician for one hour.”

Getting an edge

Mosca explains that by walking the heart-healthy walk herself, she gains an edge in building a rapport with her patients on several fronts.

Since she embraces healthy living in her own lifestyle, Mosca’s more knowledgeable about it. And knowledge is something that physicians transmit regularly to their patients. Having that knowledge enables her to avoid the barrier of referring them to other sources for information.

And because Mosca embraces a healthy lifestyle, she’s well aware of the challenges that patients encounter.

“Even though we all know to eat healthy, it’s harder to actually implement,” she says. “So if you face those barriers yourself and overcome them, I think transmitting skills and strategies is particularly important.”

Mosca also explains not to judge a book by its cover — from a patient’s and a physician’s perspective.

“There are many overweight people who exercise regularly and eat healthy; they may just be eating too much,” she explains. “We want to be careful and not make the assumption that how a physician appears [means] that they are not trying to embrace a healthy lifestyle. They could be on the path to a healthy lifestyle; they may have a genetic landscape that is much more challenging. So what this is about is opening the dialogue, and allowing physicians to show compassion and empathy if they’re in that situation.”

Gaining knowledge

Mosca suggests that physicians who are overweight should reframe the situation with their patients. In other words, don’t simply tell patients to do something that you don’t engage in.

“It’s like raising kids,” she explains. “They tune out 70% of what we say, but they tune in 90% of what we do.”

She recommends overweight physicians acknowledge to patients that they are overweight and discuss the barriers they’ve encountered. It’s likely those issues will be the same or similar to those patients experience.

A good place for physicians to gain the knowledge necessary to open that dialogue with their patients is at the Get Real About Seafood website, which offers resources for physicians who are looking to engage their patients in conversations about dietary changes and improving their health.

“By sharing strategies, you’re showing empathy,” Mosca says. “Authenticity is very important. I think it gives you an edge in your practice, and can really help your bottom line.”