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Physician's weight may skew obesity diagnosis, care

Overweight and obese physicians are less likely than their normal weight colleagues to pursue weight loss counseling with an obese patient, according to a study in the January issue of Obesity.

Researchers at the Johns Hopkins Bloomberg School of Public Health examined the effect of doctors’ body mass index (BMI) on obesity care. They found that nearly one in three physicians with a normal BMI were likely to engage their obese patients in weight loss discussions. Fewer than one in five overweight or obese doctors were likely to engage obese patients in a weight loss conversation.

More than nine out of 10 physicians were likely to diagnose obesity in a patient if they perceived the patient’s BMI met or exceeded their own.

“Physicians with normal BMI also have greater confidence in their ability to provide diet and exercise counseling and perceive their weight loss advice as trustworthy when compared [with] overweight or obese physicians,” says Sara Bleich, PhD, lead author of the study and an assistant professor with the Bloomberg School’s Department of Health Policy and Management, in a statement. “In addition, obese physicians had greater confidence in prescribing weight loss medications and were more likely to report success in helping patients lose weight.”

Using a national cross-sectional survey of 500 primary care physicians, Bleich and colleagues assessed the effect of physician BMI on obesity care, physician self-efficacy, perceptions of role modeling, and perceptions of patient trust in weight loss advice. Doctors with a self-reported BMI below 25 kg/m2 were considered to be of normal weight, and physicians reporting a BMI of at least 25 kg/m2 were considered overweight or obese.

Despite guidelines for doctors to counsel and treat obese patients, previous studies have found only one-third of these patients report receiving an obesity diagnosis or weight-related counseling from their physicians.

The Centers for Medicare and Medicaid Services (CMS) will reimburse physicians for obesity screening and counseling. CMS officials estimate that more than 30% of men and women whose care is covered via Medicare are obese.

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