Obesity bias has a negative impact on medical decision making and quality of care, according to results of a systematic review published in Obesity Reviews.
Researchers from Pontifícia Universidade Católica do Rio Grande do Sul in Brazil searched publication databases through June 2023 for studies published since 1993. Inclusion criteria were observational studies that evaluated adults with vs without obesity.
The main outcome was the difference in therapeutic decisions between patients with and without obesity. The researchers defined therapeutic decisions as any medical decisions regarding treatment or diagnostic procedure.
The systematic review included a total of 13 articles, which the researchers categorized into medical education, general health care, screening and secondary prevention of diseases, women’s health secondary prevention, and pharmacological management of health conditions.
One study reported that 3rd and 4th year medical students were more likely to order blood glucose (P <.013) and gastric pH (P =.014) tests and to recommend dietary counseling (P <.001) for patients with obesity vs those without obesity. The students were also less likely to want the patients with obesity in their continuity-of-care practice (P <.015) and were less confident that those patients would be compliant to treatment (P <.001).
In an experiment where medical students interacted with a virtually developed patient with or without obesity, medical students thought patients with vs without obesity were less likely to adhere to medical advice (P <.01), less healthy (P <.0001), and significantly more responsible for causing their shortness of breath (P <.0001). The students also had less visual contact with patients with obesity (P <.05) and were less likely to recommend symptom management for shortness of breath (P <.05).
[Obesity bias] compromises not only medical consultations but also additional procedures and treatments, predominantly in preventive screening exams, and women seem to be a particularly vulnerable group.
In general health care, a cross-sectional study using data from the National Ambulatory Medical Care Survey showed that 70% of patients with clinical obesity were undiagnosed and 63% of them received no counseling about diet, exercise, and weight reduction.
A study of patients with episodic tension-type headache in Denmark revealed that clinicians did not offer different medication or non-medical therapy treatment to patients on the basis of weight but were more likely to perceive patients with obesity as lazy (P <.001) and to have a negative attitude toward them (P <.001).
In a study on colorectal cancer screening, fewer patients aged between 51 and 80 years with obesity class III, compared with those with obese, overweight, or normal weight, reported colorectal cancer screening in the previous 5 years. A second study reported that patients with vs without obesity were 25% less likely to receive colorectal cancer screening (P =.004).
Compared with patients with type 2 diabetes and without obesity, those with type 2 diabetes and obesity were less likely to receive pharmacological treatment intensification when necessary (P =.05). Conversely, patients with obesity were more likely to receive an antidepressant than patients with normal weight.
A study that evaluated data from the National Health Interview Survey demonstrated lower rates of Papanicolaou smears in the previous 3 years (P <.001) or previous mammography (P <.002) among women with overweight or obesity compared with women with normal weight.
The researchers observed similar trends in a study evaluating data from the Asset and Health Dynamics Among the Oldest Old and Health and Retirement Study, in which fewer women with vs without class III obesity received Papanicolaou smears or mammography. However, a third study reported no association between BMI and receipt of Papanicolaou smears.
Study limitations include a high degree of heterogeneity that prevented meta-analysis, the inclusion of only 3 studies conducted after 2013, and a limited number of studies classified as good quality.
“[Obesity bias] compromises not only medical consultations but also additional procedures and treatments, predominantly in preventive screening exams, and women seem to be a particularly vulnerable group,” according to the researchers. “Such bias influences healthcare quality with negative effects on medical decision-making and on the quality of care provided to patients with obesity.”
References:
Telo GH, Fontoura LF, Avila GO, et al. Obesity bias: How can this underestimated problem affect medical decisions in healthcare? A systematic review. Obes Rev. Published online January 25, 2024. doi:10.1111/obr.13696
