Many People with Severe Obesity Face Medical Discrimination, Study Finds

Key Takeaways:

• A new study reveals that over 40% of clinics in the United States refused to schedule an appointment for a hypothetical patient with severe obesity.
  
• More than half of practices surveyed lacked the basic facilities or equipment required to provide appropriate care to patients with a body mass index (BMI) of 60 or greater.
  
• Researchers warn that discrimination and inadequate resources may contribute to poorer health outcomes, including delayed cancer detection, among people living with severe obesity.
  
  

Widespread discrimination in clinical settings

People living with severe obesity frequently encounter discrimination and barriers when seeking medical care, according to a new study published in the Annals of Internal Medicine. Researchers reported that about 2 in 5 (41%) clinics refused to schedule an appointment for a hypothetical patient weighing 465 pounds.

One receptionist at an orthopaedic surgeon’s office stated: “We’ve reached our limit for bariatric patients at this site,” without offering further explanation.

The study highlights a critical issue in access to care: beyond outright refusals, more than half of clinics (52%) did not have the equipment or facilities necessary to provide basic medical care for patients with very high body weights. Severe obesity is defined as a BMI of 40 or higher, with extremely severe obesity considered a BMI of 60 or greater.

Lack of facilities and equipment

Many clinics lacked essential infrastructure, including examination tables or chairs that could safely support higher weights, wide enough doorways and hallways for patient mobility, and appropriately sized medical gowns.

Dr Tara Lagu, senior author of the study and adjunct lecturer of medicine and medical social sciences at Northwestern University Feinberg School of Medicine in Chicago, emphasised the harmful impact of such deficiencies:

“Patients living with severe obesity are likely already struggling with shame and difficulty navigating the world. To tell a patient that they can’t be examined on a table, or can’t wear a gown, or need to stand during an appointment makes what should be a safe place and the experience of seeing a doctor humiliating and degrading. We need to acknowledge, as a profession, that all people deserve better than this.”

Affected population and health risks

According to the researchers, approximately 1 in every 270 Americans – close to 1 million adults – lives with extremely severe obesity (BMI ≥ 60). These individuals are two to three times more likely to experience significant health problems compared with the general population.

Despite this increased risk, previous studies have shown that people with obesity are less likely to receive preventive health services such as cancer screenings. Dr Lagu explained:

“Obesity affects cancer screenings, and failure to screen can result in later cancer detection. We’re always attributing worse outcomes in higher-weight patients to weight itself, but more and more studies are now pointing to worse care, lack of care or being care avoidant as possible reasons for these delays.”

Study design and findings

To investigate barriers to care, researchers used a “secret shopper” approach, in which callers attempted to schedule an appointment for a hypothetical patient weighing 465 pounds. They contacted 300 clinics across four metropolitan areas – Boston, Cleveland, Houston, and Portland, Oregon. The study covered five specialties: dermatology, endocrinology, obstetrics and gynaecology, orthopaedic surgery, and ear, nose, and throat (ENT).

Lead researcher Dr Molly Hales, a physician at University of Chicago Medicine, noted that the caller questions were intentionally designed to suggest possible urgent medical needs:

“We designed some of the questions our callers asked to be red flags for a receptionist to think, ‘I should really schedule this person,’ because the questions suggested the patient might have cancer and need an urgent workup.”

Despite this, only 59% of clinics overall were willing to schedule the appointment. ENT specialists were least likely to agree, with only 48% offering an appointment, while endocrinologists were most likely to accept and to have suitable facilities.

Humiliating workarounds

Even among clinics that agreed to see the hypothetical patient, around 1 in 6 (16%) suggested workarounds that could be humiliating, such as requiring the patient to stand during the exam or to use a sheet instead of a gown.

Dr Hales observed:

“Our numbers likely underestimate the magnitude of the problem. Likely, very few high-weight patients who are scheduling appointments know to even ask if they can be accommodated based on their weight, and they might be hesitant to ask these questions or advocate for themselves because of the social stigma.”

Potential solutions

The researchers highlighted that a Clinical Environment Checklist has been developed to guide outpatient clinics in ensuring they can provide appropriate care for patients with obesity. However, it has not been widely adopted.

Dr Hales noted:

“They designed the checklist to be used by general outpatient clinics and tested it in both primary care and subspecialty settings, so it’s a good resource for clinics in determining where there are opportunities for improvement.”