“There are several mechanisms by which provider attitudes may affect the quality of, or potential for, patient-centred care. First, primary care providers engage in less patient-centred communication with patients they believe are not likely to be adherent (54). A common explicitly endorsed provider stereotype about patients with obesity is that they are less likely to be adherent to treatment or self-care recommendations (23,24,55,56), are lazy, undisciplined and weak-willed (12,55,57–59). Second, primary care providers have reported less respect for patients with obesity compared with those without (59,60), and low respect has been shown to predict less positive affective communication and information giving (61). Third, primary healthcare providers may allocate time differently, spending less time educating patients with obesity about their health (62). For example, in one study of primary care providers randomly assigned to evaluate the records of patients who were either obese or normal weight, providers who evaluated patients who were obese were more likely to rate the encounter as a waste of time and indicated that they would spend 28% less time with the patient compared with those who evaluated normal-weight patients (59). Finally, physicians may over-attribute symptoms and problems to obesity, and fail to refer the patient for diagnostic testing or to consider treatment options beyond advising the patient to lose weight. In one study involving medical students, virtual patients with shortness of breath were more likely to receive lifestyle change recommendations if they were obese (54% vs. 13%), and more likely to receive medication to manage symptoms if they were normal weight (23% vs. 5%) (23).”
“The effects of stigma are both immediate and long-term. The direct effects of provider attitudes on patient-centred care may reduce the quality of the patient encounter, harming patient outcomes and reducing patient satisfaction. Patients with obesity who experience identity/stereotype threat or felt/enacted stigma may experience a high level of stress which can contribute to impaired cognitive function and ability to effectively communicate (66). Accumulated exposure to high levels of stress hormones (allostatic load) has several long-term physiological health effects, including heart disease, stroke, depression and anxiety disorder, diseases that disproportionately affect obese individuals and have been empirically linked to perceived discrimination (67–69). Indeed, stress pathways may present an alternate explanation for some proportion of the association between obesity and chronic disease (70).”
“Clinic equipment may also promote identity threat for patients with obesity (87,88). Waiting room chairs with armrests can be uncomfortable or too small. Equipment such as scales, blood pressure cuffs, examination gowns and pelvic examination instruments are often designed for use with smaller patients. When larger alternatives are not available, or are stored in a place that suggests infrequent use, it can signal to patients that their size is unusual and that they do not belong. These experiences, which are not delivered with malicious intent, can be humiliating.”
Full article:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381543/#!po=29.2208
