Weight Loss And Gender - Brief Article

Nutrition Research Newsletter, August, 2001 by C. Anderson, C. Peterson, L. Fletcher, J. Mitchell, P. Thuras, S. Crow

Although physicians seem to be informed about the risks associated with obesity, many factors may affect the treatment recommendations that physicians provide to patients. Physicians' treatment of obesity is influenced by patient factors including age, level of motivation, medical comorbidity, and body mass index (BMI). Management of obesity also seems to be influenced by the physician's own characteristics, with male physicians tending to view obese patients as more lacking in self-control than female physicians, and overweight physicians being less likely to emphasize the health consequences of obesity to their patients than normal-weight physicians. In addition, physicians fail to recommend treatment at all, as they often do not know what treatment would be most appropriate for the patient. The purpose of the present study was to investigate whether physicians make different weight loss recommendations and referrals to men and women. To examine attitudes toward patients, this investigation examined differences in the treatment of weight loss of men and women by keeping respondents blind to the purposes of the study.

Surveys were mailed to 700 randomly selected physicians from a list obtained from the Minnesota Medical Association that included licensed physicians from all counties in the state. The sample consisted of 300 family practice physicians, 300 internal medicine physicians, and 100 obstetrical and gynecological physicians. A total of 209 physicians returned their surveys.

One-half of the surveys distributed included descriptions of female patients and one-half described male patients, but the surveys were otherwise identical. Respondents received either a male or female questionnaire. Physicians were mailed the version randomly, with the exception of the OB-GYN physicians, who were sent the female forms. Each survey described three hypothetical patients. Following the hypothetical patient description was a series of questions and statements about attitudes toward treatment and specific interventions and referrals that the physician would view as appropriate. The final section requested information about the physician, including gender, height, weight, age, specialization, and number of years in practice. Respondents were also asked if they knew their own BMI and if they had ever attempted to lose weight, and if so, what techniques they had used.

Across all items, there were highly significant BMI effects, with physicians more likely to encourage weight loss for the patients with the higher BMIs. The only main effects for patient gender were observed for the question that asked about referral information, with the physicians more likely to agree that referral/treatment information should be provided to female patients than male patients. The primary hypothesis that physicians would demonstrate different attitudes toward men and women in treating weight loss and obesity regardless of BMI was not supported by this study; however, this study did find that physicians were more likely to recommend weight loss to female patients than male patients with a BMI of 25 kg/[m.sup.2]. This finding is consistent with previous studies that found that female patients are advised to lose weight more frequently by physicians compared with male patients. This may reflect the current sociocultural context in which women who are slightly overweight are more likely to be stigmatized. This finding may also indicate that men who are slightly overweight may not be getting the adequate weight-loss treatment from physicians.

A significantly larger percentage of physicians rated a referral to a mental health professional as appropriate for male patients, as opposed to female patients. An unexpected finding was the reverse gender effect for patients with BMI of 32 kg/[m.sup.2]. Physicians were more likely to encourage weight loss for patients with a BMI of 32 kg/[m.sup.2] who were men than were women. The reason that male patients with the highest BMI were more strongly encouraged to lose weight than female patients was unclear, but it indicates that physicians may be less likely to encourage weight loss for obese women with the same BMI. It is possible that the physicians were more concerned about the health risks of android body fat distribution in men than women.

The observed differences in physician attitudes toward male and female patients with the same BMI suggests that physicians are more prone to provide weight-loss treatment and referrals for women who may be slightly overweight, but less likely to provide treatment for women who are significantly obese compared with men. Physician gender was not found to be a significant factor; however, physician knowledge of their own BMI seemed to influence attitudes and treatment recommendations, especially toward patients with higher BMIs. Physicians who knew their own BMI were less likely to encourage weight loss for patients with a BMI of 25 kg/[m.sup.2], less likely to encourage the patient with the higher BMI (32 kg/[m.sup.2]) to accept his or her appearance, and more likely to see treatment referrals for the patients with the higher BMIs as appropriate compared with physicians who did not know their own BMI.