Stigma Keeps Obese Elders Away from Medical Care

Older adults with obesity may avoid health care due to the stigma associated with excess weight. This explains a lot of what happens by the elderly. I am different and being overweight hasn't stopped me, even with needing to put up with snide comments from a few doctors. I no longer see one doctor, but because of the way I turn some of the snide remarks back on the doctors, I have also had one doctor refuse to see me.

I admit that I ask the doctors if that comment was really necessary and if they felt that this was the unprofessional way they treated all patients. Sometimes there are a few more comments made by both the doctor and myself, but this is seldom.

Previous studies suggest that obesity is associated with weight stigma and lower rates of some preventive care. However, the effect of BMI on care and health-seeking behaviors among older adults has not been thoroughly investigated. Now, a new study looking at adults aged 65 years and older has found that obesity itself may be significantly associated with the predilection to avoid medical care. The findings, which were presented at Obesity Week 2016, also suggest that this predilection is not explained by functional impairments.

“The study found that people with a higher BMI (greater than 30) have an increased association with having an adverse perception of their physician's interpersonal manner and reporting the predilection to avoid care,” said study investigator Janet Ho, MD, Beth Israel Deaconess Medical Center in Boston.

Dr. Ho, who presented the study findings, said given the prevalence of older adults with obesity in the United States, this adverse perception or predilection to avoid care may translate into significant clinical effects. The study focused on patient perceptions of primary care providers because they traditionally have longitudinal relationships with patients.

“The findings could pertain to endocrinologists, who also often times become the primary health care provider for their patients,” Dr. Ho told Endocrinology Advisor. “Endocrinologists should care about the study findings, because patients with higher BMI who report a predilection to avoid care are the very ones who may need additional specialist support.”

Dr. Ho reports that prior research has shown that being overweight or obese may be a barrier to health care access, utilization, and quality. For example, patients with obesity have been shown to have lower rates of health care maintenance, diabetes screening, and recommended cancer screenings. She also shares that prior research has also found that provider attitudes and interactions with stigmatized groups can contribute to health care access disparities, and that said health care professionals may sometimes hold strong negative opinions about people with obesity.

Dr. Ho noted that stigma may not just affect quality of care, but also affect appropriate and timely care. To better understand the association among adults aged 65 and older who are overweight or obese, and in whom the effect of this stigma is less known, Dr. Ho and her colleagues Long Ngo, Wenxiao Zhou, and Christina Wee looked at surveys of a nationally representative sample of Medicare recipients between 2002 and2012. For this investigation, Dr. Ho and her team accounted for various demographic and clinical factors.

“The most important take-home message is that medical stigma can be implicit and insidious, and that patients with higher BMI may perceive such stigma in their interactions with health care providers, environments, and systems. As providers, especially endocrinologists who may interact frequently with patients with higher BMI, becoming aware of these biases and actively combating its effects in ourselves, colleagues, and interactions with patients is the first step towards improving care for these patients,” said Dr. Ho.

She said while it is possible to conceptually appreciate downstream effects of avoidance of care on health outcomes and costs, it is too early to report on those effects. However, examining the association between this self-reported predilection to avoid care or adverse perceptions of physicians and downstream consequences on health will be the next step in the team's research efforts. Dr. Ho said further studies may help elucidate what the best approaches for addressing this issue are.