Three Reasons “Get Tough” Backfires

New data presented at Obesity Week adds to the evidence that a naive “get tough” approach to obesity backfires. Scolding, judging, or lecturing patients with obesity leads people with obesity to:

  • Change doctors
  • Avoid healthcare
  • But not to achieve a healthier weight

Kimberly Gudzune and colleagues at Johns Hopkins won special recognition from the Health Services Research Section of the Obesity Society for their study of the impact of negative judgements patients experience from primary care providers (PCPs). Their study was singled out as one of the best presented during Obesity Week 2013.

Gudzune studied a sample of 600 adults with excess weight or obesity who had visited their PCP within the last 12 months. She collected information on feeling judged about their weight by their PCP, discussions of weight, weight loss attempts, and weight loss outcomes. She found that feeling judged might prompt weight loss attempts, but did not lead to successful outcomes. In contrast, she found that discussions about weight loss that were free from negative judgements did lead to more clinically significant weight loss outcomes.

These findings add to the body of research that tells us weight bias gets in the way of dealing with obesity as a health issue. Rebecca Puhl and colleagues have documented that weight bias leads people with obesity to avoid healthcare. Gudzune recently published another study showing that people with obesity are more likely to change doctors and seek care in an emergency department. Also this year, Angelina Sutin and Antonio Terracciano found that weight discrimination increases the risk of obesity.

So the misguided impulse to “get tougher with patients about their weight” (as the Associated Press recently phrased it) actually causes considerable harm. Don’t even get us started about The Biggest Loser.

Click here for the study by Gudzune from Obesity Week, click here for her study of doctor shopping and obesity, and click here for the study by Sutin and Terracciano.

Scream, photograph © Mingo Hagen / flickr

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