UF Health Study: Perceived Quality of Health Care Not Affected by Weight Status

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Dr. Michelle Cardel

Does body weight affect the quality of health care a person receives?

Recent studies have suggested that patients with overweight or obesity often encounter weight-based discrimination when they seek medical care. However, UF Health researchers, who analyzed survey responses from more than 83,000 participants, found no association between body weight and patients’ perceptions about the quality of the health care they received.

That’s good news for the estimated 40% of Americans who are affected by overweight or obesity.

“Unfortunately, we live in a society where weight discrimination and fat-shaming are pervasive,” said Michelle Cardel, Ph.D., M.S., R.D., an assistant professor in UF’s department of health outcomes and biomedical informatics (HOBI) and the senior author of the study. Weight discrimination could be something as subtle as a look of disapproval or disgust, a rude remark from a stranger, or even comments about losing weight from well-meaning family or friends.

“These kinds of negative reactions can lead to low self-esteem and depression among those who have overweight or obesity,” Cardel said.

When weight discrimination happens in a health care setting, it can lead to more serious problems for patients—including poor health outcomes, Cardel added.

“Patients may experience distress about seeking medical care, or they may develop a distrust of the care provider,” she said. “They may decide not to follow the provider’s recommendations, or they may opt not to seek medical care at all.”

Young-Rock Hong, a Ph.D. student in the Department of Health Services Research, Management, and Policy at UF, was lead author on the study and first author of the study. The team analyzed the survey responses of 83,231 adults ages 18 and older living in the United States who had participated in the Medical Expenditure Panel Survey (MEPS) from 2011 to 2015. The annual MEPS survey includes questions from the Consumer Assessment of Healthcare Providers and Systems Survey (CAHPS), which measures overall patient experiences with health care.

The researchers used body mass index (BMI) based on height and weight to determine which of the study participants had overweight or obesity. Among the study population, 35% had overweight, 27% had obesity and 5% had severe obesity. The remaining adults had normal weight.

Patients’ ratings were based on factors such as perceived access to health care, need for insurance, quality of interactions with providers, and their overall satisfaction with the health care they received.

The researchers found no association between study participants’ weight and their overall satisfaction with health care. In fact, adults in the higher weight ranges reported having more favorable perceptions of their access to care and their interactions with care providers. The research, “Satisfaction with Health Care Among Individuals with Overweight and Obesity: A Nationally Representative Cross-sectional Study,” appeared in the March 2019 issue of Journal of General Internal Medicine.

Other studies have found that patient experiences and perceptions about health care were likely to be influenced by factors other than weight, such as socioeconomic status.

“The differences in our study findings and those of other scientists indicate that more research is needed to help us understand what contributes to the medical experiences of people who have overweight or obesity,” Cardel said.

Other members of the research team included Gregory Pavela, Ph.D., a faculty member at University of Alabama at Birmingham, HOBI Ph.D. student Alexandra Lee, and Victoria G. Williamson, an undergraduate student in the Cardel lab.