Primary care physicians expressed less empathy and had less emotional rapport with overweight and obese patients, according to a study published in the journal Obesity and conducted by researchers from Johns Hopkins School of Medicine.

Led by Dr. Kimberly A. Gudzune, researchers observed that doctors were more likely to communicate empathy, convey concern, or express understanding with normal weight patients compared to overweight or obese patients.

Studies have shown that the doctor-patient relationship impacts health outcomes. The patients of doctors who express more empathy are more likely to follow medical advice, including making lifestyle changes that can lead to better health.

The study analyzed videotaped interactions between 39 primary care doctors and their patients, categorizing them by patient's body mass index (BMI).

Patients included in the study all had high blood pressure. Of the 208 patients, 120 were obese (BMI greater than 30), 60 were overweight (BMI between 25 and 30), and 28 were of normal weight (BMI less than 25).

Researchers quantified doctors' number of empathic phrases, including ones such as "I'm glad your feeling better" or "I agree with you."

Although the doctors were not acting overtly mean toward obese and overweight patients, they said fewer encouraging and supportive things to these patients. There was no difference, however, in the quantity of medical questions, medical advice, or discussions about regiments.

Even though the study was small, Dr. Gudzune wrote that the difference in doctors' empathic behaviors was statistically significant.

Physicians may simply have been expressing a cultural bias present in other members of society. But, considering their role in encouraging patients to make healthier decisions, they should be held to a higher standard.

"I hear from patients all the time about how they resent feeling judged negatively because of their weight," said Dr. Gudzune in a press release. "Yes, doctors need to be medical advisors, but they also have the opportunity to be advocates to support their patients through changes in their lives."