Obesity is an important cardiovascular risk factor in type 2 diabetes (1). Physician characteristics such as age and sex are related to counseling for overweight (2). Other physician characteristics may also be related. Patients indicated greater confidence in nonobese versus obese physicians. Whether this translates into increased success in obesity management is unknown (3). We aimed to study associations between the weight of general practitioners and their type 2 diabetic patients.
A postal survey was performed among 36 general practitioners participating in a shared-care diabetes project in 2000. It contained questions about the general practitioners’ age, sex, weight, height, smoking behavior, work experience, practice population size, and opinion regarding how much influence they have on a patient’s weight and smoking cessation. The project’s target population consisted of type 2 diabetic patients who were exclusively treated in primary care. Patients who were cotreated in secondary care or who were terminally ill or had dementia were excluded. Participating patients (n = 1,441) represented 87% of the target population. Data on patient age, sex, diabetes duration, BMI, and smoking were collected by nurses. We performed a regression analysis with the mean BMI of patients as the dependent variable and the above variables as predictors.
The survey response rate was 100%. Most general practitioners were nonsmoking (94%) men (83%) with a mean (±SD) age of 51.1 ± 7.0 years and work experience of 18.1 ± 8.9 years. The general practitioners’ mean BMI was 24.4 ± 3.5 kg/m2 (BMI <25 in 72%). For patients (per general practitioner), mean age was 68.2 ± 2.9 years, diabetes duration 7.2 ± 1.3 years, and BMI 29.3 ± 0.85 kg/m2; 44 ± 9% were men. The mean BMI of patients showed the strongest correlation with the BMI of general practitioners: −0.40 (partial correlation) and unstandardized coefficient B of −1.05 (95% CI −0.197 to −0.013). The optimal model (P = 0.07) had a multiple correlation (R) of 0.56, and explained variance (R2) was 31% (adjusted 17%).
We found a negative correlation between the BMI of type 2 diabetic patients and their general practitioners. Obese doctors had lean patients. Our study is limited by the cross-sectional design; associations were found, not causal relations.
Hash et al. (3) showed that patients indicated greater confidence in nonobese physicians. However, we found no translation into increased success in obesity management. On the contrary, patients of nonobese general practitioners had a higher BMI compared with patients of obese general practitioners. A discernable negative impact of patient weight on physician behavior was shown earlier (4). Could it be that nonobese general practitioners lack motivation to treat overweight patients? Is it time for general practitioners to search our own hearts?