Patients with severe obesity encounter significant obstacles when seeking care at specialty clinics, according to a new study from Northwestern Medicine. The research found that more than 40% of surveyed subspecialty practices declined to schedule appointments for hypothetical patients weighing 465 pounds. The study involved calling 300 clinics in four major metropolitan areas—Boston, Cleveland, Houston, and Portland—to request appointments for patients who could walk unassisted.
The researchers examined whether clinics met basic standards for accommodating bariatric patients, such as having exam tables or chairs with high weight limits, accessible waiting room seating, wide hallways and doorways, and appropriately sized gowns. Results showed that 52% of clinics did not meet these standards. Only 39% were fully accessible.
Dr. Tara Lagu, adjunct lecturer of medicine and medical social sciences at Northwestern University Feinberg School of Medicine and senior author of the study, said: “Patients living with severe obesity are likely already struggling with shame and difficulty navigating the world. To tell a patient that they can’t be examined on a table, or can’t wear a gown, or need to stand during an appointment makes what should be a safe place and the experience of seeing a doctor humiliating and degrading. We need to acknowledge, as a profession, that all people deserve better than this.”
The findings also indicated that endocrinology practices were most likely to both schedule appointments and provide adequate accommodations. In contrast, otolaryngology (ear, nose and throat) practices were least likely to do so—even when told the patient had symptoms suggestive of cancer.
An additional 16% of clinics offered workarounds rather than full accessibility; some asked patients to stand during exams or use sheets instead of proper gowns due to lack of appropriate equipment.
Reception staff at some clinics made comments about weight limits or redirected callers to bariatric surgeons without providing further explanation. Dr. Molly Hales, corresponding author from UChicago Medicine who conducted the research while at Northwestern University Feinberg School of Medicine, stated: “Our numbers likely underestimate the magnitude of the problem. Likely, very few high-weight patients who are scheduling appointments know to even ask if they can be accommodated based on their weight, and they might be hesitant to ask these questions or advocate for themselves because of the social stigma.”
Prior studies have shown that people with obesity are less likely to receive preventive services such as cancer screenings. The current research suggests that limited accessibility in medical settings may contribute to this trend by discouraging routine care.
“We’re always attributing worse outcomes in higher-weight patients to weight itself,” Lagu said. “But more and more studies are now pointing to worse care, lack of care or being care avoidant as possible reasons for these delays.”
The authors recommend that specialty clinics assess their facilities using resources like the Clinical Environment Checklist for Accommodating Patients with Obesity in Ambulatory Care Settings—a tool designed for both primary care and specialty environments but not yet widely implemented.
The study was funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases at the National Institutes of Health (grant 5T32AR060710-11). It will appear in the Annals of Internal Medicine on September 29.