For patients living with severe obesity, finding medical care can be an uphill battle.
A new Northwestern Medicine study has revealed that more than 40% of specialty clinics refuse to schedule appointments for patients weighing 465 pounds, raising serious concerns about discrimination and accessibility in the healthcare system.
Researchers used a “secret shopper” method, calling 300 clinics across four major U.S. cities—Boston, Cleveland, Houston, and Portland.
They posed as patients seeking care in five specialties: dermatology, endocrinology, obstetrics and gynecology, orthopedic surgery, and otolaryngology (ear, nose, and throat).
The hypothetical patient could walk independently and did not require assistance getting onto an exam table. Even so, many clinics either lacked the basic equipment to accommodate them or declined to schedule an appointment altogether.
The results, published in the Annals of Internal Medicine, were sobering.
More than half of the clinics surveyed did not meet minimum standards of care for bariatric patients, such as having exam tables and chairs with higher weight limits, wide enough hallways and doorways, or gowns that fit larger bodies.
Forty-one percent refused to schedule an appointment entirely. Ear, nose, and throat clinics were the least accommodating, agreeing to see the patient less than half the time—even when symptoms suggested a possible cancer diagnosis.
Only 39% of practices were fully accessible, with endocrinology offices being the most likely to schedule appointments and provide proper accommodations. Some clinics that agreed to see the patient still offered substandard care, such as telling the caller they would need to stand during the exam or use a sheet instead of a gown.
“Patients living with severe obesity are already struggling with shame and difficulty navigating the world,” said Dr. Tara Lagu, senior author of the study. “To tell them they can’t lie on an exam table or wear a gown turns what should be a safe space into a humiliating experience.”
The study also revealed insensitive comments from clinic staff, such as “We’ve reached our limit for bariatric patients at this site.” In one case, an orthopedic office advised the caller to see a bariatric surgeon instead.
Researchers warn that this lack of access may have serious health consequences. Previous studies show that people with obesity are less likely to receive routine preventive care, including cancer screenings. Delays in diagnosis and treatment could worsen outcomes. “We often blame poor outcomes in higher-weight patients on obesity itself,” Lagu said. “But growing evidence points to the fact that they are receiving worse care—or no care at all.”
The authors urge clinics to adopt tools like the Clinical Environment Checklist for Accommodating Patients with Obesity, which provides guidance on improving accessibility.
They stress that both urban and rural clinics must make these changes, since patients in rural areas often have fewer options for specialized care.
The message is clear: all patients, regardless of size, deserve dignity and equal access to medical treatment.
Source: Northwestern University.
