• Posted September 30, 2025

Patients With Severe Obesity Face Medical Discrimination, Study Says

People with severe obesity are likely to face discrimination when seeking health care, with many clinics outright refusing to see them, a new study says.

About 2 in 5 (41%) of clinics refused to schedule an appointment for a hypothetical patient weighing 465 pounds, according to findings published Sept. 29 in the Annals of Internal Medicine.

“We’ve reached our limit for bariatric patients at this site,” one receptionist with an orthopedic surgeon’s office said without providing a reason, researchers report.

Further, more than half (52%) lacked the facilities or equipment that could meet the basic standards of care for patients with a body mass index (BMI) of 60 or greater, results show. Severe obesity is categorized as a BMI of 40 or greater, according to the U.S. Centers for Disease Control and Prevention. BMI is an estimate of body fat based on height and weight.

For example, they didn’t have exam tables or chairs with a high enough weight limit, sufficiently wide hallways and doorways, or large enough gowns.

“Patients living with severe obesity are likely already struggling with shame and difficulty navigating the world,” said senior author Dr. Tara Lagu, an adjunct lecturer of medicine and medical social sciences at Northwestern University Feinberg School of Medicine in Chicago.

“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,” Lagu said. “We need to acknowledge, as a profession, that all people deserve better than this.”

About 1 in every 270 Americans — nearly 1 million adults — has extremely severe obesity, or a BMI of 60 or greater, researchers said.

People with severe obesity are two to three times more likely to face major health problems, researchers said. Despite this, previous research has found they are less likely to get routine screenings and preventive care, including screenings for cancer.

“Obesity affects cancer screenings, and failure to screen can result in later cancer detection,” Lagu said. “We’re always attributing worse outcomes in higher-weight patients to weight itself, but more and more studies are now pointing to worse care, lack of care or being care avoidant as possible reasons for these delays.”

For the new study, researchers used a “secret-shopper” method to attempt to schedule an appointment for a patient weighing 465 pounds at practices across five specialties (dermatology, endocrinology, ob/gyn, orthopedic surgery, and ear, nose and throat) in four metropolitan areas (Boston, Cleveland, Houston and Portland, Oregon).

“We designed some of the questions our callers asked to be red flags for a receptionist to think, ‘I should really schedule this person’ because the questions suggested the patient might have cancer and need an urgent workup,” lead researcher Dr. Molly Hales, a physician at University of Chicago Medicine, said in a news release.

All told, 300 clinics were given the secret-shopper test to see if they could accommodate a patient with severe obesity.

Ear, nose and throat doctors were the least likely to schedule a visit with the patient, with only 48% agreeing to see the person versus the overall rate of 59%, results showed.

On the other hand, endocrinologists were most willing to schedule an appointment, and most likely to have offices designed to accommodate severely obese people.

About 1 in 6 clinics (16%) that were willing to schedule the patient asked them to endure potentially humiliating workarounds, such as needing to stand during the exam because there would be nowhere to sit or to drape themselves with a sheet because no gowns would fit them.

“Our numbers likely underestimate the magnitude of the problem,” Hales said.

“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,” Hales said.

A Clinical Environment Checklist for accommodating patients with obesity has been developed but is not in widespread use, researchers noted.

“They designed the checklist to be used by general outpatient clinics and tested it in both primary care and subspecialty settings, so it’s a good resource for clinics in determining where there are opportunities for improvement,” Hales said.

More information

The U.S. Centers for Disease Control and Prevention has more on providing proper care for people with obesity.

SOURCE: Northwestern Medicine, news release, Sept. 29, 2025