By LAUREN C. HOWE
July 13, 2017
“I enjoy working out at the gym,” declares one profile. “To keep myself fit, I like to hike, bike and exercise,” says another.
These comments aren’t part of a dating site. Rather, they come from physicians’ online profiles that prospective patients view when they are looking for a new doctor.
There are good reasons doctors might strive to lead by example. “I practice what I preach by living healthy every day,” declares one physician on Kaiser Permanente’s online doctor search portal. Patients may trust or be inspired by such a doctor, the thinking goes. And if health care professionals fail to follow their own advice, they may be accused of hypocrisy.
But for some patients, particularly those battling weight issues, a doctor’s declarations of personal fitness may not have the intended effect of attracting new patients. Instead, rather than inspiring them, it can drive them away.
Recently, my colleague Benoît Monin and I studied doctors who advertise their fitness online. Past research has shown that people worry that those who claim the moral high ground will look down on others whose behavior seems unfavorable by comparison. For example, meat-eaters worry that vegetarians will judge them because of their diet. We wondered: Could emphasizing fitness make doctors seem “healthier than thou” and turn off patients?
We thought that people who are overweight and obese might be particularly sensitive to judgment from doctors. Unlike unhealthy habits such as smoking, weight can’t be hidden. Research shows that negative attitudes toward people who are overweight are surprisingly prevalent among health professionals. So potential patients who are overweight might be especially turned off by doctors who show off healthy habits.
To test this idea, in research recently published in the Journal of Personality and Social Psychology, we turned to the real-world examples of physicians practicing what they preach on the website for Kaiser Permanente, the largest managed care organization in the United States. Here, patients choose among dozens of doctors from self-descriptions only a few sentences long, making any information provided consequential. We asked adults who were overweight or obese to rate a sample of these profiles. Some physicians emphasized their fitness in these profiles, while others did not.
We found that participants who were overweight believed that the fit doctors would disapprove of patients with unhealthy habits, and as a result overweight participants preferred physicians who did not advertise their fitness. Interestingly, in our studies, doctors who emphasized their healthy habits were no more appealing to patients who were not overweight. So health care practitioners showing off a healthy lifestyle didn’t seem to draw in patients as might have been expected, and even drove away some.
This research documents that promoting that you practice what you preach can backfire. Doctors who advertise their commitment to fitness in their own lives can seem critical of patients with less-than-perfect health, and inadvertently threaten patients who are struggling. Well-meaning doctors who are proud to be leading by example could be repelling exactly the people they may hope to inspire. As a result, many individuals may be avoiding doctor visits and not getting the care they need.
These initial findings left us wondering whether fit doctors could deliver their intended message more effectively — and seem less judgmental — by communicating that they are accepting of a wide range of healthy lifestyles. This echoes stories from overweight patients who report that regardless of their actual concerns, some doctors lecture about weight as soon as they walk in.
We edited fit doctors’ profiles by adding simple sentences like “I believe that everyone has their own definition of a healthy life.” And indeed, this follow-up experiment showed that by simply acknowledging that people have different priorities for health, fit doctors were able to honestly share their interest in fitness without alienating overweight patients. Research reveals that factors like social bonds are as important to health as weight, and recognizing expanding definitions of health can benefit vulnerable patients.
Right now, federal guidelines encourage providers to model healthy behaviors, and there are even organizations urging doctors to pledge to practice healthy lifestyles. This pressure to lead by example could prompt less-than-perfect providers who understand firsthand the struggles patients face in maintaining healthy habits to keep their valuable insights to themselves. Research finds that doctors with less healthy habits tend not to advise patients on weight, diet and exercise. Perhaps these providers worry about not living up to high standards and end up silencing themselves.
By casting a new light on how patients react to doctors living up to or falling short of healthy ideals, our research suggests that the medical profession should take a more nuanced view of leading by example. It should rethink blanket recommendations that providers need to practice and demonstrate healthy habits in their own lives to be effective.
Instead, it should realize that doctors who don’t advertise healthy lifestyles may appear more approachable to some patients, while super-fit physicians may want to display compassion and understanding toward patients who do not find exercise appealing, or do not conform to stereotypical portraits of health. By understanding the complex ways in which patients form impressions of health care providers, we can ensure that the greatest number of people, from the most diverse backgrounds, find their way to the care they need.