Physician evaluation of obesity in health surveys: "who are you calling fat?"

Previous research on status generalization suggests that physicians may use non-medical factors in their evaluation, interpretation, and treatment of persons presenting for care. This study compares physicians' evaluations of obesity with physical measurements of body stature and fat collected from a large national health examination survey. While the anthropometric measures are strong predictors of physician evaluations of obesity, between 13% and 19% of the respondents were classified in ways that could not be predicted from the anthropometric measures. Moreover, personal and status characteristics were related to physicians' evaluations of obesity. Women, especially White and taller women, were more likely to be evaluated as obese than would be predicted from the anthropometric measures--African American women were less likely than their White counterparts to be so classified. Physicians' evaluation of obesity was least consistent with measured obesity for older respondents. Indeed among men, age was the most important status characteristic shaping physician evaluations: older men were more likely to be evaluated as obese. The findings suggest that the cluster of status characteristics is important to physicians during medical evaluations.