What Do Individuals With Obesity Want in am "Ideal" Primary Care Visit?

Individuals with obesity asked to define what an ideal primary care visit would look like placed being treated with respect as the priority (96.4%). They wanted a clinician to listen to them more than they talked during an appointment and to refrain from making everything about their weight. They asked not be be lectured to and for clinicians to understand that they do, in fact, care about their health.¹

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Negative experiences with weight stigma remain a common barrier for patients with obesity seeking medical care, often leading to delayed or avoided primary care visits, researchers at Drexel University’s College of Nursing and Health Professions wrote in Patient Education and Counseling. The Drexel team worked directly with patients to define what an ideal primary care visit would look like and then tested whether those ideals resonated broadly with adults living with obesity.¹

In the first of the study's 2 phases, the Obesity Action Coalition partnered with experience design firm Thoughtform to convene workshops with 14 adults with obesity. Together, they developed a narrative scenario illustrated in 9 visual story panels describing an “ideal” primary care encounter. Participants identified common frustrations, such as having to be weighed at every visit, encountering exam gowns or blood pressure cuffs of the wrong size, or being told every health concern was attributable to their weight. They emphasized instead wanting clinicians to listen, treat them respectfully, acknowledge that they care about their health, and provide referrals only to specialists who demonstrate empathy.¹

“People with obesity are asking for basic, every day, human interactions — not resource-intensive changes but literally common-sense practices, of which our primary care offices often fall short,” lead author Kristal Lyn Brown, PhD, assistant professor in the College, said in a statement.²

The second phase surveyed 250 US adults with obesity who had seen a primary care clinician within the past 5 years. The cohort was predominantly women (90.0%), with a mean BMI of 36.3 kg/m². Respondents rated their most recent primary care visit an average of 8.0 out of 10, compared to 9.4 for the co-designed ideal visit — a statistically significant difference (P <.01).¹

Respect Tops Priorities

Respect and listening emerged as the strongest priorities. Nearly all participants rated “doctor treats me with care and respect” (96.4%), “doctor really listens to me when I talk” (96.3%), and “specialists I am referred to also treat me with care and respect” (96.0%) as “very important.” Other highly valued elements included a clinician who:

• recognizes progress toward health goals (89.2%)
• avoids blaming all health issues on weight (84.8%)
• treats the person as a partner in decision-making (84.0%)

Improvements in the physical setting mattered, too: 73.2% wanted waiting and exam rooms designed to accommodate all body sizes, and 61.0% wanted access to gowns in extended sizes.¹

“The survey results showed that people living with obesity want empathetic, respectful health care,” said Brown. “We hope these results encourage providers and their staff to make their spaces more inclusive and free of weight bias and stigma.”²

The researchers underscore that routine adjustments in communication and environment may improve trust and reduce health care avoidance by this vulnerable population. Training that explicitly addresses weight stigma, coupled with staff-wide efforts to foster inclusive interactions beginning at check-in, could help reframe the primary care experience, and that matters. Brown and colleagues cite data showing that weight stigma (negative assumptions and stereotypes tied to an individuals' body size), contributes to depression, anxiety, and disordered eating behavior.³ They also emphasize that basic care may suffer. "Healthcare quality for patients with obesity may be low, as clinicians spend less time and engage in less rapport-building communication with them,"⁴ they wrote.

The researchers also highlight documented evidence of disrespectful language across health care settings. Residents in certain specialties, such as orthopedic surgery and anesthesiology, show significantly higher levels of weight bias compared with those in family medicine and other primary care disciplines.¹

The nearly unanimous rating as "very important" for respectful treatment from specialists following referral reflects a preference not widely studied before, according to Brown et al. Primary care practices could respond by actively building referral networks of specialty clinicians known to provide empathetic care.

Among the study's limitations, Brown and colleagues noted the predominance of white female participants and the recruitment of many through the Obesity Action Coalition, which may limit generalizability. Still, the findings underscore the value of integrating patient perspectives into systems-level design.¹

As the authors concluded, individuals with obesity prefer “a primary care space that is inclusive of all bodies with clinicians who listen, are respectful, and care — standards that should be an expectation for any clinical interaction.”

References

1. Reimagining primary care visits for people living with obesity: A Co-design and validation study. PEC. 2025;138. doi:10.1016/j.pec.2025.109190

2. New research reimagines primary care visits for people living with obesity. News release. Drexel Univerisity. August 25, 2025. Accessed August 26, 2025. https://drexel.edu/news/archive/2025/August/New-Research-Reimagines-Primary-Care-Visits-for-People-Living-with-Obesity

3. Puhl RM, Himmelstein MS, Pearl RL. Weight stigma as a psychosocial contributor to obesity. Am Psychol. 2020;75(2):274-289. doi: 10.1037/amp0000538

4. Gudzune KA, Beach MC, Roter DL, Cooper LA. Physicians build less rapport with obese patients. Obes (Silver Spring). 2013;21(10):2146-2152. doi:10.1002/oby.20384