Large patients and lack of preventive health care. Physician or patient driven?

D URING THE past several years, physicians have become increasingly aware of the epidemic of obesity in the United States. The alarming increase in its prevalence, both in adults and children, has led to the development of initiatives geared to the recognition of obesity as a complex disorder of energy balance requiring long-term treatment. The change in our view of obesity from a shameful social problem to a medical disorder worthy of attention is to be commended. The treatment of obesity, however, is not necessarily synonymous with the treatment of patients who are obese. Are large patients well served by their clinicians? In this issue of the ARCHIVES, Fontaine et al provide evidence that overweight patients are less likely than those of normal weight to receive important preventive health care services, particularly those that involve disrobing and clinical examination. This study, which has the advantage of being large and population based, adds to the evidence from smaller studies that overweight women do not receive adequate health care. Although the data from this study are correlational, and we cannot determine whether the reasons for this failure were physician or patient driven, it is most likely that both were important.