J Clin Gynecol Obstet

Journal of Clinical Gynecology and Obstetrics, ISSN 1927-1271 print, 1927-128X online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Gynecol Obstet and Elmer Press Inc

Journal website https://www.jcgo.org

Original Article

Volume 13, Number 2, June 2024, pages 25-34

Female Perspectives Regarding Quality of Care and Weight-Related Communication in Obstetrics-Gynecology and Family Practices

**Table 1.** Patients and Physicians’ Overall Characteristics and Differences by Clinical Practices
Variables	All (N = 330), N (%) or mean ± SD	OBGYN (N = 150), N (%) or mean ± SD	FP (N = 180), N (%) or mean ± SD	P-value
^aWeight status was based on CDC obesity status (overweight: 25 ≤ BMI < 30; class 1 obesity: 30 ≤ BMI < 35; class 2 obesity: 35 ≤ BMI < 40; class 3 obesity: 40 ≤ BMI), calculated from self-reported weight and height. BMI: body mass index; FP: family practices; OBGYN: obstetrics-gynecology.
Survey participants (n = 330)
Age (n = 326)^a
21 - 30 years	58 (17.8)	40 (27.0)	18 (10.1)	< 0.001
31 - 50 years	145 (44.5)	75 (50.7)	70 (39.3)
51 or above	123 (37.7)	33 (22.3)	90 (50.6)
Self-reported weight (kg)	106.7 ± 23.5	107.9 ± 24.1	105.7 ± 23.0	0.380
Self-reported height (cm)	163.6 ± 7.4	164.4 ± 7.9	162.9 ± 6.8	0.066
BMI (kg/m²)	39.8 ± 8.2	39.9 ± 8.5	39.8 ± 7.9	0.883
Weight status^a
Overweight	22 (6.7)	14 (9.3)	8 (4.4)	0.106
Class 1 obesity	75 (22.7)	27 (18.0)	48 (26.7)
Class 2 obesity	96 (29.1)	47 (31.3)	49 (27.2)
Class 3 obesity	137 (41.5)	62 (41.3)	75 (41.7)
Perception of own weight
Average	38 (11.5)	18 (12.0)	20 (11.1)	0.460
Overweight	150 (45.5)	73 (48.7)	77 (42.8)
Very overweight	142 (43.0)	59 (39.3)	83 (46.1)
Perceived weight bias (underestimated)
Yes	124 (37.6)	58 (38.7)	66 (36.7)	0.709
No	206 (62.4)	92 (61.3)	114 (63.3)
Hispanic (n = 324)
Yes	6 (1.8)	3 (2.1)	3 (1.7)	0.999
No	318 (98.2)	143 (97.9)	175 (98.3)
Race (n = 325)
Whites	155 (47.7)	109 (73.1)	46 (26.1)	< 0.001
Blacks	150 (46.2)	32 (21.5)	118 (67.1)
Others	20 (6.1)	8 (5.4)	12 (6.8)
Education (n = 318)
High school or less	208 (65.4)	75 (50.3)	133 (78.7)	< 0.001
Associate’s degree or higher	110 (34.6)	74 (49.7)	36 (21.3)
Survey participants’ physician information (n = 42)
Age group				< 0.001
21 - 30 years	20 (47.6)	0	20 (69.1)
31 - 50 years	10 (23.8)	4 (30.8)	6 (20.7)
51 or above	12 (28.6)	9 (69.2)	3 (10.3)
Sex				0.510
Male	16 (38.1)	6 (46.2)	10 (34.5)
Female	26 (61.9)	7 (53.8)	19 (65.5)
Experience
Attending	14 (33.3)	10 (76.9)	4 (13.8)	< 0.001
Resident	28 (66.7)	3 (23.1)	25 (86.2)

Table 1. Patients and Physicians’ Overall Characteristics and Differences by Clinical Practices

Variables

All (N = 330), N (%) or mean ± SD

OBGYN (N = 150), N (%) or mean ± SD

FP (N = 180), N (%) or mean ± SD

P-value

^aWeight status was based on CDC obesity status (overweight: 25 ≤ BMI < 30; class 1 obesity: 30 ≤ BMI < 35; class 2 obesity: 35 ≤ BMI < 40; class 3 obesity: 40 ≤ BMI), calculated from self-reported weight and height. BMI: body mass index; FP: family practices; OBGYN: obstetrics-gynecology.

Survey participants (n = 330)

Age (n = 326)^a

21 - 30 years

58 (17.8)

40 (27.0)

18 (10.1)

< 0.001

31 - 50 years

145 (44.5)

75 (50.7)

70 (39.3)

51 or above

123 (37.7)

33 (22.3)

90 (50.6)

Self-reported weight (kg)

106.7 ± 23.5

107.9 ± 24.1

105.7 ± 23.0

0.380

Self-reported height (cm)

163.6 ± 7.4

164.4 ± 7.9

162.9 ± 6.8

0.066

BMI (kg/m²)

39.8 ± 8.2

39.9 ± 8.5

39.8 ± 7.9

0.883

Weight status^a

Overweight

22 (6.7)

14 (9.3)

8 (4.4)

0.106

Class 1 obesity

75 (22.7)

27 (18.0)

48 (26.7)

Class 2 obesity

96 (29.1)

47 (31.3)

49 (27.2)

Class 3 obesity

137 (41.5)

62 (41.3)

75 (41.7)

Perception of own weight

Average

38 (11.5)

18 (12.0)

20 (11.1)

0.460

Overweight

150 (45.5)

73 (48.7)

77 (42.8)

Very overweight

142 (43.0)

59 (39.3)

83 (46.1)

Perceived weight bias (underestimated)

Yes

124 (37.6)

58 (38.7)

66 (36.7)

0.709

206 (62.4)

92 (61.3)

114 (63.3)

Hispanic (n = 324)

Yes

6 (1.8)

3 (2.1)

3 (1.7)

0.999

318 (98.2)

143 (97.9)

175 (98.3)

Race (n = 325)

Whites

155 (47.7)

109 (73.1)

46 (26.1)

< 0.001

Blacks

150 (46.2)

32 (21.5)

118 (67.1)

Others

20 (6.1)

8 (5.4)

12 (6.8)

Education (n = 318)

High school or less

208 (65.4)

75 (50.3)

133 (78.7)

< 0.001

Associate’s degree or higher

110 (34.6)

74 (49.7)

36 (21.3)

Survey participants’ physician information (n = 42)

Age group

< 0.001

21 - 30 years

20 (47.6)

20 (69.1)

31 - 50 years

10 (23.8)

4 (30.8)

6 (20.7)

51 or above

12 (28.6)

9 (69.2)

3 (10.3)

Sex

0.510

Male

16 (38.1)

6 (46.2)

10 (34.5)

Female

26 (61.9)

7 (53.8)

19 (65.5)

Experience

Attending

14 (33.3)

10 (76.9)

4 (13.8)

< 0.001

Resident

28 (66.7)

3 (23.1)

25 (86.2)

**Table 2.** Patients’ Perspective of Clinical Environment
Variables	All (N = 340), N (%)	OBGYN (N = 160), N (%)	FP (N = 186), N (%)	P-value
^aFisher’s exact test was conducted to examine the association. FP: family practices; OBGYN: obstetrics-gynecology.
When you were weighed on a scale, was the scale located in a private setting of the medical office? (n = 323)				< 0.001
Yes	218 (67.5)	83 (56.5)	135 (76.7)
No	76 (23.5)	54 (36.7)	22 (12.5)
Did not notice	29 (9.0)	10 (6.8)	19 (10.8)
When you were weighed on a scale, was the scale large enough to accommodate your weight? (n = 322)				0.337^a
Yes	318 (98.8)	145 (98.0)	173 (99.4)
No	4 (1.2)	3 (2.0)	1 (0.6)
Was the gown used during the physical exam an appropriate size? (n = 303)				< 0.001^a
Too large	8 (2.6)	5 (3.4)	3 (1.9)
Right size	174 (57.4)	110 (75.9)	64 (40.5)
Too small	19 (6.3)	14 (9.7)	5 (3.2)
Did not use	102 (33.7)	16 (11.0)	86 (54.4)
Was the blood pressure cuff used during the physical exam an appropriate size? (n = 320)				0.633^a
Too large	5 (1.6)	3 (2.0)	2 (1.1)
Right size	312 (97.5)	141 (96.6)	171 (98.3)
Too small	3 (0.9)	2 (1.4)	1 (0.6)
Was the exam table used during the physical exam an appropriate size and height? (n = 321)				0.283^a
Too large	7 (2.2)	5 (3.4)	2 (1.2)
Right size	309 (92.3)	141 (95.3)	168 (97.1)
Too small	1 (0.3)	1 (0.7)	0 (0.0)
Not used	4 (1.3)	1 (0.7)	3 (1.7)

Table 2. Patients’ Perspective of Clinical Environment

Variables

All (N = 340), N (%)

OBGYN (N = 160), N (%)

FP (N = 186), N (%)

P-value

^aFisher’s exact test was conducted to examine the association. FP: family practices; OBGYN: obstetrics-gynecology.

When you were weighed on a scale, was the scale located in a private setting of the medical office? (n = 323)

< 0.001

Yes

218 (67.5)

83 (56.5)

135 (76.7)

76 (23.5)

54 (36.7)

22 (12.5)

Did not notice

29 (9.0)

10 (6.8)

19 (10.8)

When you were weighed on a scale, was the scale large enough to accommodate your weight? (n = 322)

0.337^a

Yes

318 (98.8)

145 (98.0)

173 (99.4)

4 (1.2)

3 (2.0)

1 (0.6)

Was the gown used during the physical exam an appropriate size? (n = 303)

< 0.001^a

Too large

8 (2.6)

5 (3.4)

3 (1.9)

Right size

174 (57.4)

110 (75.9)

64 (40.5)

Too small

19 (6.3)

14 (9.7)

5 (3.2)

Did not use

102 (33.7)

16 (11.0)

86 (54.4)

Was the blood pressure cuff used during the physical exam an appropriate size? (n = 320)

0.633^a

Too large

5 (1.6)

3 (2.0)

2 (1.1)

Right size

312 (97.5)

141 (96.6)

171 (98.3)

Too small

3 (0.9)

2 (1.4)

1 (0.6)

Was the exam table used during the physical exam an appropriate size and height? (n = 321)

0.283^a

Too large

7 (2.2)

5 (3.4)

2 (1.2)

Right size

309 (92.3)

141 (95.3)

168 (97.1)

Too small

1 (0.3)

1 (0.7)

0 (0.0)

Not used

4 (1.3)

1 (0.7)

3 (1.7)

**Table 3.** Patients’ Perspective on Clinical Practice and the Quality of Care
Variables	All (N = 340), median (IQR) or N (%)	OBGYN (N = 160), median (IQR) or N (%)	FP (N = 186), median (IQR) or N (%)	P-value
^an = 290. ^bn = 325, no patient answered “never”. ^cn = 310, 44 patients responded that they did not discuss. ^dn = 293. ^en = 319, responses were not in Likert scale. ^fn = 322. ^gThe Wilcoxon rank sum test was used to compare the patients’ perspectives between two specialties. ^hChi-squared test was conducted to examine the association between the patients’ responses and specialties. ⁱFisher’s exact test was conducted to examine the association. FP: family practices; IQR: interquartile range; OBGYN: obstetrics-gynecology; OW: overweight.
How well does your physician understand what it feels like to be OW/obese^a
7-point Likert scale	5 (4 - 7)	5 (4 - 6)	6 (4 - 7)	< 0.001^g
No understanding	32 (11.0%)	19 (15.1%)	13 (7.9%)	0.014^h
Somewhat	75 (25.9%)	39 (30.9%)	36 (22.0%)
Understanding	183 (63.1%)	68 (54.0%)	115 (70.1%)
Does your physician treat you with courtesy and respect?^b
4-point Likert scale	4 (4 - 4)	4 (4 - 4)	4 (4 - 4)	0.848^g
Sometimes or usually	29 (8.9%)	14 (9.3%)	15 (8.6%)	0.810^h
Always	296 (91.1%)	136 (90.7%)	160 (91.4%)
How comfortable is your doctor when he/she discusses weight-loss and obesity treatment options with you?^c
Did not discuss	44 (14.2%)	23 (15.5%)	21 (13.0%)	0.516^h
Discussed	266 (85.8%)	125 (84.5%)	141 (87.0%)
7-point Likert scale among discussed (n = 293)	7 (4 - 7)	6 (4 - 7)	7 (5 - 7)	0.006^g
Uncomfortable	40 (15.0%)	21 (16.8%)	19 (13.5%)	0.004^h
Neutral	46 (17.3%)	31 (24.8%)	15 (10.6%)
Comfortable	180 (67.7%)	73 (58.4%)	107 (75.9%)
Does your provider use sensitivity when discussing your weight to make you feel at ease?^d
5-point Likert scale	5 (4 - 5)	5 (4 - 5)	5 (4 - 5)	0.218^g
Rarely/never or sometimes	34 (11.6%)	16 (11.5%)	18 (11.7%)	0.886ⁱ
Half of the time	8 (2.7%)	3 (2.2%)	5 (3.2%)
Most of the time or always	251 (85.7%)	120 (86.3%)	131 (85.1%)
Do you feel that your doctor treats you the same way as patients who are not overweight?^e
Not sure	69 (21.6%)	37 (24.8%)	32 (18.8%)	0.411ⁱ
Treated worse	4 (1.2%)	2 (1.3%)	2 (1.2%)
Treated the same	245 (76.8%)	110 (73.8%)	135 (79.4%)
Treated better	1 (0.3%)	0 (0)	1 (0.6%)
Overall satisfaction with care provided to OW/obese patients^f
7-point Likert scale	7 (6 - 7)	7 (7 - 7)	7 (6 - 7)	0.012^g
Dissatisfied or neutral	39 (12.1%)	9 (6.2%)	30 (17.1%)	0.003^h
Satisfied	283 (87.9%)	137 (93.8%)	146 (82.9%)

Table 3. Patients’ Perspective on Clinical Practice and the Quality of Care

Variables

All (N = 340), median (IQR) or N (%)

OBGYN (N = 160), median (IQR) or N (%)

FP (N = 186), median (IQR) or N (%)

P-value

^an = 290. ^bn = 325, no patient answered “never”. ^cn = 310, 44 patients responded that they did not discuss. ^dn = 293. ^en = 319, responses were not in Likert scale. ^fn = 322. ^gThe Wilcoxon rank sum test was used to compare the patients’ perspectives between two specialties. ^hChi-squared test was conducted to examine the association between the patients’ responses and specialties. ⁱFisher’s exact test was conducted to examine the association. FP: family practices; IQR: interquartile range; OBGYN: obstetrics-gynecology; OW: overweight.

How well does your physician understand what it feels like to be OW/obese^a

7-point Likert scale

5 (4 - 7)

5 (4 - 6)

6 (4 - 7)

< 0.001^g

No understanding

32 (11.0%)

19 (15.1%)

13 (7.9%)

0.014^h

Somewhat

75 (25.9%)

39 (30.9%)

36 (22.0%)

Understanding

183 (63.1%)

68 (54.0%)

115 (70.1%)

Does your physician treat you with courtesy and respect?^b

4-point Likert scale

4 (4 - 4)

0.848^g

Sometimes or usually

29 (8.9%)

14 (9.3%)

15 (8.6%)

0.810^h

Always

296 (91.1%)

136 (90.7%)

160 (91.4%)

How comfortable is your doctor when he/she discusses weight-loss and obesity treatment options with you?^c

Did not discuss

44 (14.2%)

23 (15.5%)

21 (13.0%)

0.516^h

Discussed

266 (85.8%)

125 (84.5%)

141 (87.0%)

7-point Likert scale among discussed (n = 293)

7 (4 - 7)

6 (4 - 7)

7 (5 - 7)

0.006^g

Uncomfortable

40 (15.0%)

21 (16.8%)

19 (13.5%)

0.004^h

Neutral

46 (17.3%)

31 (24.8%)

15 (10.6%)

Comfortable

180 (67.7%)

73 (58.4%)

107 (75.9%)

Does your provider use sensitivity when discussing your weight to make you feel at ease?^d

5-point Likert scale

5 (4 - 5)

0.218^g

Rarely/never or sometimes

34 (11.6%)

16 (11.5%)

18 (11.7%)

0.886ⁱ

Half of the time

8 (2.7%)

3 (2.2%)

5 (3.2%)

Most of the time or always

251 (85.7%)

120 (86.3%)

131 (85.1%)

Do you feel that your doctor treats you the same way as patients who are not overweight?^e

Not sure

69 (21.6%)

37 (24.8%)

32 (18.8%)

0.411ⁱ

Treated worse

4 (1.2%)

2 (1.3%)

2 (1.2%)

Treated the same

245 (76.8%)

110 (73.8%)

135 (79.4%)

Treated better

1 (0.3%)

0 (0)

1 (0.6%)

Overall satisfaction with care provided to OW/obese patients^f

7-point Likert scale

7 (6 - 7)

7 (7 - 7)

7 (6 - 7)

0.012^g

Dissatisfied or neutral

39 (12.1%)

9 (6.2%)

30 (17.1%)

0.003^h

Satisfied

283 (87.9%)

137 (93.8%)

146 (82.9%)

**Table 4.** Factors Related to Patients’ Overall Satisfaction of Clinical Practice by Specialties
Factors significant in the analysis	Adjusted OR^a	95% CI
^aMultiple logistic regression models were adjusted for age (21 - 30 years, 31 - 50 years, 51 years or above), weight status (overweight, class I, II, III obesity), race/ethnicity (Whites, Blacks, others), education (high school or less, associate’s degree or higher), specialty (OBGYN, FP) and participant’s note on the weight scale in a private setting (yes, no, did not notice). ^bThe ordinal logistic regression was conducted. ^cThe binary logistic regression was conducted. CI: confidence interval; FP: family practices; OBGYN: obstetrics-gynecology; OR: odds ratio; OW: overweight.
How well does your physician understand what it feels like to be OW/obese (reference, understanding)^b
Scale in a private setting (no vs. yes)	5.64	(3.21 - 9.89)
Scale in a private setting (not noticed vs. yes)	3.19	(1.43 - 7.10)
Does your physician treat you with courtesy and respect (reference, always)?^c
Age (31 - 50 vs. 21 - 30 years)	0.28	(0.10 - 0.77)
Age (51 or above vs. 21 - 30 years)	0.36	(0.13 - 0.97)
Scale in a private setting (no vs. yes)	2.87	(1.23 - 6.71)
Scale in a private setting (not noticed vs. yes)	0.83	(0.17 - 4.04)
How comfortable is your doctor when he/she discusses weight-loss and obesity treatment options with you (reference, comfortable)?^b
Specialty (OBGYN vs. FP)	1.91	(1.06 - 3.46)
Education (high school graduate vs. associate or more)	2.16	(1.17 - 3.97)
Scale in a private setting (no vs. yes)	2.43	(1.30 - 4.56)
Scale in a private setting (not noticed vs. yes)	1.64	(0.65 - 4.15)
Overall satisfaction with care provided to OW-obese patients (reference, dissatisfied/neutral)^c
Specialty (OBGYN vs. FP)	3.22	(1.47 - 7.07)

Table 4. Factors Related to Patients’ Overall Satisfaction of Clinical Practice by Specialties

Factors significant in the analysis

Adjusted OR^a

95% CI

^aMultiple logistic regression models were adjusted for age (21 - 30 years, 31 - 50 years, 51 years or above), weight status (overweight, class I, II, III obesity), race/ethnicity (Whites, Blacks, others), education (high school or less, associate’s degree or higher), specialty (OBGYN, FP) and participant’s note on the weight scale in a private setting (yes, no, did not notice). ^bThe ordinal logistic regression was conducted. ^cThe binary logistic regression was conducted. CI: confidence interval; FP: family practices; OBGYN: obstetrics-gynecology; OR: odds ratio; OW: overweight.

How well does your physician understand what it feels like to be OW/obese (reference, understanding)^b

Scale in a private setting (no vs. yes)

5.64

(3.21 - 9.89)

Scale in a private setting (not noticed vs. yes)

3.19

(1.43 - 7.10)

Does your physician treat you with courtesy and respect (reference, always)?^c

Age (31 - 50 vs. 21 - 30 years)

0.28

(0.10 - 0.77)

Age (51 or above vs. 21 - 30 years)

0.36

(0.13 - 0.97)

Scale in a private setting (no vs. yes)

2.87

(1.23 - 6.71)

Scale in a private setting (not noticed vs. yes)

0.83

(0.17 - 4.04)

How comfortable is your doctor when he/she discusses weight-loss and obesity treatment options with you (reference, comfortable)?^b

Specialty (OBGYN vs. FP)

1.91

(1.06 - 3.46)

Education (high school graduate vs. associate or more)

2.16

(1.17 - 3.97)

Scale in a private setting (no vs. yes)

2.43

(1.30 - 4.56)

Scale in a private setting (not noticed vs. yes)

1.64

(0.65 - 4.15)

Overall satisfaction with care provided to OW-obese patients (reference, dissatisfied/neutral)^c

Specialty (OBGYN vs. FP)

3.22

(1.47 - 7.07)