Patients With Extreme Obesity Face Limitations to Accessing Specialty Care
TUESDAY, Sept. 30, 2025 -- Patients weighing more than 450 lb face considerable limitations when attempting to access specialty care, according to a research letter published online Sept. 30 in the Annals of Internal Medicine.
Molly Hales, M.D., Ph.D., from the Northwestern University Feinberg School of Medicine in Chicago, and colleagues attempted to schedule an appointment for a hypothetical patient weighing 465 lb to examine barriers to subspecialty care. Fifteen practices were sampled in each of five subspecialties (dermatology, endocrinology, obstetrics and gynecology, orthopedic surgery, and otolaryngology) located in four metropolitan areas. A total of 441 practices were called to reach a sample size of 300 practices.
The researchers found that 123 (41 percent) of the 300 practices declined to schedule an appointment for the patient. Overall, 52 percent lacked "basic standards of care," defined as a clinic space that could accommodate the patient and an examination table and waiting room chair with adequate weight limit. A substandard plan of care was reported in an additional 16 percent of practices, which involved workarounds for accessibility limitations. Only 117 practices (39 percent) were fully accessible. Endocrinology practices were most willing to schedule the patient and to meet basic standards of care (75 and 57 percent, respectively), while otolaryngology and dermatology practices were least willing to schedule the patient and meet basic standards of care (48 and 37 percent, respectively).
"Our numbers likely underestimate the magnitude of the problem," Hales said in a statement. "Likely, very few high-weight patients who are scheduling appointments know to even ask if they can be accommodated based on their weight."
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