101
|
Hebl MR, Mannix LM. The Weight of Obesity in Evaluating Others: A Mere Proximity Effect. PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN 2016; 29:28-38. [PMID: 15272957 DOI: 10.1177/0146167202238369] [Citation(s) in RCA: 178] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Previous research demonstrates that we tend to derogate individuals who are perceived to be in a social relationship with stigmatized persons. Two experiments examined whether this phenomenon also occurs for individuals seen in the presence of an obese person and whether a social relationship is necessary for stigmatization to spread. The results from both experiments revealed that a male job applicant was rated more negatively when seen with an overweight compared to a normal weight female and that just being in the mere proximity of an overweight woman was enough to trigger stigmatization toward the male applicant. Experiment 2 examined possible moderating effects of the proximity finding. Applicants seated next to heavy (vs. average weight) individuals were denigrated consistently regardless of the perceived depth of the relationship, the participant’s anti-fat attitudes or gender, and whether or not positive information was presented concerning the woman. The profound nature of the obesity stigma and implications for impression formation processes are discussed.
Collapse
Affiliation(s)
- Michelle R Hebl
- Department of Psychology, Rice University, Houston, TX 77005, USA.
| | | |
Collapse
|
102
|
Abstract
Overweight and obesity are escalating in epidemic proportions in the United States. Individuals with overweight and obesity are often reluctant to seek medical help, not only for weight reduction but also for any health issue because of perceived provider discrimination. Providers who are biased against individuals with obesity can hinder our nation's effort to effectively fight the obesity epidemic. By addressing weight bias in the provider setting, individuals affected by obesity may be more likely to engage in a meaningful and productive discussion of weight. Providers need to be the go-to source for obesity-focused information on new and emerging treatments.
Collapse
Affiliation(s)
- Sharon M Fruh
- Professor at the University of South Alabama in Mobile
| | | | - Heather R Hall
- Professor and Associate Dean for Academic Affairs at the University of South Alabama
| | - Sara L Davis
- Instructor at the Division of Nursing at Springhill College in Mobile, AL
| | - Errol D Crook
- Abraham A. Mitchell Professor and Chair at the Department of Internal Medicine at the University of South Alabama
| | - Kimberly Zlomke
- Assistant Professor at the Department of Psychology at the University of South Alabama
| |
Collapse
|
103
|
Racial and ethnic minority patients report different weight-related care experiences than non-Hispanic Whites. Prev Med Rep 2016; 4:296-302. [PMID: 27486558 PMCID: PMC4960010 DOI: 10.1016/j.pmedr.2016.06.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 06/14/2016] [Accepted: 06/27/2016] [Indexed: 01/25/2023] Open
Abstract
Our objective was to compare patients' health care experiences, related to their weight, across racial and ethnic groups. In Summer 2015, we distributed a written survey with telephone follow-up to a random sample of 5400 racially/ethnically and geographically diverse U.S. adult health plan members with overweight or obesity. The survey assessed members' perceptions of their weight-related healthcare experiences, including their perception of their primary care provider, and the type of weight management services they had been offered, or were interested in. We used multivariable multinomial logistic regression to examine the relationship between race/ethnicity and responses to questions about care experience. Overall, 2811 members (53%) responded to the survey and we included 2725 with complete data in the analysis. Mean age was 52.7 years (SD 15.0), with 61.7% female and 48.3% from minority racial/ethnic groups. Mean BMI was 37.1 kg/m2 (SD 8.0). Most (68.2%) respondents reported having previous discussions of weight with their provider, but interest in such counseling varied by race/ethnicity. Non-Hispanic blacks were significantly less likely to frequently avoid care (for fear of discussing weight/being weighed) than whites (OR 0.49, 95% CI 0.26–0.90). Relative to whites, respondents of other race/ethnicities were more likely to want weight-related discussions with their providers. Race/ethnicity correlates with patients' perception of discussions of weight in healthcare encounters. Clinicians should capitalize on opportunities to discuss weight loss with high-risk minority patients who may desire these conversations. Minority patients may desire more information about weight management. Non-Hispanic whites may be more likely to avoid care due to fear of weight bias. Clinicians could conduct more sensitive weight loss discussions with all patients.
Collapse
|
104
|
Alberga AS, Pickering BJ, Alix Hayden K, Ball GDC, Edwards A, Jelinski S, Nutter S, Oddie S, Sharma AM, Russell-Mayhew S. Weight bias reduction in health professionals: a systematic review. Clin Obes 2016; 6:175-88. [PMID: 27166133 DOI: 10.1111/cob.12147] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 03/07/2016] [Accepted: 04/05/2016] [Indexed: 12/26/2022]
Abstract
Innovative and coordinated strategies to address weight bias among health professionals are urgently needed. We conducted a systematic literature review of empirical peer-reviewed published studies to assess the impact of interventions designed to reduce weight bias in students or professionals in a health-related field. Combination sets of keywords based on three themes (1: weight bias/stigma; 2: obesity/overweight; 3: health professional) were searched within nine databases. Our search yielded 1447 individual records, of which 17 intervention studies satisfied the inclusion criteria. Most studies (n = 15) included medical, dietetic, health promotion, psychology and kinesiology students, while the minority included practicing health professionals (n = 2). Studies utilized various bias-reduction strategies. Many studies had methodological weaknesses, including short assessment periods, lack of randomization, lack of control group and small sample sizes. Although many studies reported changes in health professionals' beliefs and knowledge about obesity aetiology, evidence of effectiveness is poor, and long-term effects of intervention strategies on weight bias reduction remain unknown. The findings highlight the lack of experimental research to reduce weight bias among health professionals. Although changes in practice will likely require multiple strategies in various sectors, well-designed trials are needed to test the impact of interventions to decrease weight bias in healthcare settings.
Collapse
Affiliation(s)
- A S Alberga
- Werklund School of Education, University of Calgary, Calgary, AB, Canada
| | - B J Pickering
- Werklund School of Education, University of Calgary, Calgary, AB, Canada
| | - K Alix Hayden
- Libraries and Cultural Resources, University of Calgary, Calgary, AB, Canada
| | - G D C Ball
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - A Edwards
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - S Jelinski
- Emergency Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - S Nutter
- Werklund School of Education, University of Calgary, Calgary, AB, Canada
| | - S Oddie
- Applied Research and Evaluation Services, Primary Health Care, Alberta Health Services, Edmonton, AB, Canada
| | - A M Sharma
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - S Russell-Mayhew
- Werklund School of Education, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
105
|
Evans CR, Lippert AM, Subramanian SV. The persistent clustering of adult body mass index by school attended in adolescence. J Epidemiol Community Health 2015. [DOI: 10.1136/jech-2015-205833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
106
|
Hunger JM, Major B, Blodorn A, Miller CT. Weighed down by stigma: How weight-based social identity threat contributes to weight gain and poor health. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2015; 9:255-268. [PMID: 29225670 PMCID: PMC5720363 DOI: 10.1111/spc3.12172] [Citation(s) in RCA: 148] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Weight stigma is pervasive, and a number of scholars argue that this profound stigma contributes to the negative effects of weight on psychological and physical health. Some lay individuals and health professionals assume that stigmatizing weight can actually motivate healthier behaviors and promote weight loss. However, as we review, weight stigma is consistently associated with poorer mental and physical health outcomes. In this article we propose a social identity threat model elucidating how weight stigma contributes to weight gain and poorer mental and physical health among overweight individuals. We propose that weight-based social identity threat increases physiological stress, undermines self-regulation, compromises psychological health, and increases the motivation to avoid stigmatizing domains (e.g., the gym) and escape the stigma by engaging in unhealthy weight loss behaviors. Given the prevalence of overweight and obesity in the US, weight stigma thus has the potential to undermine the health and wellbeing of millions of Americans.
Collapse
Affiliation(s)
- Jeffrey M Hunger
- Department of Psychological and Brain Sciences, University of California, Santa Barbara
| | - Brenda Major
- Department of Psychological and Brain Sciences, University of California, Santa Barbara
| | - Alison Blodorn
- Department of Psychological and Brain Sciences, University of California, Santa Barbara
| | - Carol T Miller
- Department of Psychological Science, University of Vermont
| |
Collapse
|
107
|
Le NTT, Robinson J, Lewis SJ. Obese patients and radiography literature: what do we know about a big issue? J Med Radiat Sci 2015; 62:132-41. [PMID: 26229678 PMCID: PMC4462985 DOI: 10.1002/jmrs.105] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 03/25/2015] [Accepted: 03/27/2015] [Indexed: 11/20/2022] Open
Abstract
Obesity is a global health issue with obese patients requiring specialised diagnosis, treatment and care through the health service. The practical and social difficulties associated with medical imaging of obese patients are an increasingly common problem and it is currently unknown how student and qualified radiographers perceive and respond to these challenges. By better understanding challenges presented in providing quality imaging and care of imaging obese patients, education for both qualified and student radiographers can be enhanced. Radiographers are heavily reliant on visual and tactile senses to locate the position of anatomical structures for diagnostic imaging and determine radiation exposure through a delicate consideration of dose, image quality and anatomical attenuation. However, obese patients require modifications to routine radiographic practice in terms of movement/assisted positioning, equipment capabilities to take increased weight or coverage. These patients may also be subject to compromised radiological diagnosis through poor visualisation of structures. In this paper, the professional and educational literature was narratively reviewed to assess gaps in the evidence base related to the skill and care knowledge for obese patients. Literature was sourced relating to discrete radiographic considerations such as the technical factors of imaging obese patients, exposure and the impact of obesity on imaging departments’ service provisions. The recent literature (post-2000 to coincide with the sharp increase in global obesity) on the perceptions of health professionals and student health practitioners has also been explored because there are no specific radiographer studies to report. By understanding the research in similar fields, we may identify what common attitudes qualified and student radiographer's hold and what challenges, technical and care related, can be prepared for.
Collapse
Affiliation(s)
- Nhat Tan Thanh Le
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney Sydney, New South Wales, Australia
| | - John Robinson
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney Sydney, New South Wales, Australia
| | - Sarah J Lewis
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney Sydney, New South Wales, Australia
| |
Collapse
|
108
|
Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griffin JM, van Ryn M. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev 2015; 16:319-26. [PMID: 25752756 PMCID: PMC4381543 DOI: 10.1111/obr.12266] [Citation(s) in RCA: 644] [Impact Index Per Article: 71.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 12/19/2014] [Accepted: 01/07/2015] [Indexed: 11/30/2022]
Abstract
The objective of this study was to critically review the empirical evidence from all relevant disciplines regarding obesity stigma in order to (i) determine the implications of obesity stigma for healthcare providers and their patients with obesity and (ii) identify strategies to improve care for patients with obesity. We conducted a search of Medline and PsychInfo for all peer-reviewed papers presenting original empirical data relevant to stigma, bias, discrimination, prejudice and medical care. We then performed a narrative review of the existing empirical evidence regarding the impact of obesity stigma and weight bias for healthcare quality and outcomes. Many healthcare providers hold strong negative attitudes and stereotypes about people with obesity. There is considerable evidence that such attitudes influence person-perceptions, judgment, interpersonal behaviour and decision-making. These attitudes may impact the care they provide. Experiences of or expectations for poor treatment may cause stress and avoidance of care, mistrust of doctors and poor adherence among patients with obesity. Stigma can reduce the quality of care for patients with obesity despite the best intentions of healthcare providers to provide high-quality care. There are several potential intervention strategies that may reduce the impact of obesity stigma on quality of care.
Collapse
Affiliation(s)
- SM Phelan
- Division of Health Care Policy and Research, Mayo ClinicRochester, Minnesota, USA
| | - DJ Burgess
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical CenterMinneapolis, Minnesota, USA
- Department of Medicine, University of MinnesotaTwin Cities, Minneapolis, Minnesota, USA
| | - MW Yeazel
- Department of Family Medicine and Community Health, University of MinnesotaTwin Cities, Minneapolis, Minnesota, USA
| | - WL Hellerstedt
- Division of Epidemiology and Community Health, University of MinnesotaTwin Cities, Minneapolis, Minnesota, USA
| | - JM Griffin
- Division of Health Care Policy and Research, Mayo ClinicRochester, Minnesota, USA
| | - M van Ryn
- Division of Health Care Policy and Research, Mayo ClinicRochester, Minnesota, USA
| |
Collapse
|
109
|
Wong MS, Gudzune KA, Bleich SN. Provider communication quality: influence of patients' weight and race. PATIENT EDUCATION AND COUNSELING 2015; 98:492-8. [PMID: 25617907 PMCID: PMC4379992 DOI: 10.1016/j.pec.2014.12.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 10/25/2014] [Accepted: 12/21/2014] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To examine the relationship between patient weight and provider communication quality and determine whether patient race/ethnicity modifies this association. METHODS We conducted a cross-sectional analysis with 2009-2010 medical expenditures panel survey-household component (N=25,971). Our dependent variables were patient report of providers explaining well, listening, showing respect, and spending time. Our independent variables were patient weight status and patient weight-race/ethnicity groups. Using survey weights, we performed multivariate logistic regression to examine the adjusted association between patient weight and patient-provider communication measures, and whether patient race/ethnicity modifies this relationship. RESULTS Compared to healthy weight whites, obese blacks were less likely to report that their providers explained things well (OR 0.78; p=0.02) or spent enough time with them (OR 0.81; p=0.04), and overweight blacks were also less likely to report that providers spent enough time with them (OR 0.78; p=0.02). Healthy weight Hispanics were also less likely to report adequate provider explanations (OR 0.74; p=0.04). CONCLUSION Our study provides preliminary evidence that overweight/obese black and healthy weight Hispanic patients experience disparities in provider communication quality. PRACTICE IMPLICATION Curricula on weight bias and cultural competency might improve communication between providers and their overweight/obese black and healthy weight Hispanic patients.
Collapse
Affiliation(s)
- Michelle S Wong
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, USA.
| | - Kimberly A Gudzune
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Sara N Bleich
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, USA
| |
Collapse
|
110
|
Patient and physician characteristics associated with the provision of weight loss counseling in primary care. Obes Res Clin Pract 2015; 8:e123-30. [PMID: 24743007 DOI: 10.1016/j.orcp.2012.12.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 12/04/2012] [Accepted: 12/15/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND A variety of physician and patient characteristics may influence whether weight loss counseling occurs in primary care encounters. OBJECTIVES This study utilized a cross-sectional survey of primary care patients, which examined patient characteristics, physician characteristics, and characteristics of the physicianâ??patient relationship associated with weight loss counseling and recommendations provided by physicians. PARTICIPANTS (N = 143, mean age = 46.8 years, mean BMI = 36.9 kg/m(2), 65% Caucasian) were overweight and obese primary care patients participating in a managed care weight loss program. MEASURES PARTICIPANTS completed self-report surveys in the clinic prior to the initial weight loss session. Surveys included items assessing demographic/background characteristics, weight, height, and a health care questionnaire evaluating whether their physician had recommended weight loss, the frequency of their physiciansâ?? weight loss counseling, and whether their physician had referred them for obesity treatment. RESULTS Patient BMI and physician sex were most consistently associated with physiciansâ?? weight loss counseling practices. Patients seen by female physicians were more likely to be told that they should lose weight, received more frequent obesity counseling, and were more likely to have been referred for obesity treatment by their physician. Length and frequency of physicianâ??patient contacts were unrelated to the likelihood of counseling. CONCLUSIONS These findings add to previous evidence suggesting possible differences in the weight loss counseling practices of male and female physicians, although further research is needed to understand this potential difference between physicians.
Collapse
|
111
|
Strømmen M, Bakken IJ, Andenæs E, Klöckner CA, Mårvik R, Kulseng B, Holen A. Fet, feit eller bare overvektig? TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2015; 135:1732-6. [DOI: 10.4045/tidsskr.14.0828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
|
112
|
Thomazeau J, Perin J, Nizard R, Bouhassira D, Collin E, Nguyen E, Perrot S, Bergmann JF, Lloret-Linares C. Pain management and pain characteristics in obese and normal weight patients before joint replacement. J Eval Clin Pract 2014; 20:611-6. [PMID: 24828954 DOI: 10.1111/jep.12176] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2014] [Indexed: 12/22/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES The objective was to compare the extent of pain interference and pain medication among persons who were classified as obese [body mass index (BMI)≥ 30 kg m(-2) ] and normal weighted (BMI ≤ 25 kg m(-2) ), before a hip or knee replacement surgery. METHODS Patients candidate for an orthopaedic surgery were successively enrolled, over a 6-month period, and classified in either the normal weight (BMI ≤ 25 kg m(-2) ) or the obese (BMI ≥ 30 kg m(-2) ) categories. Data were collected using self-administered questionnaires with items concerning pain characteristics, pain medication and pain interference. Two standardized questionnaires were associated: the Brief Pain Inventory (BPI) and the Hospital Anxiety and Depression scale (HAD). RESULTS Fifty-two obese patients (candidates for 24 hip replacements and 28 knee replacements) and 51 non-obese (23 hip replacements and 28 knee replacements) were enrolled. Obese patients suffered from a higher rate of acute pain episodes than non-obese patients (65 versus 44%, P<0.05). Pain interference on walking distance, sleep and relations with others was higher in obese patients. HAD score showed no significant difference between groups. The use of strong opioids and of non-steroidal anti-inflammatory drugs (NSAIDs) was significantly more important in obese patients (13 versus 0% and 31 versus 14%). CONCLUSIONS Obese patients suffer more significantly of unrelieved chronic pain, which lowers considerably their quality of life. Pain relief is more difficult to obtain, as it requires stronger pain medication and NSAIDs.
Collapse
Affiliation(s)
- Joséphine Thomazeau
- Service de Médecine Interne, Unité de Recherche Thérapeutique, Hôpital Lariboisière, Paris, France
| | | | | | | | | | | | | | | | | |
Collapse
|
113
|
Ellis S, Rosenblum K, Miller A, Peterson KE, Lumeng JC. Meaning of the terms "overweight" and "obese" among low-income women. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2014; 46:299-303. [PMID: 24135314 PMCID: PMC3986347 DOI: 10.1016/j.jneb.2013.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 07/26/2013] [Accepted: 08/21/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To determine how low-income, US women understand the meanings of the terms "overweight" and "obese." METHODS Low-income women (n = 145; 72% white, 12% black, and 8% Hispanic; 59% obese and 21% overweight) each participated in an individual semi-structured interview during which they were asked to explain what the terms "overweight" and "obese" mean to them. Responses were transcribed and the constant comparative method was used to identify themes. RESULTS Three themes emerged: (1) The terms are offensive and describe people who are unmotivated and depressed and do not care about themselves; (2) obese is an extreme weight (eg, 500 lb and being immobile); (3) being overweight is a matter of opinion; if a woman is "comfortable in her own skin" and "feels healthy," she is not overweight. CONCLUSIONS AND IMPLICATIONS Health education focused on obesity should consider that vulnerable populations might consider the terms "overweight" and "obese" offensive and stigmatizing.
Collapse
Affiliation(s)
- Samantha Ellis
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI
| | - Katherine Rosenblum
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
| | - Alison Miller
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI; Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI
| | - Karen E Peterson
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI; Department of Environmental Health Sciences, Human Nutrition Program, University of Michigan School of Public Health, Ann Arbor, MI
| | - Julie C Lumeng
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI; Center for Human Growth and Development, University of Michigan, Ann Arbor, MI; Department of Environmental Health Sciences, Human Nutrition Program, University of Michigan School of Public Health, Ann Arbor, MI.
| |
Collapse
|
114
|
|
115
|
Phelan SM, Dovidio JF, Puhl RM, Burgess DJ, Nelson DB, Yeazel MW, Hardeman R, Perry S, van Ryn M. Implicit and explicit weight bias in a national sample of 4,732 medical students: the medical student CHANGES study. Obesity (Silver Spring) 2014; 22:1201-8. [PMID: 24375989 PMCID: PMC3968216 DOI: 10.1002/oby.20687] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 12/14/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine the magnitude of explicit and implicit weight biases compared to biases against other groups; and identify student factors predicting bias in a large national sample of medical students. METHODS A web-based survey was completed by 4,732 1st year medical students from 49 medical schools as part of a longitudinal study of medical education. The survey included a validated measure of implicit weight bias, the implicit association test, and 2 measures of explicit bias: a feeling thermometer and the anti-fat attitudes test. RESULTS A majority of students exhibited implicit (74%) and explicit (67%) weight bias. Implicit weight bias scores were comparable to reported bias against racial minorities. Explicit attitudes were more negative toward obese people than toward racial minorities, gays, lesbians, and poor people. In multivariate regression models, implicit and explicit weight bias was predicted by lower BMI, male sex, and non-Black race. Either implicit or explicit bias was also predicted by age, SES, country of birth, and specialty choice. CONCLUSIONS Implicit and explicit weight bias is common among 1st year medical students, and varies across student factors. Future research should assess implications of biases and test interventions to reduce their impact.
Collapse
Affiliation(s)
- Sean M Phelan
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
116
|
Puhl RM, Luedicke J, Grilo CM. Obesity bias in training: attitudes, beliefs, and observations among advanced trainees in professional health disciplines. Obesity (Silver Spring) 2014; 22:1008-15. [PMID: 24124078 PMCID: PMC3968226 DOI: 10.1002/oby.20637] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 09/12/2013] [Accepted: 10/01/2013] [Indexed: 01/24/2023]
Abstract
OBJECTIVE This study examined weight bias among students training in health disciplines and its associations with their perceptions about treating patients with obesity, causes of obesity, and observations of weight bias by instructors and peers. METHODS Students (N = 107) enrolled in a post-graduate health discipline (Physician Associate, Clinical Psychology, Psychiatric Residency) completed anonymous questionnaires to assess the above variables. RESULTS Students reported that patients with obesity are a common target of negative attitudes and derogatory humor by peers (63%), health-care providers (65%), and instructors (40%). Although 80% of students felt confident to treat obesity, many reported that patients with obesity lack motivation to make changes (33%), lead to feelings of frustration (36%), and are non-compliant with treatment (36%). Students with higher weight bias expressed greater frustration in these areas. The effect of students' weight bias on expectations for treatment compliance of patients with obesity was partially mediated by beliefs that obesity is caused by behavioral factors. CONCLUSIONS Weight bias is commonly observed by students in health disciplines, who themselves report frustrations and stereotypes about treating patients with obesity. These findings contribute new knowledge about weight bias among students and provide several targets for medical training and education.
Collapse
Affiliation(s)
- Rebecca M Puhl
- Rudd Center for Food Policy and Obesity, Yale University, New Haven, Connecticut, USA,
| | | | | |
Collapse
|
117
|
Kushner RF, Zeiss DM, Feinglass JM, Yelen M. An obesity educational intervention for medical students addressing weight bias and communication skills using standardized patients. BMC MEDICAL EDUCATION 2014; 14:53. [PMID: 24636594 PMCID: PMC3995306 DOI: 10.1186/1472-6920-14-53] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 03/13/2014] [Indexed: 05/13/2023]
Abstract
BACKGROUND In order to manage the increasing worldwide problem of obesity, medical students will need to acquire the knowledge and skills necessary to assess and counsel patients with obesity. Few educational intervention studies have been conducted with medical students addressing stigma and communication skills with patients who are overweight or obese. The purpose of this study was to evaluate changes in students' attitudes and beliefs about obesity, and their confidence in communication skills after a structured educational intervention that included a clinical encounter with an overweight standardized patient (SP). METHODS First year medical students (n = 127, 47% female) enrolled in a communications unit were instructed to discuss the SPs' overweight status and probe about their perceptions of being overweight during an 8 minute encounter. Prior to the session, students were asked to read two articles on communication and stigma as background information. Reflections on the readings and their performance with the SP were conducted prior to and after the encounter when students met in small groups. A newly constructed 16 item questionnaire was completed before, immediately after and one year after the session. Scale analysis was performed based on a priori classification of item intent. RESULTS Three scales emerged from the questionnaire: negative obesity stereotyping (7 items), empathy (3 items), and counseling confidence (3 items). There were small but significant immediate post-intervention improvements in stereotyping (p = .002) and empathy (p < .0001) and a very large mean improvement in confidence (p < .0001). Significant improvement between baseline and immediate follow-up responses were maintained for empathy and counseling at one year after the encounter but stereotyping reverted to the baseline mean. Percent of students with improved scale scores immediately and at one year follow up were as follows: stereotyping 53.1% and 57.8%; empathy 48.4% and 47.7%; and confidence 86.7% and 85.9%. CONCLUSIONS A structured encounter with an overweight SP was associated with a significant short-term decrease in negative stereotyping, and longer-term increase in empathy and raised confidence among first year medical students toward persons who are obese. The encounter was most effective for increasing confidence in counseling skills.
Collapse
Affiliation(s)
- Robert F Kushner
- Division of Endocrinology, Metabolism, and Molecular Medicine, Northwestern University Feinberg School of Medicine, 750 North Lake Shore Drive, Rubloff 9-976, Chicago, IL 60611, USA
| | - Dinah M Zeiss
- Division of Endocrinology, Metabolism, and Molecular Medicine, Northwestern University Feinberg School of Medicine, 750 North Lake Shore Drive, Rubloff 9-976, Chicago, IL 60611, USA
| | - Joseph M Feinglass
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, 750 North Lake Shore Drive, Rubloff 10th Floor, Chicago, IL 60611, USA
| | - Marsha Yelen
- Office of Medical Education, Northwestern University Feinberg School of Medicine, 240 East Huron Street, Chicago, IL 60611, USA
| |
Collapse
|
118
|
Ingraham N, Roberts SCM, Weitz TA. Prior Family Planning Experiences of Obese Women Seeking Abortion Care. Womens Health Issues 2014; 24:e125-30. [DOI: 10.1016/j.whi.2013.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 10/23/2013] [Accepted: 10/24/2013] [Indexed: 12/01/2022]
|
119
|
Puhl RM, Latner JD, King KM, Luedicke J. Weight bias among professionals treating eating disorders: attitudes about treatment and perceived patient outcomes. Int J Eat Disord 2014; 47:65-75. [PMID: 24038385 DOI: 10.1002/eat.22186] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 08/07/2013] [Accepted: 08/07/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aimed to assess weight bias among professionals who specialize in treating eating disorders and identify to what extent their weight biases are associated with attitudes about treating obese patients. METHOD Participants were 329 professionals treating eating disorders, recruited through professional organizations that specialize in eating disorders. Participants completed anonymous, online self-report questionnaires, assessing their explicit weight bias, perceived causes of obesity, attitudes toward treating obese patients, perceptions of treatment compliance and success of obese patients, and perceptions of weight bias among other practitioners. RESULTS Negative weight stereotypes were present among some professionals treating eating disorders. Although professionals felt confident (289; 88%) and prepared (276; 84%) to provide treatment to obese patients, the majority (184; 56%) had observed other professionals in their field making negative comments about obese patients, 42% (138) believed that practitioners who treat eating disorders often have negative stereotypes about obese patients, 35% (115) indicated that practitioners feel uncomfortable caring for obese patients, and 29% (95) reported that their colleagues have negative attitudes toward obese patients. Compared to professionals with less weight bias, professionals with stronger weight bias were more likely to attribute obesity to behavioral causes, expressed more negative attitudes and frustrations about treating obese patients, and perceived poorer treatment outcomes for these patients. DISCUSSION Similar to other health disciplines, professionals treating eating disorders are not immune to weight bias. This has important implications for provision of clinical treatment with obese individuals and efforts to reduce weight bias in the eating disorders field.
Collapse
Affiliation(s)
- Rebecca M Puhl
- Rudd Center for Food Policy and Obesity, Yale University, New Haven, Connecticut
| | | | | | | |
Collapse
|
120
|
Walsh CO, Milliren CE, Feldman HA, Taveras EM. Sensitivity and specificity of obesity diagnosis in pediatric ambulatory care in the United States. Clin Pediatr (Phila) 2013; 52:829-35. [PMID: 23676286 DOI: 10.1177/0009922813488648] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE We examined the sensitivity and specificity of an obesity diagnosis in a nationally representative sample of pediatric outpatient visits. METHODS We used the 2005 to 2009 National Ambulatory Medical Care and National Hospital Ambulatory Medical Care surveys. We included visits with children 2 to 18 years, yielding a sample of 48 145 database visits. We determined 3 methods of identifying obesity: documented body mass index (BMI) ≥95th percentile; International Classification of Diseases, Ninth Revision (ICD-9) code; and positive answer to the question, "Does the patient now have obesity?" Using BMI as the gold standard, we calculated the sensitivity and specificity of a clinical obesity diagnosis. RESULTS Among the 19.5% of children who were obese by BMI, 7.0% had an ICD-9 code and 15.2% had a positive response to questioning. The sensitivity of an obesity diagnosis was 15.4%, and the specificity was 99.2%. CONCLUSIONS The sensitivity of the obesity diagnosis in pediatric ambulatory visits is low. Efforts are needed to increase identification of obese children.
Collapse
Affiliation(s)
- Carolyn O Walsh
- Boston Medical Center/Boston Children's Hospital, Boston, MA, USA
| | | | | | | |
Collapse
|
121
|
Bleich SN, Gudzune KA, Bennett WL, Jarlenski MP, Cooper LA. How does physician BMI impact patient trust and perceived stigma? Prev Med 2013; 57:120-4. [PMID: 23743418 PMCID: PMC3745018 DOI: 10.1016/j.ypmed.2013.05.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 04/29/2013] [Accepted: 05/12/2013] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The objective is to evaluate whether physician body mass index (BMI) impacts their patients' trust or perceptions of weight-related stigma. METHODS We used a national cross-sectional survey of 600 non-pregnant overweight and obese patients conducted between April 5 and April 13, 2012. The outcome variables were patient trust (overall and by type of advice) and patient perceptions of weight-related stigma. The independent variable of interest was primary care physician (PCP) BMI. We conducted multivariate regression analyses to determine whether trust or perceived stigma differed by physician BMI, adjusting for covariates. RESULTS Patients reported high levels of trust in their PCPs, regardless of the PCPs body weight (normal BMI=8.6; overweight=8.3; obese=8.2; where 10 is the highest). Trust in diet advice was significantly higher among patients seeing overweight PCPs as compared to normal BMI PCPs (87% vs. 77%, p=0.04). Reports of feeling judged by their PCP were significantly higher among patients seeing obese PCPs (32%; 95% confidence interval (CI): 23-41) as compared to patients seeing normal BMI PCPs (14%; 95% CI: 7-20). CONCLUSION Overweight and obese patients generally trust their PCP, but they more strongly trust diet advice from overweight PCPs as compared to normal BMI PCPs.
Collapse
Affiliation(s)
- Sara N Bleich
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | | | | | | |
Collapse
|
122
|
Abstract
Weight discrimination is prevalent in American society. Although associated consistently with psychological and economic outcomes, less is known about whether weight discrimination is associated with longitudinal changes in obesity. The objectives of this research are (1) to test whether weight discrimination is associated with risk of becoming obese (Body Mass Index≥30; BMI) by follow-up among those not obese at baseline, and (2) to test whether weight discrimination is associated with risk of remaining obese at follow-up among those already obese at baseline. Participants were drawn from the Health and Retirement Study, a nationally representative longitudinal survey of community-dwelling US residents. A total of 6,157 participants (58.6% female) completed the discrimination measure and had weight and height available from the 2006 and 2010 assessments. Participants who experienced weight discrimination were approximately 2.5 times more likely to become obese by follow-up (OR = 2.54, 95% CI = 1.58-4.08) and participants who were obese at baseline were three times more likely to remain obese at follow up (OR = 3.20, 95% CI = 2.06-4.97) than those who had not experienced such discrimination. These effects held when controlling for demographic factors (age, sex, ethnicity, education) and when baseline BMI was included as a covariate. These effects were also specific to weight discrimination; other forms of discrimination (e.g., sex, race) were unrelated to risk of obesity at follow-up. The present research demonstrates that, in addition to poorer mental health outcomes, weight discrimination has implications for obesity. Rather than motivating individuals to lose weight, weight discrimination increases risk for obesity.
Collapse
Affiliation(s)
- Angelina R Sutin
- Florida State University College of Medicine, Tallahassee, Florida, United States of America.
| | | |
Collapse
|
123
|
Chugh M, Friedman AM, Clemow LP, Ferrante JM. Women weigh in: obese African American and White women's perspectives on physicians' roles in weight management. J Am Board Fam Med 2013; 26:421-8. [PMID: 23833157 PMCID: PMC3791510 DOI: 10.3122/jabfm.2013.04.120350] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND There is little qualitative research on the type of weight loss counseling patients prefer from their physicians and whether preferences differ by race. METHODS This qualitative study used semistructured, in-depth interviews of 33 moderately to severely obese white and African American women to elucidate and compare their perceptions regarding their primary care physician's approach to weight loss counseling. Data were analyzed using a grounded theory approach and a series of immersion/crystallization cycles. RESULTS White and African American women seemed to internalize weight stigma differently. African American participants spoke about their pride and positive body image, whereas white women more frequently expressed self-deprecation and feelings of depression. Despite these differences, both groups of women desired similar physician interactions and weight management counseling, including (1) giving specific weight loss advice and individualized plans for weight management; (2) addressing weight in an empathetic, compassionate, nonjudgmental, and respectful manner; and (3) providing encouragement to foster self-motivation for weight loss. CONCLUSION While both African American and white women desired specific strategies from physicians in weight management, some white women may first need assistance in overcoming their stigma, depression, and low self-esteem before attempting weight loss.
Collapse
Affiliation(s)
- Monica Chugh
- Department of Pediatrics, New York University Langone Medical Center, New York, NY, USA
| | | | | | | |
Collapse
|
124
|
Miller DP, Spangler JG, Vitolins MZ, Davis SW, Ip EH, Marion GS, Crandall SJ. Are medical students aware of their anti-obesity bias? ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2013; 88:978-82. [PMID: 23702519 PMCID: PMC3930920 DOI: 10.1097/acm.0b013e318294f817] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PURPOSE Anti-obesity prejudices affect the quality of care obese individuals receive. The authors sought to determine the prevalence of weight-related biases among medical students and whether they were aware of their biases. METHOD Between 2008 and 2011, the authors asked all third-year medical students at Wake Forest School of Medicine to complete the Weight Implicit Association Test (IAT), a validated measure of implicit preferences for "fat" or "thin" individuals. Students also answered a semantic differential item assessing their explicit weight-related preferences. The authors determined students' awareness of their biases by examining the correlation between students' explicit preferences and their IAT scores. RESULTS Of 354 medical students, 310 (88%) completed valid surveys and consented to participate. Overall, 33% (101/310) self-reported a significant ("moderate" or "strong") explicit anti-fat bias. No students self-reported a significant explicit anti-thin bias. According to the IAT scores, over half of students had a significant implicit weight bias: 39% (121/310) had an anti-fat bias and 17% (52/310) an anti-thin bias. Two-thirds of students (67%, 81/121) were unaware of their implicit anti-fat bias. Only male gender predicted an explicit anti-fat bias (odds ratio 3.0, 95% confidence interval 1.8-5.3). No demographic factors were associated with an implicit anti-fat bias. Students' explicit and implicit biases were not correlated (Pearson r = 0.03, P = .58). CONCLUSIONS Over one-third of medical students had a significant implicit anti-fat bias; few were aware of that bias. Accordingly, medical schools' obesity curricula should address weight-related biases and their potential impact on care.
Collapse
Affiliation(s)
- David P Miller
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | | | | | | | | | | | | |
Collapse
|
125
|
Mazur A, Matusik P, Revert K, Nyankovskyy S, Socha P, Binkowska-Bury M, Grzegorczyk J, Caroli M, Hassink S, Telega G, Malecka-Tendera E. Childhood obesity: knowledge, attitudes, and practices of European pediatric care providers. Pediatrics 2013; 132:e100-8. [PMID: 23753085 DOI: 10.1542/peds.2012-3239] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To determine and compare attitudes, skills, and practices in childhood obesity management in 4 European countries with different obesity prevalence, health care systems, and economic situations. METHODS A cross-sectional survey was distributed to primary health care providers from France, Italy, Poland, and Ukraine. The questionnaire was returned by 1119 participants with a response rate of 32.4%. RESULTS The study revealed that most of the primary health care providers were convinced of their critical role in obesity management but did not feel sufficiently competent to perform effectively. The adherence to recommended practices such as routine weight and height measurements, BMI calculation, and plotting growth parameters on recommended growth charts was poor. Most primary health care providers recognized the need for continuing professional education in obesity management, stressing the importance of appropriate dietary counseling. CONCLUSIONS The study underlines insufficient implementation of national guidelines for management of obesity regardless of the country and its health system. It also makes clear that the critical problem is not elaboration of guidelines but rather creating support systems for implementation of the medical standards among the primary care practitioners.
Collapse
Affiliation(s)
- Artur Mazur
- Medical Faculty, University of Rzeszow, Rzeszow, Poland.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
126
|
Lafata JE, Morris HL, Dobie E, Heisler M, Werner RM, Dumenci L. Patient-reported use of collaborative goal setting and glycemic control among patients with diabetes. PATIENT EDUCATION AND COUNSELING 2013; 92:94-9. [PMID: 23433777 PMCID: PMC4301400 DOI: 10.1016/j.pec.2013.01.016] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 01/15/2013] [Accepted: 01/22/2013] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Little is known about how patient-clinician communication leads to better outcomes. Among patients with diabetes, we describe patient-reported use of collaborative goal setting and evaluate whether perceived competency and physician trust mediate the association between collaborative goal setting and glycemic control. METHODS Data from a patient survey administered in 2008 to a cohort of insured patients aged 18+ years with diabetes who initiated oral mono-therapy between 2000 and 2005 were joined with pharmaceutical claims data for the prior 12 months and laboratory data for the prior and subsequent 12 months (N=1065). A structural equation model (SEM) was used to test mediation models controlling for baseline HbA1c. RESULTS The hypothesized mediation model was supported. Patient-reported use of more collaborative goal setting was associated with greater perceived self-management competency and increased level of trust in the physician (p<0.05). In turn, both greater perceived competence and increased trust were associated with increased control (p<0.05). CONCLUSIONS Findings indicate that engaging patients in collaborative goal setting during clinical encounters has potential to foster a trusting patient-clinician relationship as well as enhance patient perceived competence, thereby improving clinical control. PRACTICE IMPLICATIONS Fostering collaborative goal setting may yield payoffs in improved clinical outcomes among patients with diabetes.
Collapse
Affiliation(s)
- Jennifer Elston Lafata
- Social and Behavioral Health, School of Medicine, Virginia Commonwealth University, Richmond, USA.
| | | | | | | | | | | |
Collapse
|
127
|
Mold F, Forbes A. Patients' and professionals' experiences and perspectives of obesity in health-care settings: a synthesis of current research. Health Expect 2013; 16:119-42. [PMID: 21645186 PMCID: PMC5060648 DOI: 10.1111/j.1369-7625.2011.00699.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Obesity-related stigma likely influences how obese people interact with health-care professionals and access health care. AIM To undertake a synthesis of studies examining the views and experiences of both obese people in relation to their health-care provision and health-care professionals in providing care to obese patients. SEARCH STRATEGY A systematic search of key electronic databases relating to professional or patient experiences of, or perspectives on, obesity was performed in 2008 and updated in 2010. Reference lists of article bibliographies were searched, along with hand searches of relevant journals. INCLUSION CRITERIA Studies were screened against explicit inclusion criteria and published between 1990 and 2010. Findings were examined and organized thematically. DATA EXTRACTION Data were extracted focusing on obesity, stigma and access to health-care services. All included studies were subject to critical appraisal to assess the quality of the research. FINDINGS Thirty studies were identified. All the studies reported obesity impacting on health-care interactions. Key themes identified were experiences of stigma and feelings of powerlessness, treatment avoidance, psycho-emotional functioning, professional attitudes, confidence and training, variations in health contact time and finally, differences in treatment options and preventative measures. CONCLUSION Obesity is a stigmatized condition that impacts negatively on the relationship between patients and health-care providers. Given the increasing prevalence of obesity and the range of therapeutic options available, further work is necessary to understand how the presence of obesity affects health-care interactions and decision making.
Collapse
Affiliation(s)
- Freda Mold
- Information Specialist, Health and Social Care Division, University of Surrey, Guildford, Surrey
| | - Angus Forbes
- Professor, FEND Chair in Clinical Diabetes Nursing, Department of Primary and Intermediate Care, Florence Nightingale School of Nursing and Midwifery, King’s College London, London, UK
| |
Collapse
|
128
|
Swift JA, Choi E, Puhl RM, Glazebrook C. Talking about obesity with clients: preferred terms and communication styles of U.K. pre-registration dieticians, doctors, and nurses. PATIENT EDUCATION AND COUNSELING 2013; 91:186-191. [PMID: 23369374 DOI: 10.1016/j.pec.2012.12.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Revised: 12/05/2012] [Accepted: 12/23/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To describe trainee healthcare professionals' preferred terms when talking about obesity, their beliefs about initiating discussions about weight, and their confidence about consulting with obese people. METHODS A self-completed questionnaire collected data on demographics, preferred terms, beliefs about initiation of discussions, confidence and training needs from 1036 pre-registration dieticians, nurses and doctors. RESULTS Participants' preferred terms when raising the issue of obesity with clients were BMI (mean=.96), weight (mean=.71) and unhealthy BMI (mean=.43). When defining a client's bodyweight, students endorsed the euphemism 'your weight may be damaging your health' (67.6%). A proactive, collaborative communication style was preferred by 34.9% of participants. 58.2% of participants felt confident about discussing obesity with clients and 95.1% felt that that more training would be useful. CONCLUSION It is reassuring that U.K. trainee healthcare professionals avoid value-laden terms and broadly endorse words preferred by people with obesity. It is, however, concerning that the majority of participants did not favor a proactive, collaborative communication style. PRACTICE IMPLICATIONS Educators of tomorrow's healthcare professionals could take advantage of students' desire for more training on how to effectively talk to clients with obesity about their weight. Such training would, however, require the development of clear guidelines on terminology and communication styles.
Collapse
Affiliation(s)
- Judy A Swift
- Division of Nutritional Sciences, The University of Nottingham, Nottingham, UK.
| | | | | | | |
Collapse
|
129
|
Major B, Mendes WB, Dovidio JF. Intergroup relations and health disparities: a social psychological perspective. Health Psychol 2013; 32:514-24. [PMID: 23646834 PMCID: PMC3988903 DOI: 10.1037/a0030358] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This article considers how the social psychology of intergroup processes helps to explain the presence and persistence of health disparities between members of socially advantaged and disadvantaged groups. METHOD Social psychological theory and research on intergroup relations, including prejudice, discrimination, stereotyping, stigma, prejudice concerns, social identity threat, and the dynamics of intergroup interactions, is reviewed and applied to understand group disparities in health and health care. Potential directions for future research are considered. RESULTS Key features of group relations and dynamics, including social categorization, social hierarchy, and the structural positions of groups along dimensions of perceived warmth and competence, influence how members of high status groups perceive, feel about, and behave toward members of low status groups, how members of low status groups construe and cope with their situation, and how members of high and low status groups interact with each other. These intergroup processes, in turn, contribute to health disparities by leading to differential exposure to and experiences of chronic and acute stress, different health behaviors, and different quality of health care experienced by members of advantaged and disadvantaged groups. Within each of these pathways, social psychological theory and research identifies mediating mechanisms, moderating factors, and individual differences that can affect health. CONCLUSIONS A social psychological perspective illuminates the intergroup, interpersonal, and intrapersonal processes by which structural circumstances which differ between groups for historical, political, and economic reasons can lead to group differences in health.
Collapse
Affiliation(s)
- Brenda Major
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, CA 93106, USA.
| | | | | |
Collapse
|
130
|
Hartung FM, Renner B. Perceived and actual social discrimination: the case of overweight and social inclusion. Front Psychol 2013; 4:147. [PMID: 23554597 PMCID: PMC3612696 DOI: 10.3389/fpsyg.2013.00147] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 03/07/2013] [Indexed: 11/13/2022] Open
Abstract
The present study examined the correspondence between perceived and actual social discrimination of overweight people. In total, 77 first-year students provided self-ratings about their height, weight, and perceived social inclusion. To capture actual social inclusion, each participant nominated those fellow students (a) she/he likes and dislikes and (b) about whom she/he is likely to hear social news. Students with lower Body Mass Index (BMI) felt socially included, irrespective of their actual social inclusion. In contrast, students with higher BMI felt socially included depending on the degree of their actual social inclusion. Specifically, their felt social inclusion accurately reflected whether they were actually liked/disliked, but only when they were part of social news. When not part of social news, they also showed insensitivity to their actual social inclusion status. Thus, students with a lower BMI tended to be insensitive, while students with a higher BMI showed a differential sensitivity to actual social discrimination.
Collapse
Affiliation(s)
- Freda-Marie Hartung
- Psychological Assessment & Health Psychology, Department of Psychology, University of Konstanz Konstanz, Germany
| | | |
Collapse
|
131
|
Abstract
Despite significant attention to the medical impacts of obesity, often ignored are the negative outcomes that obese children and adults experience as a result of stigma, bias, and discrimination. Obese individuals are frequently stigmatized because of their weight in many domains of daily life. Research spanning several decades has documented consistent weight bias and stigmatization in employment, health care, schools, the media, and interpersonal relationships. For overweight and obese youth, weight stigmatization translates into pervasive victimization, teasing, and bullying. Multiple adverse outcomes are associated with exposure to weight stigmatization, including depression, anxiety, low self-esteem, body dissatisfaction, suicidal ideation, poor academic performance, lower physical activity, maladaptive eating behaviors, and avoidance of health care. This review summarizes the nature and extent of weight stigmatization against overweight and obese individuals, as well as the resulting consequences that these experiences create for social, psychological, and physical health for children and adults who are targeted.
Collapse
Affiliation(s)
- Rebecca M Puhl
- Rudd Center for Food Policy and Obesity, Yale University, 309 Edwards Street, New Haven, CT 06511, USA.
| | | |
Collapse
|
132
|
Nicholls SG. Standards and classification: a perspective on the 'obesity epidemic'. Soc Sci Med 2013; 87:9-15. [PMID: 23631773 DOI: 10.1016/j.socscimed.2013.03.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 03/01/2013] [Accepted: 03/07/2013] [Indexed: 11/26/2022]
Abstract
In this paper I critique the increasing standardization of obesity. Specifically, I consider two 'definitional turns': the way language has been standardized to such an extent that it obscures uncertainty and variation, and the appearance of objectivity through quantification and standardized measurement. These, I suggest, have fostered a simplified picture of obesity, promoting the classification of weight and thereby facilitating the emergence of the 'obesity epidemic'. These definitional turns fail to acknowledge the distinctions between fat and mass and intraclass variation within weight categories. A consequence of this process of simplification has been the erroneous application of population level information to individuals in a clinical context, with potentially harmful results.
Collapse
Affiliation(s)
- Stuart G Nicholls
- Department of Epidemiology and Community Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Canada K1H 8M5.
| |
Collapse
|
133
|
Madera JM, Hebl MR. “Don't Stigmatize”: The Ironic Effects of Equal Opportunity Guidelines in Interviews. BASIC AND APPLIED SOCIAL PSYCHOLOGY 2013. [DOI: 10.1080/01973533.2012.746601] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
134
|
Ip EH, Marshall S, Vitolins M, Crandall SJ, Davis S, Miller D, Kronner D, Vaden K, Spangler J. Measuring medical student attitudes and beliefs regarding patients who are obese. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2013; 88:282-9. [PMID: 23269296 PMCID: PMC3826984 DOI: 10.1097/acm.0b013e31827c028d] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE Research shows obesity bias to undermine the patient-doctor relationship and lead to substandard care. The authors developed and tested an instrument to measure medical students' attitudes and beliefs about obese patients. METHOD The authors conducted a literature search to identify validated measures of obesity bias. Because they identified no appropriate scale, they decided to design a novel survey instrument: the Nutrition, Exercise and Weight Management (NEW) Attitudes Scale. An expert panel generated items which focus groups of third-year medical students then discussed. Next, experienced medical educators judged and weighted the remaining revised items. Then, second- and fourth-year medical students completed the scale alongside two previously validated measures of obesity bias, the Anti-Fat Attitudes Questionnaire (AFA) and Beliefs About Obese Persons Scale (BAOP). Third-year students completed the NEW Attitudes Scale before and after a simulated encounter with an obese standardized patient instructor. The authors tested the validity and reliability. RESULTS The final instrument comprised 31 items. A sample of 201 judges rated the items. A sample of 111 second- and fourth-year medical students completed the survey (mean score 24.4, range -37 to 76 out of a possible -118 to 118; higher scores indicate more positive attitudes). Pearson correlations between the NEW Attitudes Scale and AFA and BAOP were, respectively, -0.47 and 0.23. Test-retest reliability was 0.89. Students scored 27% higher after completing the standardized patient-instructor encounter (P < .001). CONCLUSION The NEW Attitudes Scale has good validity and reliability and may be used in future studies.
Collapse
Affiliation(s)
- Edward H Ip
- Department of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
135
|
Menez S, Cheskin L, Geller G. Perspectives on obesity and its treatment: health care providers and the general public in rural West Virginia and urban Baltimore. HEALTH EDUCATION & BEHAVIOR 2013; 40:663-72. [PMID: 23341478 DOI: 10.1177/1090198112473101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To determine and compare the perspectives of the general public and health care providers (HCPs) on obesity and its treatment in rural West Virginia (WV) and Baltimore, MD. METHOD Surveys were completed in both locations by the general public (WV: n = 200; Baltimore: n = 171) and HCPs (WV: n = 25; Baltimore: n = 15). RESULTS BMI (body mass index) ≥ 30 (WV: n = 94; Baltimore: n = 58) was associated with a stronger belief in the heritability of obesity and with the ability to control obesity by controlling food cost, compared with those with normal BMI (WV: n = 42; Baltimore: n = 57). Those with a high school education (WV: n = 112; Baltimore: n = 113) were less likely to agree that obesity is a problem in the community and that proper diet and exercise are realistic expectations, compared with those with at least some higher education. Perspectives of HCPs differed significantly from the general public in both locations. CONCLUSION Many differences in perspective on obesity exist between WV and Baltimore, within both populations, and between HCPs and the general public in both settings. A better understanding of patient views is important for effective obesity management. HCPs must consider each patient's level of understanding when discussing management and consequences of obesity. More time spent with patients who have less insight into their obesity may improve patient adherence with treatment and overall patient outcomes.
Collapse
Affiliation(s)
- Steven Menez
- 1Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | |
Collapse
|
136
|
Mulherin K, Miller YD, Barlow FK, Diedrichs PC, Thompson R. Weight stigma in maternity care: women's experiences and care providers' attitudes. BMC Pregnancy Childbirth 2013; 13:19. [PMID: 23339533 PMCID: PMC3577669 DOI: 10.1186/1471-2393-13-19] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Accepted: 01/16/2013] [Indexed: 11/29/2022] Open
Abstract
Background Weight stigma is pervasive in Western society and in healthcare settings, and has a negative impact on victims’ psychological and physical health. In the context of an increasing focus on the management of overweight and obese women during and after pregnancy in research and clinical practice, the current studies aimed to examine the presence of weight stigma in maternity care. Addressing previous limitations in the weight stigma literature, this paper quantitatively explores the presence of weight stigma from both patient and care provider perspectives. Methods Study One investigated associations between pre-pregnancy body mass index (BMI) and experiences of maternity care from a state-wide, self-reported survey of 627 Australian women who gave birth in 2009. Study Two involved administration of an online survey to 248 Australian pre-service medical and maternity care providers, to investigate their perceptions of, and attitudes towards, providing care for pregnant patients of differing body sizes. Both studies used linear regression analyses. Results Women with a higher BMI were more likely to report negative experiences of care during pregnancy and after birth, compared to lower weight women. Pre-service maternity care providers perceived overweight and obese women as having poorer self-management behaviours, and reported less positive attitudes towards caring for overweight or obese pregnant women, than normal-weight pregnant women. Even care providers who reported few weight stigmatising attitudes responded less positively to overweight and obese pregnant women. Conclusions Overall, these results provide preliminary evidence that weight stigma is present in maternity care settings in Australia. They suggest a need for further research into the nature and consequences of weight stigma in maternity care, and for the inclusion of strategies to recognise and combat weight stigma in maternity care professionals’ training.
Collapse
Affiliation(s)
- Kate Mulherin
- The University of Queensland, Queensland Centre for Mothers and Babies, School of Psychology, Brisbane, Australia.
| | | | | | | | | |
Collapse
|
137
|
Swift JA, Hanlon S, El-Redy L, Puhl RM, Glazebrook C. Weight bias among UK trainee dietitians, doctors, nurses and nutritionists. J Hum Nutr Diet 2012; 26:395-402. [DOI: 10.1111/jhn.12019] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- J. A. Swift
- Division of Nutritional Sciences; School of Biosciences; The University of Nottingham; Leicestershire UK
| | - S. Hanlon
- Division of Nutritional Sciences; School of Biosciences; The University of Nottingham; Leicestershire UK
| | - L. El-Redy
- Division of Nutritional Sciences; School of Biosciences; The University of Nottingham; Leicestershire UK
| | - R. M. Puhl
- Rudd Center for Food Policy & Obesity; Yale University; New Haven CT USA
| | - C. Glazebrook
- Behavioural Sciences; Division of Psychiatry; School of Community Health Sciences; The University of Nottingham; Queen's Medical Centre; Nottingham UK
| |
Collapse
|
138
|
Pantenburg B, Sikorski C, Luppa M, Schomerus G, König HH, Werner P, Riedel-Heller SG. Medical students' attitudes towards overweight and obesity. PLoS One 2012; 7:e48113. [PMID: 23144850 PMCID: PMC3489830 DOI: 10.1371/journal.pone.0048113] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 09/19/2012] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Studies from the USA have identified medical students as a major source of stigmatizing attitudes towards overweight and obese individuals. As data from Europe is scarce, medical students' attitudes were investigated at the University of Leipzig in Leipzig, Germany. DESIGN Cross-sectional survey containing an experimental manipulation consisting of a pair of vignettes depicting an obese and a normal weight 42-year-old woman, respectively. Vignettes were followed by the Fat Phobia Scale (FPS), a semantic differential assessing weight related attitudes. In case of the overweight vignette a panel of questions on causal attribution for the overweight preceded administration of the FPS. SUBJECTS 671 medical students were enrolled at the University of Leipzig from May to June 2011. RESULTS The overweight vignette was rated significantly more negative than the normal weight vignette (mean FPS score 3.65±0.45 versus 2.54±0.38, p<0.001). A higher proportion of students had negative attitudes towards the overweight as compared to the normal weight individual (98.9% versus 53.7%, p<0.001). A "positive energy balance" was perceived as the most relevant cause for the overweight, followed by "negligent personality trait", "societal and social environment" and "biomedical causes". Attributing a "positive energy balance" or "negligent personality trait" as relevant cause for the overweight was positively associated with negative attitudes. CONCLUSION The results of this study confirm and complement findings from other countries, mainly the USA, and indicate that weight bias in the health care setting may be a global issue. Stigmatizing attitudes towards overweight and obesity are prevalent among a sample of medical students at the University of Leipzig. Negative attitudes arise on the basis of holding the individual accountable for the excess weight. They call for bringing the topic of overweight and obesity more into the focus of the medical curriculum and for enhancing medical students' awareness of the complex aetiology of this health condition.
Collapse
Affiliation(s)
- Birte Pantenburg
- Integrated Research and Treatment Center AdiposityDiseases, University of Leipzig, Leipzig, Germany.
| | | | | | | | | | | | | |
Collapse
|
139
|
Mehta H, Patel J, Parikh R, Abughosh S. Differences in Obesity Management Among Physicians. Popul Health Manag 2012; 15:287-92. [DOI: 10.1089/pop.2011.0068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hemalkumar Mehta
- Department of Clinical Sciences and Administration, College of Pharmacy, University of Houston, Houston, Texas
| | - Jeetvan Patel
- Department of Clinical Sciences and Administration, College of Pharmacy, University of Houston, Houston, Texas
| | | | - Susan Abughosh
- Department of Clinical Sciences and Administration, College of Pharmacy, University of Houston, Houston, Texas
| |
Collapse
|
140
|
Bocquier A, Verger P, Basdevant A, Andreotti G, Baretge J, Villani P, Paraponaris A. Overweight and Obesity: Knowledge, Attitudes, and Practices of General Practitioners in France. ACTA ACUST UNITED AC 2012; 13:787-95. [PMID: 15897489 DOI: 10.1038/oby.2005.89] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To describe the current knowledge, attitudes, and practices of French general practitioners (GPs) in the field of adult overweight and obesity management. RESEARCH METHODS AND PROCEDURES A cross-sectional telephone survey interviewed a sample of 600 GPs, representative of the private GPs in southeastern France. A four-part questionnaire assessed personal and professional characteristics, attitudes and opinions about overweight and obesity, relevant knowledge and training, and practices (diagnostic methods, clinical assessments, weight loss objectives, types of counseling). RESULTS Most GPs knew that weight problems are health-threatening, and 79% agreed that managing these problems is part of their role. Nevertheless, 58% did not feel they perform this role effectively, and one-third did not find it professionally gratifying. Approximately 30% had negative attitudes toward overweight and obese patients; 57% were pessimistic about patients' ability to lose weight; 64% often set weight loss objectives more demanding than guidelines call for; and neither food diaries nor nutritional education were used systematically. GPs' feelings of effectiveness and attitudes toward obese patients were associated with some professional (training) and personal (BMI, personal diet experience) characteristics. DISCUSSION GPs' feelings of ineffectiveness may stem from an underlying conflict between practitioners' and patients' representations of weight problems and the relationship problems this causes. Inadequate practices and health care system organization may also play a role.
Collapse
Affiliation(s)
- Aurélie Bocquier
- Southeastern France Regional Center for Disease control, Marseilles, France.
| | | | | | | | | | | | | |
Collapse
|
141
|
Abstract
OBJECTIVE To investigate the influence of patient obesity on primary care physician practice style. RESEARCH METHODS AND PROCEDURES This was a randomized, prospective study of 509 patients assigned for care by 105 primary care resident physicians. Patient data collected included sociodemographic information, self-reported health status (Medical Outcomes Study Short Form-36), evaluation for depression (Beck Depression Index), and satisfaction. Height and weight were measured to calculate the BMI. Videotapes of the visits were analyzed using the Davis Observation Code (DOC). RESULTS Regression equations were estimated relating obesity to visit length, each of the 20 individual DOC codes, and the six DOC Physician Practice Behavior Clusters, controlling for patient health status and sociodemographics. Obesity was not significantly associated with the length of the visit, but influenced what happened during the visit. Physicians spent less time educating obese patients about their health (p = 0.0062) and more time discussing exercise (p = 0.0075). Obesity was not related to discussions regarding nutrition. Physicians spent a greater portion of the visit on technical tasks when the patient was obese (p = 0.0528). Mean pre-visit general satisfaction for obese patients was significantly lower than for non-obese patients (p = 0.0069); however, there was no difference in post-visit patient satisfaction. DISCUSSION Patient obesity impacts the medical visit. Further research can promote a greater understanding of the relationships between obese patients and their physicians.
Collapse
Affiliation(s)
- Klea D Bertakis
- Department of Family and Community Medicine, University of California, Davis, Sacramento, CA 95817, USA.
| | | |
Collapse
|
142
|
Abstract
Considerable attention has been given to the behaviors that need to be changed in individuals who are overweight and obese. Much less attention has been given to the behaviors that need to be changed in health care professionals who treat these individuals. Specifically, health care professionals, similar to the general population, have been shown to engage in weight-based discrimination. The impact this may have on patients is discussed.
Collapse
Affiliation(s)
- Craig A. Johnston
- Department of Pediatrics-Nutrition, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
143
|
Gudzune KA, Huizinga MM, Beach MC, Cooper LA. Obese patients overestimate physicians' attitudes of respect. PATIENT EDUCATION AND COUNSELING 2012; 88:23-28. [PMID: 22240006 PMCID: PMC3340528 DOI: 10.1016/j.pec.2011.12.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 12/04/2011] [Accepted: 12/11/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate whether obese patients overestimate or underestimate the level of respect that their physicians hold toward them. METHODS We performed a cross-sectional analysis of data from questionnaires and audio-recordings of visits between primary care physicians and their patients. Using multilevel logistic regression, we evaluated the association between patient BMI and accurate estimation of physician respect. Physician respectfulness was also rated independently by assessing the visit audiotapes. RESULTS Thirty-nine primary care physicians and 199 of their patients were included in the analysis. The mean patient BMI was 32.8 kg/m2 (SD 8.2). For each 5 kg/m2 increase in BMI, the odds of overestimating physician respect significantly increased [OR 1.32, 95% CI 1.04-1.68, p=0.02]. Few patients underestimated physician respect. There were no differences in ratings of physician respectfulness by independent evaluators of the audiotapes. CONCLUSION We consider our results preliminary. Patients were significantly more likely to overestimate physician respect as BMI increased, which was not accounted for by increased respectful treatment by the physician. PRACTICE IMPLICATIONS Among patients who overestimate physician respect, the authenticity of the patient-physician relationship should be questioned.
Collapse
Affiliation(s)
- Kimberly A Gudzune
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore 21287, USA.
| | | | | | | |
Collapse
|
144
|
The association between body mass index, processes of care, and outcomes from mechanical ventilation: a prospective cohort study. Crit Care Med 2012; 40:1456-63. [PMID: 22430246 DOI: 10.1097/ccm.0b013e31823e9a80] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the association between excess weight and processes of care and outcomes for critically ill adults. DESIGN Prospective cohort study. SETTING Three medical intensive care units at two hospitals. PATIENTS Five hundred eighty mechanically ventilated adult patients admitted between February 1, 2006 and January 31, 2008. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS After adjusting weight based on the recorded fluid balance before enrollment, 21.9% of subjects were categorized into different body mass index categories than without this adjustment. We used a competing risk analysis with events of interest considered death during hospitalization and successful liberation from mechanical ventilation. We found no statistically significant difference between body mass index categories (<25 kg/m² vs. 25 to <30 kg/m² vs. ≥30 kg/m²) in the competing risks analyses when the results were unadjusted or adjusted for severity of illness and comorbidities. When the analyses were adjusted for the use of continuous infusions of opioids and/or sedatives and ventilator parameters (tidal volume per ideal body weight, positive end-expiratory pressure, and airway pressure), subjects with an overweight fluid-balance-adjusted body mass index had significantly lower hazard ratios for dying while hospitalized (adjusted hazard ratio 0.68 [95% confidence interval 0.47-0.99], p=.044), and those with an obese fluid-adjusted body mass index had significantly higher hazard ratios for successful extubation (adjusted hazard ratio 1.53 [95% confidence interval 1.14-2.06], p=.005). An analysis of longer-term mortality found lower adjusted hazard ratios for subjects with overweight (adjusted hazard ratio 0.74 [95% confidence interval 0.56-0.96]) and obese (adjusted hazard ratio 0.74 [95% confidence interval 0.59-0.94]) fluid-balance-adjusted body mass indices. CONCLUSIONS Processes of provided care may affect the observed association between excess weight and outcomes for critically ill adults and should be considered when making inferences about observed results. It is unknown if disparities in processes of care are due to clinically justified reasons for variation, bias against heavier patients, or other reasons.
Collapse
|
145
|
Stone O, Werner P. Israeli dietitians' professional stigma attached to obese patients. QUALITATIVE HEALTH RESEARCH 2012; 22:768-776. [PMID: 22218267 DOI: 10.1177/1049732311431942] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The aim of this study was to explore and define the different dimensions of professional stigma attached to obese patients by dietitians. Four focus groups were conducted with 23 Israeli dietitians. Findings showed that while treating obese patients, dietitians underwent a stigmatization process involving cognitive, emotional, and behavioral phases. Obese patients with an internal locus of control, who took responsibility for their failure to diet, triggered positive feelings (e.g., pity and empathy), whereas obese patients with an external locus of control, who blamed others for their failure, triggered negative feelings (e.g., anger and frustration). Participants' emotional rejection of obese patients was manifested in three behavioral dimensions: instrumental avoidance (e.g., shorter sessions); professional avoidance (e.g., less energy and effort); and interpersonal avoidance (negative tone and evasive verbal and body language). Continuing education for dietitians is recommended to assist them in dealing with their negative feelings and behaviors toward resistant obese patients.
Collapse
Affiliation(s)
- Osnat Stone
- Maccabi Healthcare Services, Tel Aviv, Israel
| | | |
Collapse
|
146
|
Beliefs and practices of healthcare providers regarding obesity: a systematic review. Rev Assoc Med Bras (1992) 2012. [DOI: 10.1016/s0104-4230(12)70189-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
147
|
Valente Teixeira F, Luis Pais-Ribeiro J, da Costa Maia ÂRP. Crenças e práticas dos profissionais de saúde face à obesidade: uma revisão sistemática. Rev Assoc Med Bras (1992) 2012. [DOI: 10.1590/s0104-42302012000200024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
148
|
Major B, Eliezer D, Rieck H. The Psychological Weight of Weight Stigma. SOCIAL PSYCHOLOGICAL AND PERSONALITY SCIENCE 2012. [DOI: 10.1177/1948550611434400] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The authors theorized that overweight individuals experience social identity threat in situations that activate concerns about weight stigma, causing them to experience increased stress and reduced self-control. To test these predictions, women who varied in body mass index (BMI) gave a speech on why they would make a good dating partner. Half thought they were videotaped (weight visible); the remainder thought they were audiotaped (weight not visible). As predicted, higher BMI was associated with increased blood pressure and poorer performance on a measure of executive control when weight was visible and concerns about stigma were activated but not when weight was not visible. Compared to average weight women, overweight women also reported more stress-related emotions when videotaped versus audiotaped. Findings suggest that weight stigma can be detrimental to mental and physical health and deplete self-regulatory resources necessary for weight control.
Collapse
Affiliation(s)
- Brenda Major
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, CA, USA
| | - Dina Eliezer
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, CA, USA
| | - Heather Rieck
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, CA, USA
| |
Collapse
|
149
|
The influence of the stigma of obesity on H1N1 influenza vaccine sequencing in Canada in 2009. Vaccine 2011; 29:9607-10. [DOI: 10.1016/j.vaccine.2011.10.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 10/12/2011] [Accepted: 10/18/2011] [Indexed: 11/16/2022]
|
150
|
Ailshire JA, House JS. The Unequal Burden of Weight Gain: An Intersectional Approach to Understanding Social Disparities in BMI Trajectories from 1986 to 2001/2002. SOCIAL FORCES; A SCIENTIFIC MEDIUM OF SOCIAL STUDY AND INTERPRETATION 2011; 90:397-423. [PMID: 23413316 PMCID: PMC3570259 DOI: 10.1093/sf/sor001] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The implications of recent weight gain trends for widening social disparities in body weight in the United States are unclear. Using an intersectional approach to studying inequality, and the longitudinal and nationally representative American's Changing Lives study (19862001/2002), we examine social disparities in body mass index trajectories during a time of rapid weight gain in the United States. Results reveal complex interactive effects of gender, race, socioeconomic position and age, and provide evidence for increasing social disparities, particularly among younger adults. Most notably, among individuals who aged from 25-39 to 45-54 during the study interval, low-educated and low-income black women experienced the greatest increase in BMI, while high-educated and high-income white men experienced the least BMI growth. These new findings highlight the importance of investigating changing disparities in weight intersectionally, using multiple dimensions of inequality as well as age, and also presage increasing BMI disparities in the U.S. adult population.
Collapse
|