Nurses' Weight Bias in Caring for Obese Patients: Do Weight Controllability Beliefs Influence the Provision of Care to Obese Patients?

Hospital-acquired pressure injury prevention in people with a BMI of 30.0 or higher: A scoping review

AIM(S)

To: (1) explore current best practices for hospital-acquired pressure injury prevention in high BMI patients; (2) summarize nurses' experiences in preventing and managing them; (3) explore the association between a high BMI and occurrence and severity of pressure injury.

DESIGN

Exploratory.

METHODS

Scoping review.

DATA SOURCES

Ovid MEDLINE, EBSCO CINAHL Plus, JBI Evidence Synthesis, Scopus, Embase, clinical registries and grey literature (search dates: January 2009 to May 2021).

RESULTS

Overall, 1479 studies were screened. The included studies were published between 2010 and 2022. Five interventional studies and 32 best practice recommendations (Objective 1) reported low-quality evidence. Findings of thematic analysis reported in nine studies (Objective 2) identified nurses' issues as insufficient bariatric equipment, inadequate staffing, weight bias, fatigue, obese-related terminology issues, ethical dilemmas and insufficient staff education in high BMI patients' pressure injury prevention. No association between hospital-acquired pressure injury occurrence and high BMI were reported by 18 out of 28 included studies (Objective 3).

CONCLUSION

Quality of evidence was low for the interventional studies and best practice recommendations.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Current (2019) International Pressure Injury Guideline to be used despite the low quality of evidence of most best practice recommendations.

IMPACT STATEMENT

This study addressed hospital-acquired pressure injury prevention in high BMI patients. Greater proportion of studies in this review found no association between high BMI and occurrence of hospital-acquired pressure injury. Nurses need educational interventions on pressure injury prevention in high body mass index people, sufficient staffing for repositioning and improved availability of bariatric equipment.

REPORTING METHOD

We adhered to relevant EQUATOR guidelines, PRISMA extension for scoping reviews.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Larger clinical trials are needed on repositioning frequency, support surfaces, prophylactic dressings and risk assessment tools to inform clinical practice guidelines on pressure injury prevention in high BMI people.

PROTOCOL REGISTRATION

Wound Practice and Research (https://doi.org/10.33235/wpr.29.3.133-139).

The lived experiences of patients with severe obesity during hospital admissions in Norway: A phenomenological hermeneutic study

AIM

To explore the lived experiences of patients with severe obesity during hospital admissions.

DESIGN

Qualitative study design.

METHODS

Semi-structured individual interviews with 14 participants with severe obesity from Norway were conducted between May and October 2021. A qualitative phenomenological hermeneutical approach inspired by Paul Riceour was used to analyse the data.

RESULTS

The following three themes were identified through the analysis of the lived experiences of patients with severe obesity during hospital admissions: blaming my weight, being prejudged and feeling different. The participants shared various emotional experiences of encounters with healthcare professionals at hospitals. They struggled to be recognized and welcomed like everyone else and found it difficult to be judged by someone who did not know them. The various experiences resulted in a vicious circle, ultimately leading to a fear of future hospitalization.

CONCLUSION

Being a patient with obesity in a hospital setting can present various challenges, leading to feelings of shame and guilt. Experiences of stigma may not necessarily be related to the overall hospital context but rather to encounters with healthcare professionals who may be unfamiliar with the patient's history, which can lead to stigmatizing behaviours.

IMPACT

Understanding how patients with severe obesity experience their hospital admissions and the importance of familiarizing themselves with the individual patients to avoid stigmatizing behaviours is important for healthcare professionals caring for obese patients.

REPORTING METHOD

Consolidated Criteria for Reporting Qualitative Research.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

IMPACT STATEMENT

Patients with obesity often encounter stigmatization and negative attitudes from healthcare professionals, particularly in primary care settings. Patients with severe obesity experienced various challenging encounters with healthcare professionals during hospital admissions, resulting in a vicious circle, ultimately leading to a fear of future hospitalization. It is crucial for healthcare professionals involved in the care of patients with obesity to acquaint themselves with individual patients to prevent stigmatizing behaviours.

Weight stigma in healthcare settings: the experience of Arab and Jewish bariatric surgery candidates in Israel

BACKGROUND

Weight-related stigma and discrimination are prevalent in our society with adverse biopsychosocial outcomes to people with obesity and morbid obesity. Studies suggest that weight bias in healthcare settings are quite prevalent, but there have been, as far as we know, lack of studies examining prevalence and correlates of weight bias experiences among bariatric surgery candidates in Israel. We aim to understand the nature and prevalence of weight stigma among bariatric surgery candidates. To identify differences between Jewish and Arab candidates. To examine the impact of weight stigma experiences on weight bias internalization (WBI).

METHODS

A cross-sectional study was performed among 117 adult bariatric surgery candidates from three hospitals in northern Israel (47.8% Jews, 82.4% females, average BMI 42.4 ± 5.2 Kg/meter2). Patients who agreed to participate completed a structured questionnaire on the same day that the bariatric surgery committee met. WBI was measured using a validated 10-item scale. Experiences of weight stigma were measured using items adapted from prior international studies.

RESULTS

About two thirds of the participants had at least one experience of weight stigma (teased, treated unfairly, or discriminated against because of their weight). As many as 75% of participants reported that weight served as a barrier to getting appropriate health care and as many as half of participants felt in the last year that a doctor judged them because of their weight. No significant differences were found between Arabs and Jews in the prevalence of weight stigma experiences and WBI. However, a trend towards more stigma experiences among Jews was noted. WBI was predicted by female gender and experiences of weight stigma, both in general and within healthcare settings.

CONCLUSIONS

Weight stigma towards bariatric surgery candidates in Israel is quite prevalent, and specifically in healthcare settings. It is important to adopt policy actions and intervention programs to improve awareness to this phenomenon among the general public and specifically among healthcare providers, as many healthcare providers may be unaware of the adverse effect of weight stigma and of ways in which they are contributing to the problem. Future studies may validate our findings using larger sample size and longitudinal design.

The perceptions of healthcare practitioners on obesity management in Peninsular Malaysia: a cross-sectional survey

BACKGROUND

Practitioners' perceptions of patients with obesity and obesity management shape their engagement in obesity care delivery. This study aims to describe practitioners' perceptions, experiences and needs in managing patients with obesity, determine the extent of weight stigma among health practitioners, and identify the factors associated with negative judgment towards patients with obesity.

METHODS

A cross-sectional online survey was conducted from May to August 2022 with health practitioners commonly involved in obesity management in Peninsular Malaysia, including doctors in primary care, internal medicine and bariatric surgery, and allied health practitioners. The survey explored practitioners' perceptions, barriers and needs in managing obesity, and evaluated weight stigma using the Universal Measures of Bias - Fat (UMB Fat) questionnaire. Multiple linear regression analysis was used to identify demographic and clinical-related factors associated with higher negative judgment towards patients with obesity.

RESULTS

A total of 209 participants completed the survey (completion rate of 55.4%). The majority (n = 196, 94.3%) agreed that obesity is a chronic disease, perceived a responsibility to provide care (n = 176, 84.2%) and were motivated to help patients to lose weight (n = 160, 76.6%). However, only 22% (n = 46) thought their patients were motivated to lose weight. The most frequently reported barriers to obesity discussions were short consultation time, patients' lack of motivation, and having other, more important, concerns to discuss. Practitioners needed support with access to multi-disciplinary care, advanced obesity training, financing, comprehensive obesity management guidelines and access to obesity medications. The mean (SD) of the UMB Fat summary score was 2.99 (0.87), with the mean (SD) domain scores ranging between 2.21 and 4.36 (1.06 to 1.45). No demographic and clinical-related factors were significantly associated with negative judgment from the multiple linear regression analyses.

CONCLUSION

Practitioners in this study considered obesity a chronic disease. While they had the motivation and capacity to engage in obesity management, physical and social opportunities were the reasons for not discussing obesity with their patients. Practitioners needed more support to enhance their capability and opportunity to engage with obesity management. Weight stigma in healthcare settings in Malaysia should be addressed, given the possibility of hindering weight discussions with patients.

Development of Trigger Films to Explore Nursing Students' Attitudes Toward Patients with Obesity

Introduction

Given the increased prevalence of obesity and the existence of negative attitudes among health care providers toward patients with obesity (PWO), strategies are needed to assist nursing students in identifying and examining attitudes and beliefs related to the provision of care for individuals with obesity. Nursing school curricula should incorporate effective interventions for students in order to reduce stigmas and to modify negative attitudes and behaviors that interfere with quality nursing care for PWO. This article describes the process of developing and implementing an innovative bariatric sensitivity intervention (BSI) for prelicensure nursing students.

Methods

The BSI includes six trigger films that address the multi-faceted aspects of caring for PWO and provoke reflection on obesity-related attitudes and beliefs, as well as a facilitated debrief.

Conclusion

We discuss the practical aspects of video production and the successful use of multimedia instruction to affect prelicensure nursing students' behaviors.

Effects of weight bias training on student nurse empathy: A quasiexperimental study

AIM

This study aimed to identify the efficacy of weight bias training on the empathy skills of student nurses when working with a person with obesity.

BACKGROUND

Weight bias with nurses harboring negative attitudes towards patients with obesity results in inferior care and patients' reluctance to seek medical care. Empathy is a communication skill used in nursing to build trust and rapport with patients to provide optimal patient-centered care.

METHODS

This study used a quasi-experimental design with 121 undergraduate nursing students in their first semester of the nursing program. The students completed learning activities on weight bias, including reading an article on weight bias, watching a video showing an individual with obesity's experiences in the healthcare setting and participating in a group discussion and reflection on the article and video. In addition, students completed the Jefferson Scale of Empathy-Health Professions Students' version before and after the learning activities. Following the learning activities, students participated in a simulation activity with a standardized patient wearing an obesity suit. The standardized patient completed the Jefferson Scale of Patient Perceptions of Nurse Empathy to rate the patient's perception of the nursing student's level of empathy based on their interactions in the simulation scenario.

RESULTS

A comparison of the scores on the Jefferson Scale of Empathy-HPS showed there was not a significant difference in the scores before learning activities (M = 15.45, SD = 12.7) and post-learning activities (M = 15.94, SD = 11.5); t(120) = 0.476, p = .635. Data analysis identified significant changes in empathy scores on the Jefferson Scale of Empathy-HPS in the accelerated second-degree cohort with differences in scores before learning activities (M = 113.7, SD = 10.5) and post-learning activities (M = 116.5, SD = 13.4); t(50) = 2.02, p = .049. The traditional cohort did not have a significant change in empathy scores. Empathy scores and the patient's perception of empathy scores showed no relationship. Most (79 %) of the patient's perception of empathy scores was moderate. Student comments in this study support the findings that some nursing students harbor weight bias towards individuals with obesity.

CONCLUSION

There is a need to identify learning activities that eliminate weight bias in the nursing student population and result in the student's ability to demonstrate appropriate communication skills and nursing behaviors in a nondiscriminatory manner to the patient with obesity. To improve empathy behaviors, students should practice communication skills throughout the nursing curriculum.

Anti-fat attitudes of Nutrition undergraduates in Brazil toward individuals with obesity

Abstract Obesity-related prejudice and discrimination may have a source in health professionals and students. The objective was to assess anti-fat attitudes among Brazilian nutrition undergraduates who reported demographic data, weight, height and responded the Antifat Attitudes Test (AFAT) and the Brazilian Silhouette Scales to assess body image satisfaction and perception. Total and subscales of AFAT scores were compared among categories using the Mann-Whitney U test. Associations of participants’ characteristics with the AFAT were analyzed using multiple linear regression. Total AFAT score was positively associated with male sex (ß: .13; p < .001), age (ß: .06; p < .001), educational institution outside capital (ß: .03; p < .05), private institutions (ß: .08; p < .001); and negatively associated with income (ß: -.05; p = .006), participants who perceived themselves with increased BMI (ß: -.15; p < .001) and those at the third year of course (ß: -.05; p = .041). Subscales scores were positively associated with male sex and age; and negatively associated with those who perceived themselves heavier. They have anti-fat attitudes especially if they were man, older, from private institutions, are at the beginning of the course, and have lower household income - and less weight bias if they perceived with increased BMI.

The roles of experienced and internalized weight stigma in healthcare experiences: Perspectives of adults engaged in weight management across six countries

BACKGROUND/OBJECTIVES

Considerable evidence from U.S. studies suggests that weight stigma is consequential for patient-provider interactions and healthcare for people with high body weight. Despite international calls for efforts to reduce weight stigma in the medical community, cross-country research is lacking in this field. This study provides the first multinational investigation of associations between weight stigma and healthcare experiences across six Western countries.

METHODS

Participants were 13,996 adults residing in Australia, Canada, France, Germany, the UK, and the US who were actively enrolled in an internationally available behavioral weight management program. Participants completed identical online surveys in the dominant language for their country that assessed experienced weight stigma, internalized weight bias, and healthcare behaviors and experiences including perceived quality of care, avoidance or delay of seeking care, experiences with providers, and perceived weight stigma from doctors.

RESULTS

Among participants who reported a history of weight stigma (56-61%), two-thirds of participants in each country reported experiencing weight stigma from doctors. Across all six countries, after accounting for demographics, BMI, and experienced stigma, participants with higher internalized weight bias reported greater healthcare avoidance, increased perceived judgment from doctors due to body weight, lower frequency of obtaining routine checkups, less frequent listening and respect from providers, and lower quality of healthcare. Additionally, experienced weight stigma (from any source) was indirectly associated with poorer healthcare experiences through weight bias internalization, consistently across the six countries.

CONCLUSIONS

Weight stigma in healthcare is prevalent among adults actively engaged in weight management across different Western countries, and internalized weight bias has negative implications for healthcare even after controlling for BMI. The similar findings across all six countries underscore the negative consequences of weight stigma on healthcare behaviors and experiences, and emphasize the need for collective international efforts to address this problem.

Changes in anti-fat attitudes among undergraduate nursing students

BACKGROUND

The number of people with obesity has been increasing significantly in recent decades. Nursing students play a role in the care of obese patients, but the presence of a stigma regarding this patient group reduces the quality of care due to a climate of mistrust and lack of expectations.

OBJECTIVES

To analyse if the anti-fat attitudes of nursing students at the Faculty of Nursing, Physiotherapy and Podiatry at Universidad de Sevilla (Spain) change during their degree training.

DESIGN

A cross-sectional study was carried out.

SETTINGS

Undergraduate nursing institution in Spain.

PARTICIPANTS

578 nursing students enrolled at the Faculty in all academic years, from the first through the fourth.

METHODS

Following ethical approval, each participant took part in an individual self-report via the Anti-Fat Attitudes (AFA) Questionnaire, in its validated Spanish version.

RESULTS

The mean standardised AFA total was 2.29.; by domains: 1.29 in Dislike, 2.87 in Fear of fat, and 3.73 in Willpower. Analysis of variance tests showed significant differences in the AFA total score and domains by sex and academic year. Multiple linear regression analysis demonstrated that the highest prejudices were shown by enrolled participants in their first year, particularly when the AFA total score was considered.

CONCLUSIONS

Nursing students at the Faculty do not have many prejudices towards obese people. Anti-obesity attitudes among nursing students decrease as the students progress in their degree, implying that the specific training received (degree curriculum) also enables students to develop their non-technical skills.

Clinical Leadership and Management Perceptions of Inpatients with Obesity: An Interpretative Phenomenological Analysis

While obesity is recognized as a key global public health issue, there has been no research to date on the perceptions of care for people with this condition held by individuals in positions of organizational power. The aim of this study was therefore to describe the perceptions and experiences of clinical leaders and managers of providing care to inpatients with obesity at a metropolitan public health service. This study applied an interpretative phenomenological analysis (IPA) approach to qualitative research, conducting interviews with 17 participants. Their perceptions of care for inpatients with obesity encompassed both their personal understanding as an individual, and their observations about the organizational, patient and carer perspectives. Three overall themes were identified: (1) the problem of inpatients with obesity, (2) inpatients with obesity as sources of risk and (3) personal and professional perceptions of inpatients with obesity. While clinical leaders and managers were aware of the potential impact of stigma and weight bias on care given to this cohort, elements of implicit bias, stereotyping, "othering" and ambivalence were frequently present in the data. Ongoing efforts to improve care for patients with obesity must therefore include efforts to address perceptions and attitudes at all organisational levels of the workforce.

Concept of overweight bias among healthcare professionals: An evolutionary concept analysis

The aim of this concept analysis was to identify the attributes of overweight bias among healthcare providers (HCPs) and create a clear definition to guide the recognition of overweight bias among HCPs. Settings within the healthcare system are not exempt from bias and the stigmatization of persons with obesity. Overweight bias among HCPs may negatively impact health care and health outcomes. Rodger's evolutionary method was used to guide this concept analysis. The databases CINAHL Plus with Full Text, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, MEDLINE, and PsycINFO were searched. The analysis provided clarification of the concept to facilitate HCP self-awareness of overweight bias. A definition of the concept of overweight bias among HCPs is provided along with its attributes, antecedents, and consequences.

NP student encounters with obesity bias in clinical practice

This study explores NP students' encounters with obesity stigma and bias in their clinical environment as well as recommendations to decrease obesity stigma and bias. Results indicate a need for continued education on the topic of weight management within NP curricula.

The Incomplete Medicalization of Obesity: Physician Office Visits, Diagnoses, and Treatments, 1996-2014

OBJECTIVES

Despite increased awareness of obesity-related health risks and myriad treatment options, obesity still affects more than one-third of persons in the United States and is a substantial public health problem. Studies show that physicians play a key role in obesity prevention and treatment. The objective of this study was to examine the extent to which obesity is diagnosed and treated at the level of patient-physician interaction.

METHODS

We used data from the National Ambulatory Medical Care Survey (NAMCS), a nationally representative data set of US physician office visits. We estimated the number of obesity diagnoses and prescriptions of weight-loss management solutions (exercise counseling, diet counseling, or weight-loss drugs) in clinical practice from 1996 through 2014. We also calculated rates of obesity diagnosis and compared these rates with national rates of obesity based on body mass index data from the Behavioral Risk Factor Surveillance System (BRFSS) for the same period.

RESULTS

The estimated number of weight gain-related physician office visits increased from 2.3 million in 1996 to a peak of 7.6 million in 2012, and then fell to 4.5 million in 2014. National estimates of obesity diagnoses resulting from physician office visits ranged from 7.1 million in 1996 to 12.7 million in 2014 and substantially outnumbered the estimates for weight gain-related physician office visits throughout the study period. Estimates of exercise counseling and diet counseling and weight-loss medication prescriptions resulting from physician office visits fluctuated over time but never exceeded obesity diagnoses. When compared with national rates of obesity from the BRFSS, rates of obesity diagnoses resulting from physician office visits were substantially lower in the NAMCS (17%-30% vs 1%). National trends for weight-loss medication prescriptions closely mirrored those of weight gain-related physician office visits, even though fluctuations were substantial.

CONCLUSIONS

Our results suggest that obesity is largely underdiagnosed and undertreated in clinical encounters. Future studies should investigate the structural changes needed to better engage physicians in obesity prevention and care. Practitioners should also reflect on their biases in treating obesity as a chronic disease.

Do exerciser weight status and perceived motivation predict instructors' motivation and beliefs about the exerciser? A test of motivation contagion effects

We examined how fitness professionals' perceptions of a hypothetical exerciser's motivation and weight status impacted the professionals' motivation to instruct, perceived effectiveness of different interpersonal behaviors toward the exerciser, and beliefs about the exerciser's efficacy to overcome barriers to exercise. Results of a 2 (autonomous vs. controlled exerciser motivation) x 2 (normal weight vs. overweight exerciser) between-subjects experimental design showed that fitness professionals (N = 134) were more autonomously motivated to instruct, perceived autonomy-supportive behaviors as more effective, and had stronger beliefs regarding the exerciser's efficacy when the exerciser was portrayed as having autonomous motivation, compared to controlled motivation. Fitness professionals reported higher levels of controlled motivation to instruct and perceived controlling behaviors as more effective when presented with the overweight exerciser, compared to the normal weight exerciser. Our findings suggest that perceptions of exercisers' motivation and body weight can influence fitness professionals' interactions with and beliefs about their clients.