Weight Bias and Psychosocial Implications for Acute Care of Patients With Obesity

Examining weight bias attitudes and obesity beliefs among undergraduate students

Objective: This cross-sectional study examined the weight bias attitudes and obesity beliefs of health science (HS), nursing, and pre-medicine undergraduate students. Methods: Using snowballing and convenience sampling strategies, students (N = 139) completed an online survey, including a 24-item Antifat Attitudes Scale (AFAS) and eight-item Belief About Obese Persons (BAOP) scale. Results: HS students have higher weight bias than nursing and pre-medicine students combined (M = 43.45, SD = 10.75), t(137) = -2.45, p = .016). A negative correlation exists between AFAS and BAOP suggesting high weight bias influences a belief that obesity is controllable. Gender positively predicted weight bias attitudes (ß = -11.43, t = -4.33, p < .001) and obesity beliefs (ß = 3.75, t = 3.01, p = . 003). Conclusions: Findings confirm that HS students have weight bias attitudes. This supports undergraduate curricular changes on obesity etiology that may improve treatment plans of individuals who are obese.

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).

Good Things Don't Always Come in Small Packages: Comprehensive Care of Patients With Class 3 Obesity: An Integrative Review

The epidemic of obesity and morbid obesity is straining the American health care system's ability to provide quality patient care. Patients with Class 3 (also referred to as morbid or severe) obesity require specialized equipment, unique approaches in the delivery of care, and understanding of the biopsychosocial pathophysiologic mechanisms underlying their condition. This article defines Class 3 obesity, its pathophysiology, and discusses issues that arise when providing quality care of these individuals including safe patient handling, right-sized equipment, and empathetic interpersonal care. We also discuss skin and wound care issues associated with Class 3 obesity.

Patient and provider knowledge of and attitudes toward medical conditions and medication during pregnancy

BACKGROUND

Knowledge of medical conditions and their evidence-based medications varies among individuals. This range of knowledge may affect attitudes and influence medical decision-making of both patients and providers. Perceptions may be even more impactful in pregnancy, a timeframe subject to bias, and in diseases that include behavioral symptoms and often carry significant societal stigma, such as opioid use disorder (OUD). We present our findings from a survey assessing participants' knowledge of three distinct medical conditions (diabetes mellitus, bipolar disorder, and OUD) and how this knowledge affects perceptions of these disease states during pregnancy.

METHODS

Using existing surveys in the literature as a guideline, we designed a cross-sectional survey including multiple-choice questions to evaluate our hypothesis that less knowledge about a medical condition would result in more negative opinions towards that condition and its treatment throughout pregnancy. Participants responded to perception statements using a 5-point Likert scale (1 = "strongly disagree," 5 = "strongly agree"). Surveys were administered to patients in prenatal care, patients in OUD treatment, medical students, and medical residents within a single institution. Response means were generated and compared using t tests and ANOVA.

RESULTS

A total of 323 participants completed the survey. There were differences in knowledge between respondent groups and by disease state, with prenatal patients having the least knowledge of all groups about OUD diagnosis (88.5% of prenatal patients answered correctly) and its treatment (91.8% answered correctly). Overall Likert means of all responses demonstrated that participants agreed that new mothers with OUD (mean 4.27, 5 = "strongly agree") and their babies (4.12) would have challenges that others would not, compared to mothers with bipolar disorder (4.03) and their babies (3.60) as well as mothers with diabetes (3.87) and their babies (3.47), p < .001. Overall, respondents were likely to agree that women with OUD should not try to get pregnant (3.47), whereas they overall disagreed with that statement when it pertained to women with bipolar disorder (2.69, 2 = "disagree") or diabetes (2.12), p = 0.03.

CONCLUSIONS

With this single-center study, we found that, though there were gaps in knowledge regarding disease and disease treatment during pregnancy, less knowledge was not associated with more negative perceptions of disease and disease treatment during pregnancy. Perceptions were especially negative toward pregnant women with OUD. Increasing awareness of lived experiences of patients with disease, as well as the biases carried by both patients and providers, could improve treatment of chronic diseases and outcomes for patients.

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.