Monina Distor-Castro, DNP, RN, MSN, CBN, FNP-BC

Abstract:

Background: Weight stigma is pervasive in healthcare, and it discourages patients from seeking medical care, exacerbating health conditions among patients with obesity. Primary care physicians (PCPs) assess, discuss, and refer patients with obesity to weight management programs (WMP) when these are discussed during office visits. The challenge is initiating the discussion on weight interventions without patients feeling stigmatized. As the first point of contact in screening patients, this project utilizes the primary care staff (PCS: nurses and medical assistants) to provide opportunities for patients to discuss WMPs with their PCPs. Objectives: This quasi-experimental project aimed to educate PCSs about obesity stigma, mitigate it, and integrate weight assessments and WMP referrals during office visits with the patients’ PCPs. Implementation: The project compared two primary care clinics within a health maintenance organization (HMO). In the intervention clinic, 40 PCS received a 50-minute Obesity Sensitivity Training (OST) and pre-and 12 weeks post-Fat Attitude Assessment Toolkit (FAAT) with subscales on empathy, critical health, and complexity. The comparison clinic did not receive OST or FAAT. Data on WMP referrals were collected from both intervention and comparison clinics. Analysis: A one-sided paired t-test was used to analyze the means of pre- and post-intervention FAAT scores. For the second outcome, patient referrals from physicians from both clinics were collected, and ratios and chi-square analysis were calculated. Outcomes: The PCS in the intervention clinic had statistical significance in the empathy and critical health subscales (p-value .038 and .046, respectively) but not in the general complexity subscale (p-value =0.15). Referral to PCP ratio from the intervention clinic was 17.85 versus the comparison clinic 10.2; the chi-square statistic is 3.9467 with a p-value of 0.046964, significant at p<0.05. Conclusion: Primary care clinic visits are opportunities to address obesity and its related health risks and appropriate interventions. This project's outcomes highlighted the need to educate and involve the PCS in mitigating obesity stigma to help utilize the available WMP within the HMO. Future projects should explore patient-centered outcomes of WMP referrals in relation to OST.

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