sedentary behavior.22-24 Research suggests that providers may attribute obesity to behavioral factors rather than other uncontrollable factors, 25-27 which can exacerbate weight bias in health care. However, becoming aware of the complex and uncontrollable factors contributing to obesity – such as biology, genetics, and the environment – can help mitigate weight bias.28-30 Furthermore, by sharing information about the complexity of obesity with patients, providers can help patients with obesity in their weight management efforts. 23 Personal lifestyle behaviors reflect only one contributing factor for weight and health. o Low access to affordable healthy foods o Medications causing weight gain o Sleep deprivation o Marketing of unhealthy foods o Metabolic and endocrine dysfunctions o Genetics o Age Causal Beliefs about Obesity: Lack of self-discipline Poor eating/activity Biological, genetic, environmental causes More stereotyping & stigma - Greater understanding of complex etiology - Reduced stigma Among patients with obesity: - Reduced self-blame - Increased self-efficacy for weight loss 8 Fat Heavy Large size Weight problem Morbidly obese Weight bias can occur in multiple forms and from different health professionals, and can be expressed in both subtle and overt ways. Here are some examples: Provider Attitudes and Comments from Providers Language · Insensitive language about excess body weight (e.g., referring to a patient as “fat”) · Expressing insensitive jokes that place individuals with obesity as the target of humor or ridicule Part 1: How is Weight Bias Expressed in Health Care? Weight bias can be expressed as… · Negative weight-based assumptions (e.g., that obesity is an issue of selfdiscipline) · Stereotypes about individuals with obesity (e.g., lazy, lacking willpower) · Judgments that patients with obesity are non-compliant with treatment 9 Medical Equipment · Medical equipment that is too small to be functional for patients with obesity (e.g., patient gowns, examination tables, blood pressure cuffs, speculum, and scales) Part 1: How is Weight Bias Expressed in Health Care? Weighing Procedures · Being weighed is a sensitive experience for many patients with overweight and obesity. Some patients may even avoid medical care because they do not want to be weighed. · Making negative comments or facial gestures while weighing their patients, which leads to embarrassment and shame. 10 Part 1: How is Weight Bias Expressed in Health Care? · Medical examination and waiting rooms can be unwelcoming to patients with obesity. · Common reasons include negative attitudes by office staff, waiting room chairs that are too small, and reading materials that stigmatize weight. Office Environment · Providers may incorrectly assume that patients with obesity have lower motivation for health behavior changes, poorer treatment compliance, and poorer adherence to medications, compared to thinner patients. · Consequently, providers may spend less time in appointments educating patients, and avoid discussions about weight-related health. Health Services and Care A study evaluated 255 physicians on their attitudes about patients with obesity and obesity management.1 Research Highlight Treatment for obesity is ineffective % of physicians reporting agreement Patients are unlikely to be succeed in losing weight Physicians’ attitudes Patients lack discipline to lose weight Patients are not motivated to lose weight 51% 34% 78% 52% 11 Additionally, as patients’ BMI increases, physicians report,17,36 Less patience Less desire to help the patient Less respect for patients Greater perception of patient as a waste of time Less compliant - Less motivated - - Less disciplined - Less adherent to medications - Less trustworthy - More annoying Most commonly reported by physicians to be their frustrations for treating patients with obesity Part 1: Physicians Studies show that physicians hold negative attitudes and stereotypes about patients with obesity and view them as,1,8,15,16,18,20,31-35 “I became very frustrated when a doctor disregarded what I was telling him because he had already made up his mind that obesity was at the root of all my problems.” - Patient reporting weight bias 12 Research Highlight A national sample of nearly 2,500 patients with obesity were asked about their physicians’ obesity care practices.42 o About received a diagnosis for obesity o About received counseling for weight reduction, diet, or exercise Although patients with obesity frequently identify their primary care provider as their source of information for weight management, research demonstrates that physicians’ attitudes may influence the quality of care for these patients. Part 1: Physicians’ Weight Management Practices For instance, studies indicate that providers may,37-41 · Fail to document obesity in patients’ charts · Avoid discussions about weight loss · Spend less time providing health education · Underutilize practices that promote lifestyle changes (e.g., referrals to nutritionists) 13 Part 1: Consequences for Patient-Provider Relationships In addition to weight management practices, weight bias can have negative implications for the quality of patient-provider relationships. Research Highlight A 2014 national study of 600 U.S. adults with overweight and obesity examined the influence of perceiving weight-related judgment from