participants who were assigned physicians with with normal weight, adults assigned physicians with overweight or obesity felt, - Less trust for physicians - Less willing to follow medical advice - More inclined to change providers Findings were significant regardless of patients’ own body weight 19 vz General issues of weight bias and patient discomfort can be intensified in the OBGYN setting. In response to such stigmatization, women with obesity and overweight report avoiding or even cancelling routine gynecological exams, pap smears, and mammography.78-82 Particularly, given the risks associated with obesity in pregnancy and greater concern for mental health during this period,83,84 providers need to be particularly cognizant of weight stigma and its negative impact on quality of care for pregnant women. Part 1: Special Consideration: OBGYN Practices Studies have documented weight bias from maternity care providers towards pregnant women with obesity, including85,86 - Assuming patients’ lack of motivation for weight management - Feeling repulsed by patients - Delivering poor quality of post-natal care for patients - Providing inadequate health education about gestational weight gain, exercise, and diet during pregnancy - “He [obstetrician] used to have me in tears - every time I'd go and see him, he'd tell me I was putting on too much weight, and he would literally shout at me. I don't smoke, I've never drunk throughout; it was the only thing that I was doing wrong, and he used to have me in tears.”87 - Sally Woman sharing experience of maternity care 20 Part 1: Research indicates significant levels of weight bias even among health providers specializing in obesity care.14 For example, specialists report perceiving individuals with obesity as lazy, stupid, and worthless. Patients seeking weight loss surgery often report differential treatment in medical settings based on their weight.88,89 In one study of adults with obesity seeking weight loss surgery, reported receiving inappropriate comments about their weight from their doctors.89 These findings highlight the need to educate and train health professionals to provide stigma-free care in their pre- and post-operative care. Increased awareness of and competency to address lingering stigma after surgery can also help professionals to support patients adjust to the physical, emotional, and even social changes following surgery. Special Consideration: Bariatric Surgery Furthermore, recent students have documented that having any history of obesity and the method of weight loss (lifestyle changes vs surgery) are important factors contributing to weight stigmatization of individuals who have successful lost weight. 87,90-92 If you could… Weight bias leads to negative psychological, social, economic, and physical health consequences for individuals with obesity, and can also have an impact on health care utilization. Part 2: Impact of Weight Bias on Patients The section will review the scientific evidence regarding the impact of weight bias on the behavior, life outcomes, emotional and physical health of individuals with obesity. 2 Part 2: Consequences for Health Care Utilization Research shows that weight bias in health care is a barrier for health care utilization. Compared to women of lower body weight, women with obesity are,1-7 According to research, 2,4,8-10 some women with obesity delay preventive health services because of, Less likely More likely to seek routine preventive health services and cancer screenings to cancel and delay appointments to report lower quality of received care 1. Previous experiences of feeling disrespected from providers 2. Embarrassment of being weighed 3. Negative attitudes by providers 4. Medical equipment too small to be functional for their body size In a recent study,11 adults were asked, If your doctor described your weight in a way that makes you feel stigmatized, how would you react? Research Highlight Reactions I would be upset/ embarrassed I would seek a new doctor I would avoid future doctor appointments Adults n = 1064 41% 21% 19% The language providers use about weight is important 3 Part 2: Reactions of Patients to Experiences of Weight Bias Receiving negative judgment by providers because of their weight Feeling upset by comments about their weight Perceiving a lack of empathy from providers Feeling as if they will not be taken seriously Being blamed for their weight and related problems Being reluctant to discuss their weight concerns Feeling judged about their weight, thus becoming less trusting of their doctors Patients with obesity report…10,12-18 4 In light of this evidence, it is possible to conceptualize in a cycle of obesity and bias in health care settings. The cycle of obesity and bias in healthcare settings begins at the top right hand corner of the diagram with obesity. The health consequences of obesity increase health care utilization with more frequent medical visits to facilities and provider contacts. When a patient perceives weight bias in a health care encounter, this can result in negative emotional responses, which may in turn increase avoidance of future health care services. Avoidance of care can in turn exacerbates poor self-care behaviors and could contribute to additional complications and co-morbid conditions of obesity. 3. Increased medical visits 2. Health consequences 6. Avoidance of health care 1. Obesity 5. Negative feelings resulting from bias 7. Unhealthy behaviors, poor self care 4. Perceived weight bias in health care Part 2: Cycle of Bias and Obesity 5 Part 2: Personal Impact of Weight Bias What are the personal consequences of weight bias? Research19