MUSC BARIATRIC SURGERY PROGRAM2010

WWW.MUSCHEALTH.COM/WEIGHTLOSSSURGERY

Sensitivity Training: Weight Bias

May 2010

Lesson

This lesson is designed for all employees of the Medical University of South Carolina Medical Center.

It will take approximately 15 minutes to complete.

Goal and Objectives

Goal To provide an overview of the obesity epidemic and

discuss what constitutes weight bias and discrimination and your role in preventing it.

At the end of this lesson, the participant will be able to: Define obesity and weight bias. Discuss examples of weight bias and weight bias

attitudes in healthcare. Identify strategies to improve sensitivity when

working with patients who are obese.

Obestity Trends* Among U.S.Adults: BRFSS, 2008

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)<10%

10%–14%

15%–19%

20%–24%

25%–29%

≥30%

The CDC reports that in 1990 no states had more than a 15% prevalenceof obesity (BMI≥30), but in 2008, 32 states have obesity prevalence ≥25%

and 6 states have obesity prevalence ≥30% (Flegal et al., 2008)

30.1% of South Carolinians are obese

May 2010

Obesity Defined

Overweight and obesity are both labels for ranges of weight that are greater than what is generally considered healthy for a given height (CDC, 2010)

Obesity is measured by Body Mass Index (BMI) BMI is a calculation of height to weight comparison (kg/m2) BMI is used to screen for weight categories that may lead to

health problemsNormal Weight

(BMI 18.5 to 24.9)

Overweight(BMI 25 to 29.9)

Severely Obese(BMI 35 to 39.9)

Obese(BMI 30 to 34.9)

Morbidly Obese(BMI 40 or more)

May 2010

Facts About the Obesity Epidemic

Obesity is the leading preventable cause of death (CDC, 2010)

2.5 million deaths are weight-related annually More than one third of U.S. adults (>72 million people) and

16% of U.S. children are obese

Costs attributed to overweight and obese patients Obesity-related health care costs totaled ~$117 billion in

2000

May 2010

What is Weight Bias?

Weight bias refers to:o Attitudes that negatively affect our interpersonal interactionso A person who is stigmatized because he or she is overweight or

obese o Stereotypes ascribed to obese individuals increases their

vulnerability, unfair treatment, prejudice, and discrimination

Stigmatizing attitudes toward obese individuals usually emerge when people believe that excess weight is controllable and is a problem of lack of personal responsibility (Brownell et al., 2009)

Prevalence of weight discrimination has increased by 66% in past 10 years and is comparable to rates of racial discrimination, which can perpetuate the disparities already present in their lives (Andreyeva, Puhl, & Brownell, 2008)May 2010

Consequences of Weight Bias

Negative Emotional Consequences: Depression Anxiety Low self-esteem Social rejection Suicidality

Negative impact on physical health and behaviors that contribute to obesity: Unhealthy weight control

behaviors Binge-eating episodes Avoidance of physical activities

May 2010

Where is weight bias prevalent?

Education Stigmatization from teachers, peers, and parents Weight bias from educators influences students academic

performance Anti-fat attitudes begin as early as preschool (Puhl &

Brownell, 2006)

Employment Disadvantages in hiring, wages, promotions and job

terminationsThe media

Overweight people remain one of the last acceptable targets of humor and ridicule in television, films, advertising, and magazines

Interpersonal relationships Stereotypes, rejection, prejudice, verbal teasing, physical

bullying and aggression, relational victimizationMay 2010

Weight Bias Attitudes in Healthcare

Healthcare professionals may possess negative attitudes toward obese patients and believe patients are lazy, noncompliant, undisciplined, and possess low willpower (Puhl & Brownell, 2001)

Physicians >50% of MDs in a study viewed obese patients as: awkward,

unattractive, ugly, noncompliant, weak-willed, sloppy, and lazy

Nurses 69% of nurses studied believe that personal choices about food and

physical activity explain obesity

Medical Students Students reported that denigration by physicians, residents, and

other students was due to the assumption that patients are to blame for their obesity and they cause extra work for the students (Puhl & Heuer, 2009)

May 2010

Weight Bias in Healthcare

Patient perspective: 53% of patients received inappropriate comments from

doctors about their weight 84% of patients believe that weight is blamed for most of

their medical problems Patients feel like “second class citizens”

Health care workers feel: ill equipped, ineffective, and unprepared to treat obesity treating obesity is professionally unrewarding

May 2010

Weight Bias in Healthcare

Obese patients who experience stigma in weight bias may delay or forgo essential preventive care

Reasons for delaying care: Disrespectful treatment Embarrassment about being weighed Receiving unsolicited advice to lose weight Gowns, exam tables, equipment, and chairs being too small

May 2010

Check your own attitude!

• Honestly describe to yourself the feelings you may have toward this obese person• What are the

labels you give this person?

• Is this person worth your best care?

• Would you treat this person differently than the person in the previous photo?• This is the

same person, after having lost 110 lbs, 12 months after bariatric surgery

May 2010

Not all obese individuals are seeking to lose weight – so do not assume that they are

Create a weight friendly environment Be sensitive when completing daily weights Know the weight limits of the equipment that you use regularly

(exam tables, scales, hospital beds, radiology equipment, wheelchairs)

Be mindful of language Be mindful of language used with discussing weight with

patients Patients dislike the terms “obesity” and “fatness” but feel more

comfortable when referring to “weight”, “excess weight”, or “BMI” (Wadden & Didie, 2003)

Treat obese patients with the same respect as any patient suffering from a chronic disease

Doing Your Part…Strategies to Improve Sensitivity

May 2010

References

Andreyeva T, Puhl RM, Brownell KD. Changes in perceived weight discrimination among Americans, 1995-1996 through 2004-2006. Obesity 2008:16(5);1129-1134.

Brownell KD, Schwartz MB, Puhl RM, Henderson KE, Harris JL. The need for bold action to prevent adolescent obesity. J of Adol Health 2009:45;S8-S17.

Centers for Disease Control and Prevention. Overweight and Obesity. Retrieved from: http://www.cdc.gov/obesity/index.html on May 7, 2010.

Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999-2008. JAMA. 2010;303(3):235-241.

Puhl R, Brownell KD. Bias, discrimination, and obesity. Obes Res 2001:9(12); 788-805.

Puhl RM, Brownell KD. Confronting and coping with weight stigma: an investigation of overweight and obese adults. Obesity 2006:14(10); 1802-1815.

Puhl RM, Heuer CA. The stigma of obesity: a review and update. Obesity 2009:17(5);941-964.

Rudd Center for Food Policy and Obesity. Weight bias: A social justice issue. New Haven, CT: Yale University, 2009.

Wadden TA, Didie E. What’s in a name? Patients preferred terms for describing obesity. Obes Res 2003:11(9); 1140-1146.

May 2010

Congratulations!

You have completed the learning portion of this lesson.

Close this lesson and then complete the test.