Weight Stigma: Doctors Guilty of Prejudice Against Obese, Too

June 05, 2014

SOFIA, Bulgaria — A new survey of almost 700 healthcare professionals in a large German university hospital that specializes in research and treatment of obesity has found that almost 60% of staff there expressed negative attitudes toward the condition, a figure not dissimilar to that found among the general public.

"We expected that healthcare professionals would have a better understanding of the causes of obesity, but that was not true," psychologist Claudia Sikorski, PhD, of Leipzig University, Germany, told the European Congress on Obesity in Sofia last week.

Asked to comment on the findings, psychologist Jason Halford, PhD, of the University of Liverpool, United Kingdom, and chair of the UK Association for the Study of Obesity, said, "We should not be surprised. Doctors and other healthcare professionals are not different from any other section of society — negative attitudes toward obesity persist."

Research has shown "that obese people get a rougher ride than any other patient whose condition is behavior-related, including drug addicts and HIV-infected individuals. Physicians tend to view them less kindly," Dr. Halford noted. And this is despite the fact that "most of the adult population is overweight or obese themselves, including these healthcare professionals, so there is another paradox."

Dr. Sikorski says her findings indicate that doctors, nurses, and therapists should receive training on "weight stigma"; she compares the situation to that of smoking-cessation counseling. "It was not the blame that helped smokers quit smoking, but higher taxes on cigarettes, etc — environmental changes — so I see the parallel there for obesity. All we see is the blaming of individuals, but that decreases their psychological health, and it decreases their success."

Dr. Halford, who was not involved with this study, says it all boils down to "whether obesity is seen as a legitimate condition or as a personal issue or failing." He agrees with Dr. Sikorski that education for healthcare professionals is the way forward. "Medics don't really know what to do with these patients; they are not an easy population to work with. So we need to increase the understanding of the multifactorial causes of obesity and teach doctors that there are ways of dealing with the issue."

Is It Harder to Care for Obese Patients?

Dr. Sikorski's survey was conducted in 2011; all physicians, nurses, and therapists in her hospital in Leipzig were asked to complete a questionnaire regarding stigmatizing attitudes, the work-related impact of obesity, and the perceived causes.

They obtained a 39% response rate, with 682 individuals replying to the questionnaire. Approximately 150 of the respondents were physicians (all specialties), 150 were nurses, and the remainder were therapists, she explained.

For the stigmatizing-attitudes part of the survey, respondents were asked to imagine a fictional female patient, aged 42, with a body mass index of 32, and were instructed to characterize that patient using 14 opposing adjectives from the Fat Phobia Scale, for example, "lazy" or "diligent."

"We found that the obese vignette was rated a lot more negatively than the normal-weight vignette, across all adjective pairs," Dr. Sikorski said.

Regarding the work-related impact of obesity, only 25% of respondents graded the current healthcare of obese patients to be "good" or "very good," she explained.

Of the respondents, 63% "somewhat" or "strongly" agreed that it was difficult to get the resources needed to care for obese patients — for example, to gain access to specialist equipment.

But Dr. Halford said he doesn't believe this is a legitimate reason to cite work-related difficulties, because specialist equipment for obese patients has been widely available throughout Europe for a number of years.

Little Understanding of Complexity of Obesity Among Doctors

For the perceived causes of obesity, respondents mainly said that the obese woman in the vignette "had too little willpower or just simply ate too much or exercised too little," Dr. Sikorski explained. Genetic causes or the "obesogenic environment" were not viewed as important; healthcare professionals "were much more likely to blame the individual," she noted.

While few predictors of negative attitudes could be identified on multivariate analysis, one was pinpointed, and that was "years in practice."

"The more experienced the professional, the less negative attitude toward patients," she observed. And "when people endorse biomedical causes for obesity, they show less negative attitudes," she added, noting also that the nursing staff agreed on obesity as an illness to a greater extent than physicians.

Such weight stigmatization has implications, she stressed. It can result in aggression toward obese patients, for example. "There have been reports of hostile behavior, and there might even be issues of neglect. Those are things that happen when people perceive their patients as just being a burden," she said.

"The consequences of this negative mind-set are that it changes behavior," she explained to Medscape Medical News. "If you think about a doctor who thinks it's the individual's fault that she is obese, what is he or she going to recommend for that person? 'You just need to eat less and exercise more'? That might lead to frustrating weight-loss attempts in obese individuals."

While acknowledging that such lifestyle advice must be given, she said doctors need "to have realistic goals for the patient" and acknowledge that this is an acquired skill.

Dr. Halford said: "Obesity must be discussed, but you have to challenge things in a positive way, giving patients some insight into their problem and helping them to develop coping strategies for their overconsumption and underactivity."

Medical Education Required

Both Drs. Sikorski and Halford believe that educating healthcare professionals about weight stigma is the logical way forward.

Dr. Sikorski suggests that a course could be introduced for healthcare professionals and be taught in medical schools "to explain the complexity of the causes of obesity to help reduce these negative attitudes and induce empathy with obese patients."

She said her team has tested a short seminar among medical students, whereby they invited an obese patient to the setting and the students interviewed the patient and heard about the patient's experiences.

Given the worldwide obesity epidemic and the fact that the obesity is now classified as a disease by the American Medical Association, "this is not being taught to the extent that it should be," she observed, adding, "Less experienced colleagues need more support and guidance in caring for these patients."

2014 European Congress on Obesity. Abstract TS:OS2.3, presented May 30, 2014.

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