Bias
TRUE or FALSE:
Bias is internal, while discrimination is external.
TRUE.
Bias is an innate or learned prejudice against or in favor of a group or an idea. (Bias CAN be external when one chooses to act on their implicit bias). Discrimination, however, is the unjust treatment of a group.
The minimum BMI for classification of an individual with obesity.
What is a BMI of >30?
This is a major institutional barrier to obtaining effective preventative care in treating obesity as a disease.
Health insurance.
"It is typical for health insurance plans to explicitly exclude obesity treatment for coverage...Denying people with obesity access to treatment may have medical consequences, but also denies people an opportunity to lose weight, which itself may reduce exposure to bias and discrimination."
A new movement that supports people of all sizes in adopting healthy behaviors.
What is Health At Every Size?
"The Health At Every Size approach is a continuously evolving alternative to the weight-centered approach to treating clients and patients of all sizes...The HAES approach promotes balanced eating, life-enhancing physical activity, and respect for the diversity of body shapes and sizes."
TRUE or FALSE:
In terms of strength of bias, weight bias is comparable to a racial minority bias (i.e. against Muslim-Americans).
FALSE.
One study found that weight bias is significantly stronger compared to biases against Muslims and LGBTQ people. "Obesity stigma may be the most robust bias because society tends to discriminate against individuals who are seen as responsible for their traits more than individuals who are seen as not responsible for their traits."
TRUE or FALSE: Obesity is classified as a metabolic disease.
FALSE.
While obesity can have adverse metabolic effects, it is classified by the Obesity Medical Association as a chronic, relapsing, multi-factorial, neurobehavioral disease.
This government organization does not classify obesity as a medically-determinable impairment, and therefore denies disability benefits to people on the sole basis of obesity.
What is the Social Security Administration?
"Obesity is not a listed impairment; however, the functional limitations caused by the MDI of obesity, either alone or in combination with another impairment(s), may medically equal a listing."
Medically-determinable impairments that ARE covered by disability benefits: HIV, cancer, heart disease, schizophrenia, depression.
Simple methods of intervention for medical students that reduced stigma towards obesity.
What are educational videos, role-playing exercises, and written materials?
"After the educational course, medical students demonstrated significantly improved attitudes and beliefs about obesity compared with the control group. The effectiveness of the intervention was still supported 1 year later."
There are different types of rapport (positive, emotional, and social rapport) that physicians employ when visiting with patients. Physicians are less likely to build this type of rapport with their overweight or obese patients.
What is emotional rapport?
"We did find that physicians were significantly less likely to build emotional rapport with overweight and obese patients. Emotional rapport building includes statements of empathy, legitimation, concern, reassurance, partnership, and self-disclosure, which is considered essential to creating a patient-centered experience."
It is estimated that of all the factors that contribute to obesity, this factor contributes 40-70%.
What is genetics?
Women with obesity are less likely to use these types of medical services.
What are preventative services?
"Even when women with obesity have more frequent physician appointments, they seem least likely to use preventive services."
This is an example of using person-first language when discussing obesity.
What are "patients with obesity," or "patients affected by obesity"? (Rather than "obese patients.")
In 2017 the American Medical Association passed a resolution to destigmatize obesity, and one of its recommendations called for using person-first language when discussing obesity with patients.
Even though this type of treatment for obesity can be effective, physicians generally view patients with obesity as non-adherent.
What is medication?
"We found that patients with higher BMI were less likely to be perceived as adherent to medications by their physicians...Several studies have shown that patients who are perceived as nonadherent by their physician may not receive guideline-recommended care."
A few of the most common diseases associated with obesity.
What is cancer, type 2 diabetes, sleep apnea, hypertension, osteoarthritis, and depression?
Why do you think some physicians avoid discussing weight at all with their patients with obesity?
Time constraints, word choice (don't want to offend the patient), lack of confidence in treatment, lack of confidence in patient's ability to make changes, lack of resources to provide patient, obesity as a societal/socioeconomic rather than medical problem.
"The reasons clinicians gave for not intervening on obesity were as follows: that discussing weight was interactionally difficult; it was not seen as the GPs' responsibility to treat people with obesity; nurses and GPs lacked knowledge about interventions and it had not been prioritized in the GPs' curriculum; a lack of confidence in patients' ability to make changes; and a lack of confidence in the efficacy of treatments."
Think of a few specific health objectives a physician can discuss with patients affected by obesity, rather than the broad and often unattainable goal of dramatic weight loss.
Reducing blood pressure, limiting cholesterol intake, choosing healthy foods, a physical exercise plan that is adapted to the individual patient.
"Women equated generic weight loss advice from their physician with lack of concern, attention, and support...Past studies also found that patients prefer an individualized approach rather than having a discussion on the health consequences of obesity."
In this year, one of the first studies was published that reported physicians' negative attitudes towards people with obesity.
What is 1969?
"In 1969, Maddox and Liederman addressed fat biases using self-report measures among 100 physicians and student clerks from a medical clinic. Obese patients were viewed as unintelligent, unsuccessful, inactive, and weak-willed. In addition, physicians indicated that they preferred not to treat overweight patients and that they did not expect success when they were responsible for their management."
An effective, yet underutilized, option to treat severe obesity in individuals with a BMI of over 40.
What is bariatric surgery?
Obesity is generally considered a "problem of willful behavior," and most insurance companies do not cover obesity management services.
These are "problems of willful behavior" that health insurance companies DO typically cover.
What is substance abuse, alcoholism, and sexually transmitted diseases?
"One likely contributor [to coverage policies] are perceptions that obesity is a problem of willful behavior and that treatment is unsuccessful and expensive. Although health insurance typically covers treatment for substance abuse and sexually transmitted diseases, which are also considered to be problems of willful behavior, persons with obesity may not receive the services they need."
A patient rarely comes to the doctor to discuss their weight, though studies have shown that the frequency of these weight discussions with patients increases the likelihood that they will take action to improve their health. What is an appropriate way to bring up weight for a patient with obesity who presents with a different concern (i.e. chief complaint is back pain)?
**First, ask if the patient would like to discuss their weight.**
"Health practitioners should acknowledge that most patients with obesity are aware of the excess weight, many of them have tried to lose weight for decades, and that bringing about the weight issue during medical appointments might be frustrating for them. Prior to discussing the issue of excess weight, health practitioners should ask patients’ permission, and a refuse should be respected and followed."
Another good approach is to use the shared decision-making (SDM) model.
"SDM involves a process in which both parties, patient and provider, share information and work collectively to come to a treatment decision."