"Is It Time to Throw out the Weighing Scales?" Implicit Weight Bias Among Healthcare Professionals Working in Bariatric Surgery Services and Their Attitude Towards Non-weight Focused Approaches

Overview

Journal EClinicalMedicine

Specialty General Medicine

Date 2022 Dec 26

PMID 36568685

Authors

S Abbott

E Shuttlewood

S W Flint

P Chesworth

H M Parretti

Affiliations

Soon will be listed here.

Abstract

Background: People living with overweight or obesity (PLwO) can be stigmatised by healthcare professionals (HCPs). Reducing focus on weight is a proposed strategy to provide less threatening healthcare experiences. Given the lack of research on weight bias within obesity services, this study aimed to explore implicit bias among obesity specialist HCPs and explore views on non-weight focused approaches.

Methods: Obesity specialist HCPs were invited to a webinar, "An exploration of non-weight focused approaches within bariatric services", held in October 2021. Implicit weight bias was examined using the BiasProof mobile device test, based on the Implicit Association Test. Poll data was analysed descriptively, and qualitative data was analysed using framework analysis.

Findings: 82 of the 113 HCPs who attended the webinar consented to contribute data to the study. Over half (51%) had an implicit weight bias against PLwO. Most (90%) agreed/strongly agreed that obesity services are too weight focused and that patients should not be weighed at every appointment (86%). Perceived benefits of taking a non-weight focused approach included patient-led care, reducing stigma and supporting patient wellbeing, while perceived barriers included loss of objectivity, inducing risk and difficulty demonstrating effectiveness.

Interpretation: Our findings indicate that half of obesity specialists HCPs in our sample of 82 providers, who are primarily dieticians and psychologists, have an implicit weight bias against PLwO. HCPs feel that a weight-focused approach within services was a barrier to patient care, but that there is a lack of alternative non-weight focused measures. Further research is needed into substitute outcome measures for clinical practice, also seeking the views of PLwO, and into interventions to address implicit weight bias.

Funding: Johnson & Johnson funded the BiasProof licence and publication open access charge.

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References

Kopelman P, Jebb S, Butland B . Executive summary: Foresight 'Tackling Obesities: Future Choices' project. Obes Rev. 2007; 8 Suppl 1:vi-ix. DOI: 10.1111/j.1467-789X.2007.00344.x. View

Nickel F, Tapking C, Benner L, Schuler S, Ottawa G, Krug K . Video Teaching Leads to Improved Attitudes Towards Obesity-a Randomized Study with 949 Participants. Obes Surg. 2019; 29(7):2078-2086. DOI: 10.1007/s11695-019-03804-9. View

GREENWALD A, McGhee D, Schwartz J . Measuring individual differences in implicit cognition: the implicit association test. J Pers Soc Psychol. 1998; 74(6):1464-80. DOI: 10.1037//0022-3514.74.6.1464. View

Hofmann W, Gawronski B, Gschwendner T, LE H, Schmitt M . A meta-analysis on the correlation between the implicit association test and explicit self-report measures. Pers Soc Psychol Bull. 2005; 31(10):1369-85. DOI: 10.1177/0146167205275613. View

Lee M, Ata R, Brannick M . Malleability of weight-biased attitudes and beliefs: a meta-analysis of weight bias reduction interventions. Body Image. 2014; 11(3):251-9. DOI: 10.1016/j.bodyim.2014.03.003. View

Ranganath K, Smith C, Nosek B . Distinguishing automatic and controlled components of attitudes from direct and indirect measurement methods. J Exp Soc Psychol. 2008; 44(2):386-396. PMC: 2350226. DOI: 10.1016/j.jesp.2006.12.008. View

McLean M, McLean L, McLean-Holden A, Campbell L, Horner A, Kulkarni M . Interphysician weight bias: A cross-sectional observational survey study to guide implicit bias training in the medical workplace. Acad Emerg Med. 2021; 28(9):1024-1034. DOI: 10.1111/acem.14269. View

Hunter J, Rawlings-Anderson K, Lindsay T, Bowden T, Aitken L . RETRACTED: Exploring student nurses' attitudes towards those who are obese and whether these attitudes change following a simulated activity. Nurse Educ Today. 2018; 65:225-231. DOI: 10.1016/j.nedt.2018.03.013. View

Schwartz M, Chambliss H, Brownell K, Blair S, Billington C . Weight bias among health professionals specializing in obesity. Obes Res. 2003; 11(9):1033-9. DOI: 10.1038/oby.2003.142. View

10.

Brown A, Flint S, Batterham R . Pervasiveness, impact and implications of weight stigma. EClinicalMedicine. 2022; 47:101408. PMC: 9046114. DOI: 10.1016/j.eclinm.2022.101408. View

11.

Gale N, Heath G, Cameron E, Rashid S, Redwood S . Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013; 13:117. PMC: 3848812. DOI: 10.1186/1471-2288-13-117. View

12.

OBrien K, Puhl R, Latner J, Mir A, Hunter J . Reducing anti-fat prejudice in preservice health students: a randomized trial. Obesity (Silver Spring). 2010; 18(11):2138-44. DOI: 10.1038/oby.2010.79. View

13.

Molloy M, Sabol V, Silva S, Guimond M . Using Trigger Films as a Bariatric Sensitivity Intervention: Improving Nursing Students' Attitudes and Beliefs About Caring for Obese Patients. Nurse Educ. 2015; 41(1):19-24. DOI: 10.1097/NNE.0000000000000225. View

14.

Coulman K, Hopkins J, Brookes S, Chalmers K, Main B, Owen-Smith A . A Core Outcome Set for the Benefits and Adverse Events of Bariatric and Metabolic Surgery: The BARIACT Project. PLoS Med. 2016; 13(11):e1002187. PMC: 5127500. DOI: 10.1371/journal.pmed.1002187. View

15.

McVey G, Walker K, Beyers J, Harrison H, Simkins S, Russell-Mayhew S . Integrating weight bias awareness and mental health promotion into obesity prevention delivery: a public health pilot study. Prev Chronic Dis. 2013; 10:E46. PMC: 3617990. DOI: 10.5888/pcd10.120185. View

16.

Flint S, Leaver M, Griffiths A, Kaykanloo M . Disparate healthcare experiences of people living with overweight or obesity in England. EClinicalMedicine. 2021; 41:101140. PMC: 8452776. DOI: 10.1016/j.eclinm.2021.101140. View

17.

Phelan S, Dovidio J, Puhl R, Burgess D, Nelson D, Yeazel M . Implicit and explicit weight bias in a national sample of 4,732 medical students: the medical student CHANGES study. Obesity (Silver Spring). 2013; 22(4):1201-8. PMC: 3968216. DOI: 10.1002/oby.20687. View

18.

Reinka M, Quinn D, Puhl R . Examining the relationship between weight controllability beliefs and eating behaviors: The role of internalized weight stigma and BMI. Appetite. 2021; 164:105257. DOI: 10.1016/j.appet.2021.105257. View

19.

Yang W, Abbott S, Borg C, Chesworth P, Graham Y, Logue J . Global variations in preoperative practices concerning patients seeking primary bariatric and metabolic surgery (PACT Study): A survey of 634 bariatric healthcare professionals. Int J Obes (Lond). 2022; 46(7):1341-1350. DOI: 10.1038/s41366-022-01119-x. View

20.

Schaefer J, Magnuson A . A review of interventions that promote eating by internal cues. J Acad Nutr Diet. 2014; 114(5):734-60. DOI: 10.1016/j.jand.2013.12.024. View