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Sensitivity Training: Weight Bias

Sensitivity Training: Weight Bias. MUSC BARIATRIC SURGERY PROGRAM 2010 WWW.MUSCHEALTH.COM/WEIGHTLOSSSURGERY. 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.

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Sensitivity Training: Weight Bias

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  1. Sensitivity Training: Weight Bias MUSC BARIATRIC SURGERY PROGRAM 2010 WWW.MUSCHEALTH.COM/WEIGHTLOSSSURGERY May 2010

  2. 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.

  3. 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.

  4. Obestity Trends* Among U.S.Adults: BRFSS, 2008 <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% The CDC reports that in 1990 no states had more than a 15% prevalence of obesity (BMI≥30), but in 2008, 32 states have obesity prevalence ≥25% and 6 states have obesity prevalence ≥30% (Flegal et al., 2008) (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) • 30.1% of South Carolinians are obese May 2010

  5. Normal Weight(BMI 18.5 to 24.9) Overweight(BMI 25 to 29.9) Obese(BMI 30 to 34.9) Severely Obese(BMI 35 to 39.9) Morbidly Obese(BMI 40 or more) 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 problems May 2010

  6. 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

  7. What is Weight Bias? • Weight bias refers to: • Attitudes that negatively affect our interpersonal interactions • A person who is stigmatized because he or she is overweight or obese • 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

  8. 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

  9. 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 terminations • The 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 victimization May 2010

  10. 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

  11. 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

  12. 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

  13. 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

  14. Doing Your Part…Strategies to Improve Sensitivity • 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 May 2010

  15. 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

  16. Congratulations! You have completed the learning portion of this lesson. Close this lesson and then complete the test.

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