Weight Sensitivity Training

Objectives Define obesity and stigma Describe how weight stigma affects quality of life To increase awareness of weight bias among health care professionals To raise awareness and improve attitudes among healthcare provider toward the obese patient

Defining Obesity In general, when range of weight is greater than what is considered healthy for a given height Identifies ranges of weight that increases likelihood of certain diseases and health problems For adults, range determined by using weight & height to calculate a number called the “body mass index” (BMI) BMI 18.5-24.9 Normal Weight BMI 25-29.9 Overweight BMI 30-34.9 Obesity (Class 1) BMI 35-39.9 Obesity (Class 2) BMI >40 Obesity (Class 3) (NIH)

What causes Obesity? Variety of factors Eating too many calories Not getting enough physical activity Body weight is a result of: Genes Metabolism Behavior Environment Culture Socioeconomic status

Stigma of Obesity Definition of Stigma: Negative attitudes that influence our interpersonal interactions “Growing recognition of weight bias and stigma, and its potential harmful consequences for obese persons.” Substantial evidence of obesity stigma in: Employment Education Healthcare (Puhl & Brownell, 2001)

Stereotypical Attributes of Obese Person Lazy Less competent Sloppy Less conscientious “Think slower” Poor self discipline Emotionally unstable (Puhl, RM, Brownell KD Bias, Discrimination, and Obesity 2001)

Obesity Attitudes in Health Care Self-report studies show that Physicians, Nurses, and medical students view obese patients as: Non-compliant Dishonest Lazy Lacking in self-control Weak-willed Unsuccessful Sloppy (Paul & Townsend, 1995; Roehling, 1999)

It has been said obesity is “the last socially acceptable form of prejudice” “Most obese patients have experienced a lifetime of prejudice and discrimination” (Murray, D. Morbid Obesity-psychological aspects and surgical interventions AORN J 2003)

Utilization of Healthcare 498 obese women surveyed: Obese women delay preventive services despite high access to care Reasons: Disrespectful treatment by providers Embarrassment of being weighed Negative attitudes by providers Medical equipment too small Receive unsolicited advice to lose weight (Amy et al., 2006, International Journal of Obesity)

What can we do as Health Care Providers? Consider that patients may have had negative experiences with health professionals Recognize that being overweight is a product of many factors Recognize that many patients have tried to lose weight repeatedly Emphasize behavioral changes rather than weight Acknowledge the difficulty of lifestyle change Realize small weight losses can result in big health gains Create a Supportive Environment (Rudd Center for Food Policy & Obesity Yale University)

Supportive Language OLD New Overweight, obese Person/Patient of size Willpower Commitment Good/Bad What works for you Diet Eating Style Exercise Regimen Activity Style/Physical activity Expectations Discoveries Prescribe Negotiate Limit, restrict Choice, experience Ideal Weight Healthy Weight (Centers for Obesity Research and Education)

Create a Supportive Environment Treat patient with dignity and respect: Direct eye contact Good listening skill Empathy Avoid labeling patient: Big, hefty, plump, fat Special equipment: Know weight limits & comfort Avoiding labeling that indicates obesity to others Know how to use bariatric equipment Utilize wider beds and furniture Have proper size BP cuffs & gowns Need easy doorway and bathroom access

Privacy Scales should be kept in a place where patients can be weighed privately Don’t make loud requests for extra large items Don’t say: “I need a “Big Boy” bed” Instead, say: “I would like to request a Bariatric Wheelchair/Bariatric Bed” Don’t say: All available lifting help to room 123 Instead, say: “All available help for transfer report to Nurses’ station”

Weight Management Center Physician-monitored weight loss program Program is combined with: * Dietary and Nutritional Counseling * Behavior modification

New Weight Loss Surgery Program Dr. Julie Kim Gastric Band Surgery: Uses an implantable device that creates a bottleneck near top of stomach making it hard to overeat. -Adjustable & Reversible Gastric Bypass Surgery: Reduces functional capacity of the stomach changing the way food passes through the stomach and intestines -Used to treat severe obesity Vertical Sleeve Gastrectomy: The stomach us divided vertically and stapled removing more than 85% of the stomach. The remaining stomach is shaped like a slim banana and measures 1-5 ounces This surgery can be stage 1 of a 2-staged Roux-en-Y

Summary Weight stigma is common in health care settings Obesity bias may decrease quality and use of health care services for many individuals Health professionals can make a difference by becoming aware of their own biases, developing empathy, and working to address the needs and concerns of obese patients. (Rudd Center for Food Policy & Obesity Yale University)

Weight Sensitivity Test 1. Weight discrimination is one of the few discriminations that still exists and is accepted. a. True b. False 2. Self-report studies show that physicians, nurses and medical students view obese patients as: (check all that apply) a. Non-compliant b. Dishonest c. Lazy d. Lacking in self-control e. Unsuccessful f. Sloppy

Weight Sensitivity Test 3. Reasons obese women delay preventive services despite access to care include: (Check all that apply) a. Disrespectful treatment by health providers b. Embarrassment of being weighed c. Negative attitudes by providers d. Medical equipment too small 4. Size discrimination is evident in: (Check all that apply) a. Employment b. Education c. Healthcare

Weight Sensitivity Training 5. How can we provide a supportive environment for patients of size: a. Treat patient with dignity and respect b. Avoid labeling patient big or fat c. Have proper sized BP cuffs and gowns d. Know how to use bariatric equipment