1. Weight Sensitivity Training

2. 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

3. 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 Normal Weight
BMI Overweight
BMI Obesity (Class 1)
BMI Obesity (Class 2)
BMI > Obesity (Class 3)
(NIH)

4. 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

5. 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)

6. 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)

7. 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)

8. 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)

9. 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)

10. 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)

11. 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)

12. 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

13. 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”

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

15. 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

16. 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)

17. 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

18. 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

19. 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