1. I S THERE WEIGHT BIAS IN HEALTH CARE AND FITNESS PROFESSIONALS ? I F SO, IDENTIFY STRATEGIES FOR INCREASING SENSITIVITY AND COMBATING THIS BIAS http://www.youtube.com/watch?v=7DKFl-Az8i4

2. PICTURE THIS… You are a physician and you have been treating a patient suffering from obesity for the past 7 years. When you first began treating this patient they weighed 450lbs; since then your patient has gained 150lbs and has come to you with several complaints about your prescribed treatments along with reasons why your treatments have not been successful. In addition to these complaints, your patient has also informed you that they have been recently experiencing a shortness of breath while trying to do everyday tasks. As their primary care physician you try to explain how the sudden shortness of breath could be attributed to the excess weight gain. Your patient then requests a screening of some sort to make sure that its “nothing serious”, but you assure your patient that if they lost weight that the shortness of breath would subside. Instead of writing a referral for a screening, you prescribe an exercise routine and a low-fat diet and schedule a follow-up in four months to monitor their progress. Later on that week your supervisor informs you that the patient went for a second opinion and found that the sudden shortness of breath was a result of a pulmonary embolism. You also learn that your patient has accused you of being insensitive and prejudice against “fat people”. As the physician, how do you respond?

3. S OCIETAL V IEWS Obese stereotypes leading to: stigma rejection prejudice discrimination

4. Weight Bias ↓ Vulnerability For ↓ Depression, Anxiety, Low Self-Esteem, Poor Body Image, Suicidal Acts and Thoughts

5. S OCIAL AND E CONOMIC C ONSEQUENCES Social rejection Poor quality of relationships Lower SES (socioeconomic status) Worse academic outcomes

6. H EALTH C ONSEQUENCES Unhealthy eating behaviors Binge eating Unhealthy weight control practices Coping with stigma with eating more and Refusing to diet Avoidance of physical activity Cardiovascular health Elevated ambulatory blood pressure Increased physiological stress Poor quality of life overall

7. D ISCRIMINATION IN H EALTH C ARE One of the most documented places for discrimination Physicians describe their obese patients as people who are weak- willed, ugly, or awkward Survey of nurses found 28% reported they felt repulsion when they see an obese person Survey of Michigan physicians stated obesity as one of the top most negative patient characteristic The American Academy of Family Physicians surveyed 324 members 39% physicians believed that patients were lazy 2/3 believed that obese patients lack self-control

8. G ETTING H ELP … Often rude and unwelcoming When referred for gastric bypass surgery, patients are often treated disrespectfully by physicians Avoidance or delays of medical care and assistance Survey reported that 12.7 of obese women avoid medical appointments because of weight related concerns such as stigmatization

9. C ONSEQUENCES OF DISCRIMINATION Increases the need for medical attention due to the increases of health effects Chronic progressive diseases diabetes mellitus osteoarthritis cardiovascular disease Obesity-related conditions result in 300,000 deaths/year in the U.S.

10. C ONSEQUENCES Management of obesity-related medical conditions made up 9.4% of the health care expenditure in the U.S. in 1999. Social & Fiscal cost of obesity on society and the individual is enormous, and these costs are all due to the negative attitudes and perspectives that professionals in the health care system have toward obese patients

11. U NWELCOMING ENVIRONMENTS Inadequate equipment Unaccommodating waiting rooms Insufficient medical supplies

12. C REATING A S UPPORTIVE E NVIRONMENT Sensitivity when weighing obese patients Appropriate medical equipment Weight-friendly waiting room Appropriate examination room

13. T OOLKITS F OR H EALTH C ARE P ROVIDERS Designed to help clinicians across various practice settings with easy-to-implement solutions to improve delivery and care to over weight patients. Designed for busy professionals Customized for various practice settings Designed to Improve provider-patient communication Assist in providing more sensitive care to patients

14. P REVENTING WEIGHT BIAS : HELPING WITHOUT HARMING IN CLINICAL PRACTICE Module 1: Increases Self-Awareness of Weight Bias Module 2: Improving Provider-Patient Interactions Module 3: Overview of Weight Bias in Health Care Settings Module 4: Office Environment Strategies to Reduce Weight Bias Module 5: Weight Bias Resources for OBGYN Providers Module 6: Weight Bias Resources for Pediatricians Module 7: Weight Bias Resources for Bariatric Surgery Clinics Module 8: Resources for Overweight Patients

15. P ATIENT -P ROVIDER C OMMUNICATION 1) Acknowledge that patients may truly care about their health 2) Empower patients to participate in their medical care 3) Evaluate your own assumptions about what constitutes a "good" patient 4) Know that behavior change results from positive negotiation & interaction

16. C ONCLUSION Despite the many efforts to implement coping strategies and an overall decrease in stigmatizing obese individuals, psychosocial functioning of obese individuals cannot be satisfied without substantial transformation on a larger scale. http://www.youtube.com/watch?v=c5cUAdhOwYs&feature=related http://www.youtube.com/watch?v=MbJ7hPhyPz0&feature=related