Article

Primary care physicians' attitudes about obesity and its treatment.

University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
Obesity research (Impact Factor: 4.95). 10/2003; 11(10):1168-77. DOI: 10.1038/oby.2003.161
Source: PubMed

ABSTRACT This study was designed to assess physicians' attitudes toward obese patients and the causes and treatment of obesity.
A questionnaire assessed attitudes in 2 geographically representative national random samples of 5000 primary care physicians. In one sample (N = 2500), obesity was defined as a BMI of 30 to 40 kg/m(2), and in the other (N = 2500), obesity was defined as a BMI > 40.
Six hundred twenty physicians responded. They rated physical inactivity as significantly more important than any other cause of obesity (p < 0.0009). Two other behavioral factors-overeating and a high-fat diet-received the next highest mean ratings. More than 50% of physicians viewed obese patients as awkward, unattractive, ugly, and noncompliant. The treatment of obesity was rated as significantly less effective (p < 0.001) than therapies for 9 of 10 chronic conditions. Most respondents (75%), however, agreed with the consensus recommendations that a 10% reduction in weight is sufficient to improve obesity-related health complications and viewed a 14% weight loss (i.e., 78 +/- 5 kg from an initial weight of 91 kg) as an acceptable treatment outcome. More than one-half (54%) would spend more time working on weight management issues if their time was reimbursed appropriately.
Primary care physicians view obesity as largely a behavioral problem and share our broader society's negative stereotypes about the personal attributes of obese persons. Practitioners are realistic about treatment outcomes but view obesity treatment as less effective than treatment of most other chronic conditions.

0 Bookmarks
 · 
190 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In order to manage the increasing worldwide problem of obesity, medical students will need to acquire the knowledge and skills necessary to assess and counsel patients with obesityFew educational intervention studies have been conducted with medical students addressing stigma and communication skills with patients who are overweight or obese. The purpose of this study was to evaluate changes in students' attitudes and beliefs about obesity, and their confidence in communication skills after a structured educational intervention that included a clinical encounter with an overweight standardized patient (SP). First year medical students (n = 127, 47% female) enrolled in a communications unit were instructed to discuss the SPs' overweight status and probe about their perceptions of being overweight during an 8 minute encounter. Prior to the session, students were asked to read two articles on communication and stigma as background information. Reflections on the readings and their performance with the SP were conducted prior to and after the encounter when students met in small groups. A newly constructed 16 item questionnaire was completed before, immediately after and one year after the session. Scale analysis was performed based on a priori classification of item intent. Three scales emerged from the questionnaire: negative obesity stereotyping (7 items), empathy (3 items), and counseling confidence (3 items). There were small but significant immediate post-intervention improvements in stereotyping (p = .002) and empathy (p < .0001) and a very large mean improvement in confidence (p < .0001). Significant improvement between baseline and immediate follow-up responses were maintained for empathy and counseling at one year after the encounter but stereotyping reverted to the baseline mean. Percent of students with improved scale scores immediately and at one year follow up were as follows: stereotyping 53.1% and 57.8%; empathy 48.4% and 47.7%; and confidence 86.7% and 85.9%. A structured encounter with an overweight SP was associated with a significant short-term decrease in negative stereotyping, and longer-term increase in empathy and raised confidence among first year medical students toward persons who are obese. The encounter was most effective for increasing confidence in counseling skills.
    BMC Medical Education 03/2014; 14(1):53. · 1.41 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective This study examined weight bias among students training in health disciplines and its associations with their perceptions about treating patients with obesity, causes of obesity, and observations of weight bias by instructors and peers.Methods Students (N = 107) enrolled in a post-graduate health discipline (Physician Associate, Clinical Psychology, Psychiatric Residency) completed anonymous questionnaires to assess the above variables.ResultsStudents reported that patients with obesity are a common target of negative attitudes and derogatory humor by peers (63%), health-care providers (65%), and instructors (40%). Although 80% of students felt confident to treat obesity, many reported that patients with obesity lack motivation to make changes (33%), lead to feelings of frustration (36%), and are non-compliant with treatment (36%). Students with higher weight bias expressed greater frustration in these areas. The effect of students' weight bias on expectations for treatment compliance of patients with obesity was partially mediated by beliefs that obesity is caused by behavioral factors.Conclusions Weight bias is commonly observed by students in health disciplines, who themselves report frustrations and stereotypes about treating patients with obesity. These findings contribute new knowledge about weight bias among students and provide several targets for medical training and education.
    Obesity 04/2014; 22(4). · 3.92 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Rationale, aims and objectivesThe objective was to compare the extent of pain interference and pain medication among persons who were classified as obese [body mass index (BMI) ≥30 kg m−2] and normal weighted (BMI ≤25 kg m−2), before a hip or knee replacement surgery.Methods Patients candidate for an orthopaedic surgery were successively enrolled, over a 6-month period, and classified in either the normal weight (BMI ≤25 kg m−2) or the obese (BMI ≥30 kg m−2) categories. Data were collected using self-administered questionnaires with items concerning pain characteristics, pain medication and pain interference. Two standardized questionnaires were associated: the Brief Pain Inventory (BPI) and the Hospital Anxiety and Depression scale (HAD).ResultsFifty-two obese patients (candidates for 24 hip replacements and 28 knee replacements) and 51 non-obese (23 hip replacements and 28 knee replacements) were enrolled. Obese patients suffered from a higher rate of acute pain episodes than non-obese patients (65 versus 44%, P < 0.05). Pain interference on walking distance, sleep and relations with others was higher in obese patients. HAD score showed no significant difference between groups. The use of strong opioids and of non-steroidal anti-inflammatory drugs (NSAIDs) was significantly more important in obese patients (13 versus 0% and 31 versus 14%).Conclusions Obese patients suffer more significantly of unrelieved chronic pain, which lowers considerably their quality of life. Pain relief is more difficult to obtain, as it requires stronger pain medication and NSAIDs.
    Journal of Evaluation in Clinical Practice 06/2014; · 1.51 Impact Factor

Full-text (2 Sources)

View
307 Downloads
Available from
May 22, 2014