Preferences for physician weight status among women with overweight

Women's perceptions of body mass graphics and their preferences for weight counselling

Health care providers may lack data-driven guidance about best practises for discussing weight. We assessed women's self-perception of body mass index (BMI) and preferences for weight counselling by provider characteristics and the initiating question. A voluntary, anonymous survey was completed by 756 women (age ≥ 19 year) at our tertiary care obstetrics and gynaecology clinics in autumn 2021. The respondents' height and weight were collected before respondents selected graphics from a validated Body Image Scale that they felt best represented their current body size and which graphs should prompt weight loss or gain recommendations. Respondents were asked their preferences about provider characteristics for discussion about weight and to identify which of six initiating questions from a provider was most and least preferred. Blank responses were allowed. In 708 responses, 366 women (52%) selected the most accurate graphic that corresponded to their BMI; the selected graphic represented a lower than actual BMI in 268 women (38%) and higher in 74 women (10%). In 648 responses, 374 women (58%) preferred a female provider, but provider body shape, ethnicity/race and age were not important to most women. The most preferred question to initiate a discussion about weight was "A lot of women have trouble achieving or maintaining a healthy weight; is that something we can discuss?" in 181 of 555 women (33%), and the least preferred question was "Do you feel like you are at an appropriate weight?" in 172 of 554 women (31%). Provider knowledge about patient preferences regarding questions may facilitate the discussion about weight.

Physician weight influences responses to a public health message about the genetics of obesity

OBJECTIVE

Many patients prefer lean physicians to physicians with obesity and place higher credence in their weight management advice. Because genetic information about weight can be viewed as self-serving for individuals with overweight or obesity, physicians with obesity may be discounted when sharing such information. As provision of genetic information regarding weight becomes increasingly common in public health messaging, could a physician's own weight influence how these messages are received by the public?

METHODS

In an online survey, 967 participants were randomly assigned a physician profile (lean v. has obesity) with a media interview transcript discussing genetic factors of a common health condition (obesity v. osteoporosis).

RESULTS

Participants perceived the physician with obesity who discussed genetic factors in obesity as less trustworthy and less credible. Participants were also less likely to anticipate following her advice on weight-related issues. Participants with higher BMI had less negative perceptions of this physician.

CONCLUSION

Physicians with obesity, when providing public health messaging regarding genetic information about obesity, may be met with distrust and negative attitudes toward the physician.

PRACTICAL IMPLICATIONS

Future research should investigate health communication strategies that address this form of weight stigma while accurately conveying genetic factors that contribute to weight.

Modeling Behavioral Economics Strategies in Social Marketing Messages to Promote Vegetable Consumption to Low-Resource Louisiana Residents: A Conjoint Analysis

BACKGROUND

Behavioral economics strategies implemented within social marketing campaigns improve eating behavior.

OBJECTIVE

To identify which behavioral economics strategies in social marketing messages particularly messengers, norms, and commitments will promote low-income Louisiana residents to add more vegetables to meals.

DESIGN

Full profile traditional conjoint analysis survey with single concept ratings.

PARTICIPANTS

Purposive sample of low-resource Louisiana residents (N = 213) SETTING: Online survey.

INTERVENTION

Participants rated randomized concepts that featured a messenger and a message.

MAIN OUTCOME MEASURE

Ratings (one to nine) of likelihood to add vegetables to meals.

STATISTICAL ANALYSIS

A model of ratings was generated using mixed-effects multiple regression, which accounted for repeated measurement of participants. Interactions of variables and covariates were modeled.

RESULTS

There was a significant main effect of the messenger variable (P = 0.02) and main effect of the message variable (P = 0.008). Pairwise comparisons demonstrated differences between friend (μ (predicted mean) = 6.80) and mother (μ = 7.06; P = 0.03) as well as friend and normal-weight doctor (μ = 7.03; P = 0.04). Pairwise comparisons demonstrated differences between descriptive norm (μ = 6.79) and grocery list precommitment (μ = 7.02; P = 0.05) along with descriptive norm and injunctive norm (μ = 6.98; P = 0.04). Covariate models demonstrated main effects of race (P = 0.006) and sex (P = 0.0001). There was significant variation in the message variable and frequency of vegetable intake interaction (P = 0.01).

CONCLUSIONS

Both message and messenger variables predicted the likelihood to add vegetables to meals. Race and sex influenced ratings to add vegetables. As reported vegetable consumption increased, behavioral economics messages improved the likelihood to add vegetables to meals. Behavioral economic approaches are well suited to social marketing messages that aim to promote healthy eating behavior in low-income LA residents.

Influence of weight etiology information and trainee characteristics on Physician-trainees' clinical and interpersonal communication

OBJECTIVE

This analysis explores the effects of relaying information about the genetic and behavioral causes of obesity (vs. control) on physician trainees' verbal communication behavior with a virtual patient with obesity. Moderation by physician trainees' gender and BMI was also assessed.

METHODS

119 physician trainees' verbal responses were recorded and coded using a close-ended content analytic approach.

RESULTS

Physician trainees in the behavioral and genetic information conditions were more likely to discuss weight (behavioral: AOR = 5.40; genetic: AOR = 6.58,) and provide lifestyle counseling (behavioral: AOR = 10.92; genetic: AOR = 3.50). Those in the behavioral condition were more likely to make assumptions about the patient's lifestyle behavior (AOR = 5.53) and use stigmatizing language (AOR = 4.69). Heavier physician trainees in the genetic condition had shorter interactions (β = -0.53, p <  0.01).

CONCLUSION

Emphasizing the genetic causes of overweight offers a potential avenue for encouraging clinical communication with patients with obesity, without also increasing prejudice and bias. Additional efforts may be needed to reap the benefits of genetic information for providers with higher weight.

PRACTICE IMPLICATIONS

For providers, considering genetic factors underlying patient body weight and obesity risk may serve to reduce stigmatizing communication with patients.