Perceived weight stigma in healthcare settings among adults living with obesity: A cross-sectional investigation of the relationship with patient characteristics and person-centred care

Exploring the perceptions of obesity, health habits, stigma, and eating behaviors in Brazil

BACKGROUND

Obesity is a chronic and complex disease influenced by various factors that hinder weight loss and maintenance. However, perceptions of obesity are often marked by stigma. This study assessed perceptions of obesity, weight stigma, health habits, and emotional eating in a representative sample of the Brazilian population.

METHODS

This cross-sectional study included a representative sample of 2560 Brazilian participants. Data were collected from structured online questionnaires covering demographic aspects, perceptions of obesity, stigma, health habits, and behaviors related to emotional eating.

RESULTS

The prevalence of obesity in the sample was 26%. However, 61% of these individuals did not receive a formal diagnosis. Although 76% of the participants considered obesity a disease, 65% believed that diet and exercise were sufficient treatments. Only 5% of the participants with obesity considered 10% weight loss beneficial for associated comorbidities. It was widely believed that normalizing body mass index (BMI) is necessary for positive health outcomes. Emotional eating behaviors were slightly more prevalent among individuals with obesity (25%) but were present across all BMI ranges.

CONCLUSIONS

The findings of this investigation underscore the necessity for comprehensive education regarding obesity as a complex multifactorial condition. They emphasize the importance of promoting awareness of the benefits associated with modest weight reduction, improving the diagnosis and documentation of obesity in clinical settings, and implementing targeted interventions to address misconceptions concerning treatment modalities and the impact of emotional eating behaviors.

Mapping Psychological Well-Being in Morbid Obesity: A Network Analysis Approach

Background/Objectives: Identifying key psychological well-being factors in morbid obesity is crucial for designing effective mental health and weight management interventions. This study explores the interconnections between the dimensions of psychological well-being in a large sample of adults with morbid obesity enrolled in an inpatient nutritional rehabilitation program. Methods: A sample of 3212 participants (F = 58%; mean age = 57.18 years; mean Body Mass Index = 43.40 kg/m2) completed the Psychological General Well-Being Index (PGWBI) upon admission to the clinic. A network analysis approach examined the relationships among the PGWBI dimensions (anxiety, depression, positive well-being, self-control, vitality, and general health). Results: Network analysis revealed that vitality and positive well-being exhibited the highest values across closeness (1.432; 0.353), strength (0.853; 0.917), and expected influence (0.853; 0917), indicating their key role in psychological well-being. Depression also demonstrated moderate relevance, suggesting its connection to other well-being factors, though it was not the primary determinant. In contrast, self-control and general health had negative strength and expected influence values (-0.660; -1.641), indicating a less central role in the network. Additionally, anxiety and depression displayed negative betweenness (-0.645), reinforcing their more peripheral position. Conversely, positive well-being and vitality showed the highest betweenness (1.291), highlighting their role as key connecting nodes within the well-being network. Conclusions: Findings suggest interventions targeting positive well-being and vitality may most effectively enhance psychological well-being in morbid obesity, emphasizing strength-based approaches that foster positive affect, motivation, and resilience rather than focusing solely on reducing distress or weight-related concerns.

What it Means to Call Your Patient Obese: The Impact of Communicating Weight Stigma in Patient-Provider Conversations

Perceived weight stigma has been shown to have serious consequences in healthcare, including poorer mental health, physical health, and other social injustices for overweight individuals. However, the full impact of stigmatized language use (like "obese") in patient-provider interactions remains unclear. Therefore, we conducted an online experiment (N = 501) in the US to examine the effects of stigmatized language use in conversations with healthcare providers, including on patients' perceptions of themselves as well as their healthcare experience. Results show that stigmatized conversation about weight initiated by healthcare providers results in higher weight self-stigma among patients, failing to increase their desire to lose weight (likely a goal of providers via these interactions). Additionally, patients exposed to stigmatized conversation experience decreased patient-centered communication, lower trust in healthcare providers, decreased quality of healthcare, and decreased satisfaction with their healthcare providers. Furthermore, this study found some support for the moderating effect of narrative transportation and perceived body size on some of the outcomes. Hence, in healthcare practice, our results suggest that healthcare providers should reduce their use of stigmatized language when discussing weight with their patients as a way to improve weight self-stigma among patients as well as patient-centered communication and related outcomes.

The Effect of Lifestyle Coaching Design on Patient Engagement and Weight Loss in Non-diabetic Patients of a Semaglutide-Supported Digital Obesity Program in the UK: A Comparative Retrospective Cohort Study

Digital weight-loss services (DWLSs) that supplement continuous lifestyle coaching with semaglutide therapy have shown promise in delivering continuous and effective obesity care. However, the extent to which lifestyle coaching design influences patient engagement and program effectiveness is unknown. This study retrospectively analysed several engagement markers and weight loss percentage over 16 weeks in a large semaglutide-supported DWLS in the UK (n=154). The comparative analysis found that patients who received lifestyle coaching that was proactive and personalised sent a statistically higher number of messages to their health coach (Mean=19.37 vs Mean=8.55) and opened the program app more frequently (Mean = 49.31 days vs Mean = 40.06 days) than patients whose coaching was reactive and standardised. Mean 16-week weight loss was 10.1% in the proactive group compared to 8.9% in the reactive group, but the difference was not statistically significant. A two-sample t-test found that female patients (Mean = 9.76%) tended to lose more weight than male patients (Mean = 6.88%), (t(152) = 1.89, p = 0.04). The findings add vital layers of nuance to the emerging literature on semaglutide-supported DWLSs, indicating that a proactive, personalised coaching approach leads to better patient engagement, but that such engagement is not correlated with better short-term weight-loss or program adherence outcomes. Moreover, the cohort's comparably higher mean weight loss relative to previous real-world semaglutide studies lend support to the advice of leading global health institutions of using the medication only as an adjunct to multidisciplinary lifestyle therapy. Investigators should expand on this research by conducting comparable studies over a longer period and with medication-only control groups.

The relationship between person-centred care and well-being and satisfaction with care of patients living with obesity

Person-centred care (PCC) is associated with improved patient well-being and higher levels of satisfaction with care but its impact on individuals living with obesity is not well-established. The main aim of this study was to assess the relationship between PCC and the physical and social well-being of patients living with obesity, as well as their satisfaction with care. This study is based on a cross-sectional, web-based survey administered among a representative panel of Dutch individuals living with obesity. The primary outcomes were physical and social well-being and satisfaction with care. The primary exposure was a rating of overall PCC, encompassing its eight dimensions. In addition, covariates considered in the analyses included sex, age, marital status, education level, body mass index, and chronic illness. The data from a total of 590 participants were analysed using descriptive statistics, correlation analyses, and multiple regression analyses. Among PCC dimensions, participants rated 'access to care' the highest (M 4.1, SD 0.6), while 'coordination of care' (M 3.5, SD 0.8) was rated lower than all other dimensions. Participants' overall PCC ratings were positively correlated with their physical (r = 0.255, P < .001) and social well-being (r = 0.289, P < .001) and their satisfaction with care (r = 0.788, P < .001), as were the separate dimension scores. After controlling for sex, age, marital status, education level, body mass index, and chronic illness in the regression analyses, participants' overall PCC ratings were positively related to their physical (β = 0.24, P < .001) and social well-being (β = 0.26, P < .001), and satisfaction with care (β = 0.79, P < .001). PCC holds promise for improved outcomes among patients living with obesity, both in terms of physical and social well-being, as well as satisfaction with care. This is an important finding, particularly when considering the profound physical, social, and psychological consequences associated with obesity. In addition to highlighting the potential benefits of PCC in the healthcare of individuals living with obesity, the findings offer valuable insights into strategies for further refining the provision of PCC to meet the specific needs of these patients.

'Beyond the Scale': A Qualitative Exploration of the Impact of Weight Stigma Experienced by Patients With Obesity in General Practice

OBJECTIVE

Obesity is a complex, chronic, relapsing disease that requires an individualised approach to treatment. However, weight stigma (WS) experienced in healthcare settings poses a significant barrier to achieving person-centred care for obesity. Understanding the experiences of people living with obesity (PwO) can inform interventions to reduce WS and optimise patient outcomes. This study explores how patients with obesity perceive WS in general practice settings; its impact on their psychological well-being and health behaviours, and the patients suggestions for mitigating it.

METHODS

In-depth semistructured interviews were conducted with 11 PwO who had experienced WS in general practice settings in Ireland. The interviews were conducted online via Zoom between May and August 2023; interviews lasted between 31 and 63 min (M = 34.36 min). Interviews were audio-recorded, transcribed verbatim and analysed using inductive reflexive thematic analysis.

RESULTS

Three overarching themes specific to participants' experience of WS in general practice were generated: (1) shame, blame and 'failure'; (2) eat less, move more-the go-to treatment; (3) worthiness tied to compliance. A fourth theme: (4) the desire for a considered approach, outlines the participants' suggestions for reducing WS by improving the quality of patient-provider interactions in general practice.

CONCLUSION

The findings call for a paradigm shift in the management of obesity in general practice: emphasising training for GPs in weight-sensitive communication and promoting respectful, collaborative, and individualised care to reduce WS and improve outcomes for people with obesity.

PATIENT OR PUBLIC CONTRIBUTION

PPI collaborators played an active and equal role in shaping the research, contributing to the development of the research questions, refining the interview schedule, identifying key themes in the data, and granting final approval to the submitted and published version of the study.