1
|
Webber SC, Thille P, Liu K, Wittmeier K, Cain P. Determining Associations Among Health Orientation, Fitness Orientation, and Attitudes Toward Fatness in Physiotherapists and Physiotherapy Students Using Structural Equation Modeling. Physiother Can 2024; 76:220-229. [PMID: 38725602 PMCID: PMC11078247 DOI: 10.3138/ptc-2022-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/30/2022] [Accepted: 09/06/2022] [Indexed: 05/12/2024]
Abstract
Purpose Research suggests physiotherapists hold negative attitudes and beliefs toward fatness and fat people. Physiotherapists are also health-conscious, and invested in healthy lifestyle behaviours including physical activity. Our purpose was to describe relationships between health orientation, fitness orientation, and fat attitudes. Methods Physiotherapists (n = 187) and physiotherapy students (n = 34) completed an online survey (Health Orientation Scale, Multidimensional Body-Self Relations Questionnaire, Fat Attitudes Assessment Toolkit). Structural equation modeling estimated associations between fat attitudes (dependent variable) and health and fitness orientation (independent variables). Results Participants scored high in orientation toward fitness and health. We found strong positive associations between fitness orientation and health orientation (p < 0.001). Health orientation was not significantly associated with fat attitudes (p = 0.075), whereas increased age was associated with more positive fat attitudes (p < 0.01). Although most participants acknowledged that factors outside an individual's control contribute to body weight, many also agreed with normative negative perspectives. Conclusions Physiotherapists are highly oriented toward fitness and health. This may underlie beliefs in the controllability of body weight and contribute to negative attitudes toward fatness and fat people. Further research, with greater sample sizes is necessary to further investigate associations between health orientation and fat attitudes.
Collapse
Affiliation(s)
- Sandra C. Webber
- From the:
Department of Physiotherapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Patricia Thille
- From the:
Department of Physiotherapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kun Liu
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kristy Wittmeier
- Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Patricia Cain
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| |
Collapse
|
2
|
Termaat J, Piya MK, McBride KA. Community-based care needs for adults with class III obesity before and after tertiary weight management: An exploratory study. Obes Sci Pract 2024; 10:e732. [PMID: 38213316 PMCID: PMC10782639 DOI: 10.1002/osp4.732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/27/2023] [Accepted: 12/04/2023] [Indexed: 01/13/2024] Open
Abstract
Objective Class 3 obesity (severe obesity) is defined by a body mass index ≥40 kg/m2. Tertiary weight-management programs (WMPs) are hospital-based multidisciplinary services that aim to support individuals with severe obesity. Severe shortage of WMPs has led to waitlists and pressure on clinicians to discharge patients. Community obesity management often fails to support patients in maintaining weight loss/health gains. This study aimed to explore the needs of patients for community-based obesity care. Methods A qualitative study was undertaken via a tertiary WMP in Sydney, Australia. Semi-structured interviews/focus groups explored perceptions of purposively sampled patients and their clinicians on the community-based support needs of people with severe obesity. Data were audio-recorded, transcribed verbatim, and then thematically analyzed. Results Eleven patients and seven clinicians were interviewed. Four themes were identified: the importance of accountability and motivation to maintain weight-loss/health gains; limitations within community-based obesity management for those with severe obesity; perspectives on structured community programs for patients transitioning into/out of tertiary WMPs; and impact of mental health, stigma, and social isolation on engagement with community-based services. Conclusions Community-based programs are needed to support those awaiting access to tertiary WMPs and to help maintain health gains once discharged. Such programs should address issues of social isolation and integrate with current models of tertiary metabolic and primary health care.
Collapse
Affiliation(s)
- Jillian Termaat
- School of MedicineWestern Sydney UniversityPenrithNew South WalesAustralia
| | - Milan K. Piya
- School of MedicineWestern Sydney UniversityPenrithNew South WalesAustralia
- South Western Sydney (SWS) Metabolic Rehabilitation and Bariatric ProgramCamden and Campbelltown HospitalsCamdenNew South WalesAustralia
- Translational Health Research InstituteWestern Sydney UniversityPenrithNew South WalesAustralia
| | - Kate A. McBride
- School of MedicineWestern Sydney UniversityPenrithNew South WalesAustralia
- Translational Health Research InstituteWestern Sydney UniversityPenrithNew South WalesAustralia
| |
Collapse
|
3
|
Tenedero CB, O'Brien KT, Patel BP, Strom M, Deveci AC, Chu L, Jayawardena S, Noseworthy R, McPherson AC, Walsh CM, Hamilton JK. Medical students' perceived comfort and competence performing physical examinations on patients with obesity: A mixed-methods needs assessment. Clin Obes 2024; 14:e12617. [PMID: 37559427 DOI: 10.1111/cob.12617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/16/2023] [Accepted: 07/26/2023] [Indexed: 08/11/2023]
Abstract
Physicians are unsatisfied with their training in the care of patients with obesity. Physical examination is a key component of care, and modifications to techniques are often necessary for patients with obesity. To determine learning needs, we examined medical students' perceived comfort and competency in conducting physical examinations on patients with obesity. This mixed-methods study of Canadian medical students used a questionnaire and semi-structured focus groups to assess medical students' perceived comfort and competence in examining patients with obesity. Participants included 175 Canadian medical students. A minority of medical students felt comfortable (42%) or competent (14%) examining patients with obesity. Physical exam challenges included modifying exam manoeuvres, interpreting findings and communicating sensitively around weight. Lack of early exposure to patients with obesity, minimal instruction by preceptors and a lack of curricular focus on obesity were felt to be barriers to improving these skills. Students perceived their lack of confidence as negatively impacting their ability to manage patients with obesity and more training in this area was desired to prevent disparities in care. Medical students feel that adequate training on how to perform an obesity-specific physical examination is lacking. Developing curricula and including formal teaching around these key competencies within medical education is essential.
Collapse
Affiliation(s)
- Christine B Tenedero
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | | | - Barkha P Patel
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Michele Strom
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Arin C Deveci
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lisa Chu
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | | | - Rebecca Noseworthy
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Amy C McPherson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Catharine M Walsh
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- SickKids Research and Learning Institutes, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jill K Hamilton
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
4
|
Dunham M. Obesity bias awareness decreases nursing students' bias toward patients with obesity. Nursing 2024; 54:56-60. [PMID: 38271133 DOI: 10.1097/01.nurse.0000998024.65699.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
PURPOSE To determine if obesity bias scores among nursing students changed after education was delivered and to what degree body mass index (BMI) was associated with a personal experience of bias during a student's healthcare history. METHODS A quantitative, quasi-experimental design was used to analyze sociodemographic information and Implicit Association Test scores of junior, senior, and full-time accelerated coursework track nursing students. RESULTS Generally, obesity bias declined among the group. However, bias increased regarding increasing BMI. CONCLUSION Obesity bias awareness and obesity education can decrease obesity bias among nursing students.
Collapse
Affiliation(s)
- Marguerite Dunham
- Marguerite Dunham is an NP and the program coordinator in Bariatric Surgery for Comprehensive Weight Management at Jefferson Health-Abington
| |
Collapse
|
5
|
Marshall C, Estes SJ. Reproductive Surgery in Females with Obesity: Reproductive Consequences of Obesity and Applications for Surgical Care. Semin Reprod Med 2023; 41:97-107. [PMID: 37967852 DOI: 10.1055/s-0043-1776915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Obesity is the most common medical problem in women of reproductive age. The surgical applications for this population, many of who are interested in current or future fertility, are critical to safe and effective evaluation and management of issues that impact the reproductive system. As rates of obesity continue to rise worldwide, it is projected that one in two individuals will have obesity by 2030 leading to increasing numbers of individuals affected by a disease process that has implications for their gynecologic surgical care, fertility-related assessment, and infertility treatment. Offering patients with obesity access to safe reproductive surgery is a cornerstone of reproductive autonomy. This review will summarize current recommendations regarding surgical concepts for the operating room, office hysteroscopy, oocyte retrieval, and embryo transfer in female patients with obesity.
Collapse
Affiliation(s)
- Ciara Marshall
- Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Stephanie J Estes
- Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
- Division of Reproductive Endocrinology and Infertility, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| |
Collapse
|
6
|
Ebner DW, Burger KN, Broderick B, Mahoney DW, Kellogg TA, Acosta A, Kisiel JB. Positive Predictive Value for Multitarget Stool DNA After Bariatric and Metabolic Surgery. GASTRO HEP ADVANCES 2023; 2:902-910. [PMID: 37876832 PMCID: PMC10597571 DOI: 10.1016/j.gastha.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
BACKGROUND AND AIMS Bariatric and metabolic surgery (BMS) may adversely affect noninvasive stool tests for colorectal cancer (CRC) screening through several mechanisms. Multitarget stool DNA (mt-sDNA) is approved for CRC screening; however, performance in post-BMS patients is unknown. As the rates of BMS are anticipated to increase with rising incidence of obesity, it is important to evaluate mt-sDNA test performance among these patients. METHODS In a multisite academic and community-based practice, we obtained mt-sDNA results from 10/2014 to 12/2019 through electronic records and an institutional BMS registry. Average CRC risk patients with BMS prior to a positive mt-sDNA underwent a detailed chart review. Follow-up colonoscopy findings were compared to those among BMS patients screened with colonoscopy alone and a historical cohort of patients without BMS, screened by mt-sDNA. The primary study endpoint was the positive predictive value (PPV) for advanced colorectal neoplasia. RESULTS Among 336 average-risk patients who had mt-sDNA after BMS, mt-sDNA was positive in 49 (14.6%), 47/49 (96%) underwent follow-up colonoscopy, and the PPV for advanced neoplasia was 12/47 (25.5%). This is similar to the PPV for advanced colorectal neoplasia (425/1542, 28%) in a historical cohort of persons without prior BMS, screened by mt-sDNA at our center (P = .86). Among those who had prior BMS, the rate of advanced neoplasia was higher after mt-sDNA compared to screening colonoscopy alone. CONCLUSION Despite anatomic and physiologic mechanisms that could alter blood or DNA content in stool, BMS does not appear to adversely affect the PPV of mt-sDNA.
Collapse
Affiliation(s)
- Derek W. Ebner
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Kelli N. Burger
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota
| | - Brendan Broderick
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota
| | - Douglas W. Mahoney
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota
| | - Todd A. Kellogg
- Division of Endocrine & Metabolic Surgery, Mayo Clinic, Rochester, USA Minnesota
| | - Andres Acosta
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - John B. Kisiel
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
7
|
Pham A, Camfield C, Curtis A, Sumerwell C, Ahrens KR, Hodax J. A Mixed Methods Study on Healthcare Transition From Pediatric to Adult Care in Transgender and Gender-Diverse Adolescents and Young Adults. J Adolesc Health 2023:S1054-139X(23)00213-6. [PMID: 37294254 DOI: 10.1016/j.jadohealth.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE This study assessed healthcare transition (HCT) readiness and barriers to HCT among transgender and gender diverse (TGD) adolescent and young adults (AYA) using mixed-method techniques. METHODS Fifty TGD AYA participants were surveyed using a validated transition readiness assessment questionnaire and open-ended questions examining challenges, influential factors, and health implications of HCT. Open-ended responses underwent qualitative analysis to identify consistent themes and response frequency. RESULTS Participants felt most prepared for communicating with providers and completing medical forms and least prepared for navigating insurance/financial systems. Half of the participants anticipated worsening mental health during HCT, with additional concerns related to transfer logistics and transphobia/discrimination. Participants identified intrinsic skills and external factors (such as social relationships) that would contribute to a more successful HCT. DISCUSSION TGD AYA face unique challenges in navigating the transition to adult health care, particularly related to concerns of discrimination and negative impacts on mental health, but these challenges may be mitigated by certain intrinsic resilience factors as well as targeted support from personal networks and pediatric providers.
Collapse
Affiliation(s)
- An Pham
- Seattle Children's Hospital, Division of Adolescent Medicine, Seattle, Washington.
| | | | - Amy Curtis
- Seattle Children's Hospital, Division of Child and Adolescent Psychiatry, Seattle Washington
| | - Catherine Sumerwell
- Seattle Children's Hospital, Division of Adolescent Medicine, Seattle, Washington
| | - Kym R Ahrens
- Seattle Children's Hospital, Division of Adolescent Medicine, Seattle, Washington; Seattle Children's Research Institute, Seattle, Washington
| | - Juanita Hodax
- Seattle Children's Hospital, Division of Endocrinology, Seattle Washington
| |
Collapse
|
8
|
Haș IM, Teleky BE, Vodnar DC, Ștefănescu BE, Tit DM, Nițescu M. Polyphenols and Cardiometabolic Health: Knowledge and Concern among Romanian People. Nutrients 2023; 15:nu15102281. [PMID: 37242164 DOI: 10.3390/nu15102281] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
The cardiometabolic health of the population is a crucial indicator of public health, considering the significant impact of cardiovascular disease (CVD) and diabetes on global mortality. Determining the population's knowledge and the predictors of these pathologies is essential in developing effective educational and clinical strategies for the prevention and management of cardiometabolic risk (CMR). Polyphenols are natural compounds with a multitude of beneficial effects on cardiometabolic health. This study explored the current knowledge, understanding, and awareness of CMR, the benefits of polyphenols among Romanians, and how sociodemographic and clinical characteristics influence this aspect. Five hundred forty-six subjects responded anonymously to an online questionnaire designed to assess their knowledge. The data were collected and analyzed based on gender, age, education level, and BMI status. Most respondents expressed concern to a great or very great extent about their health (78%) and food (60%), with significant differences (p < 0.05) depending on age, educational level, and BMI status. Of the respondents, 64.8% declared that they were familiar with the CMR term. Still, the results showed a weak correlation between the stated risk factors and the self-assessment of increased risk (r = 0.027) for CVD or diabetes. Only 35% of the respondents reported a good or very good knowledge of the term "polyphenols", 86% recognized the antioxidant effect, and significantly fewer (26%) recognized the prebiotic effect. Developing and implementing targeted educational strategies to enhance learning and individual behaviors related to CMR factors and the benefits of polyphenols is necessary.
Collapse
Affiliation(s)
- Ioana Mariana Haș
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania
| | - Bernadette-Emőke Teleky
- Institute of Life Sciences, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania
- Department of Food Science and Technology, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania
| | - Dan-Cristian Vodnar
- Institute of Life Sciences, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania
- Department of Food Science and Technology, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania
| | - Bianca Eugenia Ștefănescu
- Institute of Life Sciences, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania
| | - Delia Mirela Tit
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 29 N. Jiga St., 410028 Oradea, Romania
| | - Maria Nițescu
- Department of Preclinical-Complementary Sciences, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania
| |
Collapse
|
9
|
Welberry HJ, Chau T, Heffernan M, San Jose JC, Jorm LR, Singh MF, Sachdev PS, Anstey KJ, Lautenschlager NT, Valenzuela M, McNeil J, Brodaty H. Factors Associated with Participation in a Multidomain Web-Based Dementia Prevention Trial: Evidence from Maintain Your Brain (MYB). J Alzheimers Dis 2023; 92:959-974. [PMID: 36806506 DOI: 10.3233/jad-220990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND The Maintain Your Brain (MYB) trial aims to prevent cognitive decline and dementia through multidomain, web-based risk-reduction. To facilitate translation, it is important to understand drivers of participation. OBJECTIVE To describe characteristics associated with participation in MYB. METHODS This was an observational ancillary study of MYB, a randomized controlled trial nested within the 45 and Up Study in New South Wales, Australia. We linked 45 and Up Study survey and MYB participation data. The study cohort comprised 45 and Up Study participants, aged 55-77 years at 1 January 2018, who were invited to participate in MYB. 45 and Up Study participant characteristics and subsequent MYB consent and participation were examined. RESULTS Of 98,836 invited, 13,882 (14%) consented to participate and 6,190 participated (6%). Adjusting for age and sex, a wide range of factors were related to participation. Higher educational attainment had the strongest relationship with increased MYB participation (university versus school non-completion; AdjOR = 5.15; 95% CI:4.70-5.64) and lower self-rated quality of life with reduced participation (Poor versus Excellent: AdjOR = 0.19; 95% CI:0.11-0.32). A family history of Alzheimer's disease was related to increased participation but most other dementia risk factors such as diabetes, obesity, stroke, high blood pressure, and current smoking were associated with reduced participation. CONCLUSION Higher socio-economic status, particularly educational attainment, is strongly associated with engagement in online dementia prevention research. Increasing population awareness of dementia risk factors, and better understanding the participation barriers in at-risk groups, is necessary to ensure online interventions are optimally designed to promote maximum participation.
Collapse
Affiliation(s)
- Heidi J Welberry
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia.,Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Tiffany Chau
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Megan Heffernan
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Juan Carlo San Jose
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Louisa R Jorm
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Maria Fiaratone Singh
- School of Health Sciences and Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Kaarin J Anstey
- UNSW Ageing Futures Institute, University of New South Wales, Sydney, New South Wales, Australia.,School of Psychology, University of New South Wales, Sydney, Australia.,Neuroscience Research Australia
| | - Nicola T Lautenschlager
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, Australia.,North Western Mental Health, Royal Melbourne Hospital, Parkville, Australia
| | - Michael Valenzuela
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Henry Brodaty
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
10
|
Hart S. Weight stigma an unacceptable burden: Pervasive bias robs patients of appropriate, compassionate care. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:608-609. [PMID: 35961716 PMCID: PMC9374072 DOI: 10.46747/cfp.6808608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Stephanie Hart
- Family physician in Okotoks, Alta, with a practice dedicated to sexual health
| |
Collapse
|
11
|
Medical avoidance among marginalized groups: the impact of the COVID-19 pandemic. J Behav Med 2022; 45:760-770. [PMID: 35688960 PMCID: PMC9186488 DOI: 10.1007/s10865-022-00332-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/12/2022] [Indexed: 11/16/2022]
Abstract
Medical avoidance is common among U.S. adults, and may be emphasized among members of marginalized communities due to discrimination concerns. In the current study, we investigated whether this disparity in avoidance was maintained or exacerbated during the onset of the COVID-19 pandemic. We assessed the likelihood of avoiding medical care due to general-, discrimination-, and COVID-19-related concerns in an online sample (N = 471). As hypothesized, marginalized groups (i.e., non-White race, Latinx/e ethnicity, non-heterosexual sexual orientation, high BMI) endorsed more general- and discrimination-related medical avoidance than majoritized groups. However, marginalized groups were equally likely to seek COVID-19 treatment as majoritized groups. Implications for reducing medical avoidance among marginalized groups are discussed.
Collapse
|
12
|
Klobodu SS, Mensah PA, Willis M, Bailey D. Weight Bias Among Nutrition and Dietetics Students in a Ghanaian Public University. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:406-411. [PMID: 35351356 DOI: 10.1016/j.jneb.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 01/15/2022] [Accepted: 01/23/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To measure the internal consistency reliability of 3 weight bias scales among nutrition and dietetics students enrolled at a public university in Ghana and to use the Fat Phobia Scale (FPS) to determine the prevalence of weight bias and the differences in gender and body mass index. DESIGN Online survey gathered self-reported height, weight, and demographic data. Explicit weight bias was assessed using validated FPS, Beliefs About Obese People, and Attitudes Toward Obese Persons scales. PARTICIPANTS Sample of 172 students. MAIN OUTCOME MEASURES Prevalence of weight bias. ANALYSIS Cronbach α reliability test was used to measure the internal consistency of scales. The prevalence of weight bias was expressed as a percentage. Independent t tests and analysis of variance were used to explore differences in gender and weight categories. RESULTS The reliability scores for FPS, Beliefs About Obese People, and Attitudes Toward Obese Persons scales were 0.92, 0.51, and 0.38, respectively. About 53% of participants expressed weight bias. A significant difference was observed for weight bias between overweight and obese participants, with participants with obesity showing greater weight bias (P = 0.03). CONCLUSION AND IMPLICATIONS Fat Phobia Scale (most reliable) identified more than half of the students had a negative attitude toward obesity. Weight bias training within this population may improve attitudes toward obesity.
Collapse
Affiliation(s)
- Seth Selorm Klobodu
- Department of Nutrition and Food Science, California State University, Chico, CA.
| | - Peace Akua Mensah
- Department of Nutrition and Food Science, University of Ghana, Legon, Ghana
| | - Mariah Willis
- Psychology Department, California State University, Chico, CA
| | | |
Collapse
|
13
|
Sagi-Dain L, Echar M, Paska-Davis N. Experiences of weight stigmatization in the Israeli healthcare system among overweight and obese individuals. Isr J Health Policy Res 2022; 11:5. [PMID: 35101130 PMCID: PMC8802507 DOI: 10.1186/s13584-022-00518-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 01/19/2022] [Indexed: 12/22/2022] Open
Abstract
Introduction Weight stigmatization, a common phenomenon in the healthcare system, exerts numerous adverse consequences on patients' wellbeing. The objective of this study was to estimate the extent and characteristics of weight stigmatization in Israel, based on the reports of overweight and obese individuals. Methods This study was performed by distribution of a cross-sectional open anonymous survey in social media platforms, targeting respondents with body mass index over 25 kg/m2. The questionnaire consisted of Likert-scale based as well as open-ended questions, evaluating the experience during past medical appointments. Our primary outcome was the prevalence of disrespectful treatment. Subgroup analysis was performed by various demographic characteristics. Results Of the 1697 respondents, 59.0% reported frequent experiences of disrespectful approach, and 48.6% noted receiving suboptimal treatment related to excess weight. Insulting, insensitive and judgmental comments were noted by 58%, stemming from diverse healthcare disciplines, while 29.3% noted office equipment not suitable for overweight people. Avoidance of a needed medical appointment was reported by 40.5%, significantly associated with past adverse experiences of weight stigmatization in the healthcare system. The respondents offered numerous suggestions to improve the existing situation, including education of the medical personnel, thorough research of obesity, and establishment of specific guidelines for approach to patients with excess weight. Conclusion Weight stigmatization is prevalent in Israeli healthcare system; thus, decreasing the rates of this phenomenon should be an important national goal. Formal education about the wide prevalence and adverse effects of weight stigmatization should be practiced by academic institutions, professional organizations, and regulatory bodies. Straightforward policies with continuing supervision should be endorsed by the healthcare system to prevent weight-based discrimination. Finally, appropriate-size equipment for obese patients should become one of the requirements for accreditation of medical centers and facilities. Supplementary Information The online version contains supplementary material available at 10.1186/s13584-022-00518-9.
Collapse
|
14
|
Jungnickel T, von Jan U, Engeli S, Albrecht UV. Exploring the weight bias of professionals working in the field of obesity with a mobile IAT: a pilot study. Ther Adv Endocrinol Metab 2022; 13:20420188221098881. [PMID: 35592657 PMCID: PMC9112301 DOI: 10.1177/20420188221098881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 04/19/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Obesity is common in many industrialized nations and often accompanied by related health issues. Furthermore, individuals living with overweight or obesity are often confronted with stigmatization in their daily lives. These problems may be aggravated if the objectivity of health care professionals is compromised due to (unconscious) prejudices. If pharmaceutical companies, regulatory agencies, and health insurers are also susceptible to these biases, decisions related to the development, approval, and reimbursement of obesity-related therapies may be negatively impacted. MATERIALS AND METHODS The 'Implicit Association Test' (IAT) is a psychometric test allowing to measure these attitudes and could therefore assist to reveal unconscious preferences. A self-developed mobile version, in the form of a ResearchKit-based IAT app was employed in the presented study. The objective was to determine (potential) weight bias and its characteristics for professionals attending a national obesity-related conference in Germany (G1), compared to a control group (without stated interest in the topic, G2) - both using the mobile app - and a historical control (G3) based on data provided by Project Implicit acquired by a web app. RESULTS Explicit evaluations of G1 were neutral at a higher percentage compared with G2 and G3, while implicit preference toward lean individuals did not differ significantly between G2 and G3, and G1. CONCLUSION The greater discrepancy between the (more neutral) explicit attitude and the unconscious preference pointing in the anti-obesity direction could indicate an underestimated bias for the professional participants in G1. Implicit preference is often ingrained from childhood on, and difficult to overcome. Thus, even for professionals, it may unconsciously influence decisions made in the care they provide. Professionals in any given health care sector directed at obesity care should thus be made aware of this inconsistency to enable them to consciously counteract this potential effect.
Collapse
Affiliation(s)
- Tobias Jungnickel
- Peter L. Reichertz Institute for Medical
Informatics of the TU Braunschweig and Hannover Medical School, Hannover
Medical School, Hannover, Germany
| | - Ute von Jan
- Peter L. Reichertz Institute for Medical
Informatics of the TU Braunschweig and Hannover Medical School, Hannover
Medical School, Hannover, Germany
| | | | - Urs-Vito Albrecht
- Peter L. Reichertz Institute for Medical
Informatics of the TU Braunschweig and Hannover Medical School, Hannover
Medical School, Hannover, Germany
- Department of Digital Medicine, Medical Faculty
OWL, Bielefeld University, Bielefeld, Germany
| |
Collapse
|
15
|
Nestorowicz S, Saks N. Addressing Bias Toward Overweight Patients: a Training Program for First-Year Medical Students. MEDICAL SCIENCE EDUCATOR 2021; 31:1115-1123. [PMID: 34457955 PMCID: PMC8368903 DOI: 10.1007/s40670-021-01282-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 05/29/2023]
Abstract
BACKGROUND Physicians may have biases toward overweight patients which likely influences clinical judgments and can lead to disparities in patient care. An increasing number of adults are considered overweight/obese, so it is important to address these biases in training future physicians. METHODS Forty-five first-year medical students participated in art museum programs and physician presentations, or were part of the control group. Four validated measures Beliefs About Obese Persons Scale, Attitudes Toward Obese Persons Scale, Fat Phobia Scale, and the Harvard Implicit Association Test (IAT) and researcher-generated questions, measured levels of bias before and after study activities. RESULTS All participants demonstrated decreased bias. ANCOVA analysis did not reveal significant differences between the experimental and control groups. However, prior to the study 75% of participants had "preference for thin individuals." Forty percent of those participating in study activities indicated a positive change by associating more positive traits with obese body shapes, compared to 29% of the control group. Study activities were rated positively. DISCUSSION/CONCLUSION The art museum was an engaging/relaxing place for reflection on body types and biases. Physicians provided important instruction for normalization/de-stigmatization of patient care. Although there were no significant findings, the study has raised questions for continuing this work. What are most effective ways/times to address weight bias within the medical school curriculum? Could this work extend to other marginalized patient groups? The diversity in art and humanities creates a rich resource for discussing viewpoints and experiences. The small number of participants and the timing/lack of focus in museum sessions are noted as limitations.
Collapse
Affiliation(s)
| | - Norma Saks
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ USA
| |
Collapse
|
16
|
Boyce TM, Neiterman E. Women in larger bodies' experiences with contraception: a scoping review. Reprod Health 2021; 18:89. [PMID: 33926501 PMCID: PMC8082612 DOI: 10.1186/s12978-021-01139-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/12/2021] [Indexed: 01/29/2023] Open
Abstract
Background As the prevalence of obesity increases and the age of onset decreases, more women of reproductive age will be living in larger bodies. Research on weight-related efficacy and safety has informed clinical guidelines for routine and emergency contraceptive use by women with a higher body mass index; however, patient perspectives are needed to understand women in larger bodies’ experiences with contraception and contraceptive care. This scoping review summarizes the literature on women in larger bodies’ experiences with contraception with the goal of gaining a better understanding of the nature of these experiences and identifying gaps in the existing research. Methods Following Arksey and O’Malley’s framework, a scoping review of the literature was conducted. Four databases (PubMed, PsycINFO, SCOPUS, and CINAHL) were searched for peer-reviewed, empirical articles published in English between 2010 and 2020, with a focus on North America, Europe, Australia, and New Zealand. Data were summarized by identifying key themes in the reviewed literature. Results Twenty-nine articles meeting the eligibility criteria were reviewed. The literature was predominantly quantitative (n = 27), with only one qualitative study and one systematic review, respectively. Five themes were identified, including (1) use of contraception among women in larger bodies; (2) knowledge, attitudes towards and beliefs about contraception; (3) contraceptive (dis)satisfaction among women in larger bodies; (4) contraceptive counseling; and (5) barriers to contraception. The findings revealed that women in larger bodies may have unmet contraceptive care needs. Despite many articles addressing the need to improve contraceptive counseling for women in larger bodies (n = 26), few explored how women felt about their care (n = 2). Finally, only two articles focused on emergency contraception, indicating a need for further research. Conclusion This scoping review emphasizes the pressing need for qualitative research to explore women in larger bodies’ experiences with routine and emergency contraception, as well as receiving contraceptive counseling and care. Future research exploring the lived experiences of women in larger bodies is necessary to better characterize their contraceptive needs and identify avenues to improve patient care. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01139-2. As obesity becomes more prevalent, more women of reproductive age will be living in larger bodies. This review highlights what is known about women in larger bodies’ experiences with contraception and suggests where future research is needed. We searched four databases for papers published in English from 2010 to 2020. Our review included 29 articles. Nearly all of the studies were quantitative, with one qualitative study and one review. Most articles talked about contraceptive use, but few of them included emergency contraception. Some papers highlighted women’s knowledge and opinions about contraception, whereas others talked about their contraceptive (dis)satisfaction. Many articles discussed contraceptive counseling. Finally, some papers considered potential barriers to contraception. Our findings suggest that women in larger bodies have unmet contraceptive needs. Notably, this review aimed to focus on patient experiences but women’s voices were rarely represented. Future qualitative research on women’s lived experiences will provide a better understanding of women in larger bodies’ contraceptive needs and suggest how care can be improved.
Collapse
Affiliation(s)
- Tierney M Boyce
- School of Public Health and Health Systems, Faculty of Health, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Elena Neiterman
- School of Public Health and Health Systems, Faculty of Health, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| |
Collapse
|
17
|
Endoscopy in the Morbidly Obese: A Case Highlighting Healthcare Inequities. Am J Gastroenterol 2021; 116:229-233. [PMID: 33337658 DOI: 10.14309/ajg.0000000000001081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/23/2020] [Indexed: 12/11/2022]
|
18
|
Erridge S, Moussa O, McIntyre C, Hariri A, Tolley N, Kotecha B, Purkayastha S. Obstructive Sleep Apnea in Obese Patients: a UK Population Analysis. Obes Surg 2021; 31:1986-1993. [PMID: 33423181 PMCID: PMC8041687 DOI: 10.1007/s11695-020-05196-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/25/2020] [Accepted: 12/29/2020] [Indexed: 11/29/2022]
Abstract
Background Obstructive sleep apnea (OSA) is an increasingly common disorder associated with increased cardiovascular disease, mortality, reduced productivity, and an increased risk of road traffic accidents. A significant proportion of patients with OSA in the UK are undiagnosed. This study aims to identify risk factors for OSA in an obese cohort. Method A population-based study was conducted of obese patients (BMI ≥ 30 kg/m2) from the Clinical Practice Research Datalink (CPRD). A logistic regression model was used to calculate odds ratios (ORs) for developing OSA according to other clinicopathological characteristics. Multivariate analysis was conducted of individual factors that affect the propensity to develop OSA. Statistical significance was defined as p < 0.050. Results From 276,600 obese patients identified during a data extraction of the CPRD in July 2017, the prevalence of OSA was 5.4%. The following risk factors were found to be independently associated with increased likelihood of OSA: male sex (OR = 3.273; p < 0.001), BMI class II (OR = 1.640; p < 0.001), BMI class III (OR = 3.768; p < 0.001), smoking (OR = 1.179; p < 0.001), COPD (OR = 1.722; p < 0.001), GERD (OR = 1.557; p < 0.001), hypothyroidism (OR = 1.311; p < 0.001), acromegaly (OR = 3.543; p < 0.001), and benzodiazepine use (OR = 1.492; p < 0.001). Bariatric surgery was associated with reduced risk of OSA amongst this obese population (OR = 0.260; p < 0.001). Conclusions In obese patients, there are numerous comorbidities that are associated with increased likelihood of OSA. These factors can help prompt clinicians to identify undiagnosed OSA. Bariatric surgery appears to be protective against developing OSA.
Collapse
Affiliation(s)
- S Erridge
- Division of Surgery, Department of Surgery & Cancer, Imperial College London, Academic Surgical Unit, 10th Floor QEQM, St Mary's Hospital, South Wharf Road, London, W2 1NY, UK.
| | - O Moussa
- Division of Surgery, Department of Surgery & Cancer, Imperial College London, Academic Surgical Unit, 10th Floor QEQM, St Mary's Hospital, South Wharf Road, London, W2 1NY, UK
| | - C McIntyre
- Division of Surgery, Department of Surgery & Cancer, Imperial College London, Academic Surgical Unit, 10th Floor QEQM, St Mary's Hospital, South Wharf Road, London, W2 1NY, UK
| | - A Hariri
- Department of Otolaryngology, Head and Neck Surgery, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - N Tolley
- Department of Otolaryngology, Head and Neck Surgery, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - B Kotecha
- Department of Otolaryngology, Head and Neck Surgery, Royal National Throat, Nose and Ear Hospital, Gray's Inn Road, London, WC1X 8DA, UK
| | - S Purkayastha
- Division of Surgery, Department of Surgery & Cancer, Imperial College London, Academic Surgical Unit, 10th Floor QEQM, St Mary's Hospital, South Wharf Road, London, W2 1NY, UK
| |
Collapse
|
19
|
Tarozo M, Pessa RP. Impacto das Consequências Psicossociais do Estigma do Peso no Tratamento da Obesidade: uma Revisão Integrativa da Literatura. PSICOLOGIA: CIÊNCIA E PROFISSÃO 2020. [DOI: 10.1590/1982-3703003190910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Trata-se de uma revisão integrativa da literatura, cujo objetivo foi investigar as consequências psicossociais do estigma do peso em adultos e sua influência no tratamento da obesidade. A busca envolveu as bases de dados PubMed, Web of Science e PsycINFO e incluiu artigos em inglês e português publicados nos últimos cinco anos. Foram selecionados quinze artigos, analisados a partir da definição de dois subtemas: “A relação entre estigma, psicopatologias e transtornos do comportamento alimentar” e “A estigmatização entre os profissionais de saúde”. Os resultados apontam para o grande impacto do estigma do peso na saúde psicossocial da pessoa com obesidade e para as atitudes estigmatizantes dos profissionais de saúde no cuidado terapêutico. Observa-se um enfoque patológico do enfrentamento da obesidade com estratégias de cunho comportamental que minimizam a compreensão da problemática. Atualmente, o tratamento da obesidade promovido pelo modelo biomédico não abrange as demandas de caráter psicossocial, o que torna necessário a educação permanente para capacitação dos profissionais de saúde e a implementação de protocolos de intervenção específicos a este grupo populacional. A contribuição de profissionais de diversas áreas, e em especial, daqueles de saúde mental, é essencial em atenção às diferentes particularidades do tratamento, devendo ser baseada em uma perspectiva integral e humanizada, e inserida nos diferentes contextos psicossociais. Devido à perversidade do estigma do peso e suas graves consequências, futuros estudos são necessários para investigação desse problema e das atitudes dos profissionais da saúde, familiares, mídia e da população em geral em relação à pessoa com obesidade.
Collapse
|
20
|
Jones CA, Forhan M. Addressing weight bias and stigma of obesity amongst physiotherapists. Physiother Theory Pract 2019; 37:808-816. [PMID: 31362578 DOI: 10.1080/09593985.2019.1648623] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Backgound: Physiotherapists, as with all other healthcare professionals, report attitudes toward patients with obesity and beliefs about obesity that contribute to weight bias and stigma. Objectives: Determine if physiotherapists' attitudes and/or beliefs changed after attending an educational seminar that included content about the challenges faced by patients with obesity undergoing joint replacement and strategies on how to work effectively and sensitively with this population.Methods: Physiotherapists completed a survey before and after attending a one day seminar to evaluate attitudes (The Attitude Towards Obese Persons, ATOP) and beliefs (Beliefs About Obese Persons, BAOP) towards obesity. To provide a reference, the seminar group's attitudes and beliefs were compared to a provincial cohort of 383 physiotherapists who completed the online version of the survey.Results: The pre-seminar mean ATOP score (71.3 ± 19.3) was similar to the online mean score (72.6 ± 15.3) (p = .66). The post-seminar ATOP score decreased (63.6 ± 15.9) (p = .02) indicating greater negative attitudes. The mean difference of the seminar BAOP showed a modest increase (mean difference 4.6, p = .001) indicating that participants believed obesity was less in control of the individual.Conclusions: Seminar information presented by respected and trusted leaders did not challenge participants' implicit attitudes and beliefs towards obesity. Further evaluation of theory-driven approaches specifically targeting physiotherapists is needed to address stigmatization within the profession.
Collapse
Affiliation(s)
- C Allyson Jones
- Faculty of Rehabilitation Medicine, 2-50 Corbett Hall, University of Alberta, Edmonton, AB, Canada
| | - Mary Forhan
- Faculty of Rehabilitation Medicine, 2-50 Corbett Hall, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
21
|
Jiao J. Introduction to AIMS Special Issue "Obesity and Food Intake in Vulnerable Populations". AIMS Public Health 2015; 2:161-162. [PMID: 29546101 PMCID: PMC5690376 DOI: 10.3934/publichealth.2015.1.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 03/31/2015] [Indexed: 11/20/2022] Open
Affiliation(s)
- Junfeng Jiao
- Urban Information Lab, School of Architecture, The University of Texas at Austin, Austin, Texas, TX 78712, USA
| |
Collapse
|