Bariatric Times

APR 2017

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

Issue link: https://bariatrictimes.epubxp.com/i/813249

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11 Brief Report Bariatric Times • April 2017 e v e r y t h i n g . " S h e t r i e d t o s o o t h e h i m b y s a y i n g t h a t t h e y w e r e d o i n g i t t o g e t h e r a n d h e w a s " s u p e r v i s i n g " . An o t h e r p a r t i c i p a n t c o m m e n t e d , " Y e a h , I s t a r t e d d o i n g s o m e w a l k i n g a n d , m a n , m y k n e e s s t a r t e d h u r t i n g . I' v e n e v e r h a d m y k n e e s h u r t . It fe l t l i k e e v e r y t h i n g w a s k i n d o f l i k e g o i n g s o u t h o n m e . " D I S C U S S I O N T h e s e a c c o u n t s i n t h e p a r t i c i p a n t s ' o w n v o i c e s s t a n d a s a s h a r p r e m i n d e r t h a t i n d i v i d u a l s w i t h o b e s i t y s u ffe r a s a r e s u l t o f t h e d i s e a s e . O b e s i t y e x p o s e s p a t i e n t s t o t h e r i s k o f e m b a r r a s s m e n t , fr u s t r a t i o n , a n d h o p e l e s s n e s s . It i s r e a l a n d p o i g n a n t , a n d t h e s e i n d i g n i t i e s a r e n o t e a s i l y a m e l i o r a t e d , e s p e c i a l l y a s m a n y o f t h e m a r e b o l s t e r e d b y o p i n i o n s a n d c o m m e n t s o f i n d i v i d u a l s c l o s e t o t h e p a t i e n t s , s u c h a s fa m i l y m e m b e r s , a n d t h u s a r e e v e n m o r e p a i n fu l . H e a l t h c a r e p r o v i d e r s d e fi n e t h e i r r o l e a s c u r i n g d i s e a s e a n d a l l e v i a t i n g p a i n a n d s u ffe r i n g , b u t w i d e s p r e a d r e p o r t s o f w e i g h t d i s c r i m i n a t i o n a m o n g t h i s g r o u p s u g g e s t t h a t t h e s y m p t o m s a n d t h e a c c o m p a n y i n g d i s a b i l i t i e s o f o b e s i t y a r e n o t v i e w e d b y p r o v i d e r s a s p a i n fu l o r t h e c a u s e o f s u ffe r i n g . T h e o bv i o u s qu e s t i o n i s , " Ho w d o w e a s h e a l t h c a r e p r o fe s s i o n a l s c h a n g e t h e s e a t t i t u d e s i n bo t h o u r s e l v e s a n d o t h e r s ?" T h e l i t e r a t u r e c o n t a i n s s e v e r a l r e p o r t s o f a t t e m p t s t o c h a n g e n e g a t i v e s t e r e o t y p e s a n d t h e s e s t i g m a r e d u c t i o n s t r a t e g i e s h a v e y i e l d e d v a r y i n g r e s u l t s . C i a o a n d La t n e r 1 2 t e s t e d t w o a p p r o a c h e s t o r e d u c i n g s t i g m a . O' B r i e n e t a l 1 4 d i d fo c u s i n p a r t i c u l a r o n c h a n g i n g n e g a t i v e a t t i t u d e s o f h e a l t h c a r e p r o v i d e r s . B u r m e i s t e r e t a l 1 5 t e s t e d a fi l m i n t e r v e n t i o n . T o d a t e , n o i n t e r v e n t i o n h a s e m e r g e d a s o v e r w h e l m i n g l y s u c c e s s fu l . R e be c c a P u h l , Di r e c t o r o f R e s e a r c h & W e i g h t S t i g m a In i t i a t i v e s a t t h e R u d d C e n t e r fo r F o o d P o l i c y & Obe s i t y a t Y a l e U n i v e r s i t y , Ne w Ha v e n, Co nne c t ic ut , ha s r e la y e d st ig ma - r e duc t io n st r a t e g ie s, inc luding c ha lle ng ing pe r so na l a ssumpt io ns a nd st e r e o t y pe s, a nd using a ppr o pr ia t e a nd se nsit iv e la ng ua g e a bo ut w e ig ht . 1 6 W e pr o po se a n a ppr o a c h t ha t inv o lv e s e xa mining o ur o w n be lie fs, r e fr a ming o ur o w n v ie w o f t he pa t ie nt , a nd c o nfr o nt ing bia se s o n both an interpersonal and system- wide basis. This approach also involves engaging in sympathetic dialogue with patients with obesity concerning the benefits of bariatric s u r g e r y , r e c o g n i z i n g t h a t , fo r s o m e , i t i s a " l a s t r e s o r t " i n l o s i n g w e i g h t a n d a l l e v i a t i n g c o m o r b i d i t i e s . S t e p 1. E x a m i n e o u r o w n t h i n k i n g f o r n e g a t i v e s t e r e o t y p e s a n d b i a s . D o w e p e r s o n a l l y fi n d t h e p a t i e n t w i t h o b e s i t y t o b e u n a t t r a c t i v e , u n k e m p t , o r l a z y ? D o w e b e l i e v e t h a t t h e y a r e t o s o m e e x t e n t , r e s p o n s i b l e fo r t h e i r c o n d i t i o n ( i . e . , i s i t t h e i r " fa u l t " ? ) If s u c h e x a m i n a t i o n u n e a r t h s a n y n e g a t i v e a t t i t u d e s i n o u r s e l v e s , i t w o u l d b e u s e fu l t o " r e fr a m e " o u r p e r c e p t i o n s o f t h e p a t i e n t w i t h o b e s i t y S t e p 2—R e f r a m e o u r v i e w o f p a t i e n t s w i t h o b e s i t y . R e fr a m i n g o u r p e r c e p t i o n s o f t h e p a t i e n t w i t h o b e s i t y o r c h a n g i n g o u r t h i n k i n g t o s e e t h e p a t i e n t i n a m o r e s y m p a t h e t i c l i g h t , c a n b e h e l p fu l . P e r h a p s t h e p a t i e n t a p p e a r s u n a t t r a c t i v e , a t l e a s t t o s o m e e x t e n t , b e c a u s e h e o r s h e h a s " g i v e n u p " t r y i n g t o l o o k g o o d a s s u g g e s t e d b y o n e r e s p o n d e n t i n o u r s t u d y . If a p a t i e n t m o v e s s l o w l y , p e r h a p s i t i s n o t o u t o f l a z i n e s s b u t r a t h e r b e c a u s e o f a l a c k o f e n e r g y , p e r s i s t e n t fa t i g u e , a n d k n e e p a i n . R e fr a m i n g a l s o h e l p s p r o v i d e r s l i s t e n m o r e a t t e n t i v e l y . F o r t h o s e w h o d e a l w i t h o b e s i t y o n a d a i l y ba s i s , i t i s u n d e r s t a n d a bl e t o s e e e v e r y p r o bl e m i n t e r m s o f t h e p a t i e n t ' s o be s i t y , a n d t h u s be c o m e i n a t t e n t i v e t o o t h e r c o n c e r n s . W h e t h e r t h e c o n c e r n r e l a t e s t o o be s i t y o r s o m e o t h e r p r o bl e m , r e fr a m i n g o u r o w n p e r c e p t i o n p r o m o t e s a m o r e h o l i s t i c a n d s y m p a t h e t i c v i e w o f t h e p a t i e n t . S t e p 3—Co nf r o nt b i a s e s . W e c a n a l s o a t t e m p t t o c o n fr o n t t h e bi a s e s o f o t h e r s . W e w o u l d n o t t o l e r a t e c o m m e n t s m a d e a bo u t p a t i e n t s t h a t a r e r a c i a l l y o r g e n d e r - bi a s e d . Y e t , t h e n e g a t i v e a t t i t u d e s t o w a r d p a t i e n t s w i t h o be s i t y c a n r e s u l t i n s u c h c o m m e n t s fr o m h e a l t h c a r e p r o v i d e r s . T h e s a m e r e s p e c t a n d c o u r t e s y s h o u l d be e xt e n d e d t o p a t i e n t s w i t h o be s i t y a n d , s h o u l d o n e e n c o u n t e r s u c h c o m m e n t s a bo u t p a t i e n t s w i t h o be sit y fro m c o lle a g ue s, t he se sho uld be g e nt ly c o nfro nt e d. On sy st e m le v e l, w e c a n w o rk t o o v e rc o me so c ie t a l bia se s t o w a rd indiv idua ls w it h o be sit y . T he Obe sit y Ac t io n Co a lit io n (OAC) ha s a lo ng r e c o rd o f c ha lle ng ing suc h bia se s in t he g re a t e r so c ie t y , a nd it s a dv o c a c y w o rk sho uld be re c o g nize d a nd suppo rt e d. Adv o c a c y c a n c o me fro m other sources as well. For example, perhaps in the future we will see the discipline-specific professional organizations, such as the American Medical Society, American Nurses As s o c i a t i o n , t h e N a t i o n a l As s o c i a t i o n o f S o c i a l W o r k e r s , p a r t n e r w i t h O AC t o p r o v i d e e d u c a t i o n a n d t r a i n i n g t o c o m b a t t h e s e b i a s e s . O b e s i t y s t i g m a i s a s o c i e t a l i s s u e , n o t o n e s p e c i fi c t o i n d i v i d u a l s . D h u r a n d h a r , 1 7 w r i t i n g s p e c i fi c a l l y a b o u t w e i g h t b i a s i n p h y s i c i a n s , n o t e d : " W e i g h t b i a s n o t o n l y h u r t s i n d i v i d u a l v i c t i m s s o c i a l l y , b u t a l s o h u r t s s o c i e t y , b y i n fl u e n c i n g p o l i c y d e c i s i o n s a b o u t h e a l t h , r e s e a r c h , a n d p a t i e n t c a r e , a n d i n t u r n d i s t r a c t s fr o m fi n d i n g e ffe c t i v e s o l u t i o n s . " S t e p 4—E n g a g e i n s y m p a t h e t i c d i a l o g u e w i t h p a t i e n t s w i t h o b e s i t y c o n c e r n i n g t h e b e n e f i t s o f b a r i a t r i c s u r g e r y . W e c a n e n g a g e i n r e s p e c t fu l d i a l o g u e w i t h p a t i e n t s w i t h o b e s i t y , r e c o g n i z i n g t h e i r p l i g h t , h e a r i n g t h e i r c o n c e r n s . W e c a n r e c o r d t h e i r a i l m e n t s a n d i n fo r m t h e m t h a t t r e a t m e n t s , s u c h a s p h a r m a c o t h e r a p y , d e v i c e s ( e . g . , i n t r a g a s t r i c b a l l o o n s y s t e m s ) , a n d s u r g i c a l p r o c e d u r e s e x i s t fo r w e i g h t l o s s a n d c o m o r b i t y i m p r o v e m e n t . W e c a n r e c o g n i z e t h a t , fo r s o m e p a t i e n t s , w e i g h t l o s s s u r g e r y i s a n i m p o r t a n t o p t i o n , o n e t h a t p e r h a p s r e p r e s e n t s a " l a s t r e s o r t . " T h e i r c o u r a g e t o u n d e r g o s u r g e r y i n t h e fa c e o f r e p e a t e d fa i l u r e s o f o t h e r m e t h o d s s h o u l d g e n e r a t e r e s p e c t r a t h e r t h a n r i d i c u l e . RE F E RE N CE S 1 . P u h l RM , M o ss-Ra c u si n CA , S c h w a r tz M B, Br o w n e l l K D . W e i g h t sti g m a ti za ti o n a n d bi a s r e d u c ti o n : P e r sp e c ti v e s o f o v e r w e i g h t a n d o be se a d u l ts. H e a l t h E d uc Re s . 2 0 0 8 ; 2 3 : 3 4 7 – 3 5 8 . 2 . P u h l RM , H e u e r CA . O be si ty sti g m a : I m p o r ta n t c o n si d e r a ti o n s f o r p u bl i c h e a l th . Am J Publ i c H e a l t h . 2 0 1 0 ; 1 0 0 : 1 0 1 9 – 1 0 2 8 . 3 . A n d r e y e v a T, P u h l RM , Br o w n e l l K D . Ch a n g e s i n p e r c e i v e d w e i g h t d i sc r i m i n a ti o n a m o n g A m e r i c a n s, 1 9 9 5 – 1 9 9 6 th r o u g h 2 0 0 4 – 2 0 0 6 . O be si t y . 2 0 0 8 ; 1 6 : 1 1 2 9 – 1 1 3 4 . 4 . P u h l RM , Br o w n e l l K D . Bi a s, d i sc r i m i n a ti o n , a n d o be si ty . O be si t y . 2 0 0 1 ; 9 : 7 8 8 – 8 0 5 . 5 . P u h l RM , H i m m e l ste i n M S , G o r i n s A A , S u h Y J. M i ssi n g th e ta r g e t: i n cl u d i n g p ersp ecti ves o f w o m en w i th o verw ei gh t an d o besi ty to i n f o rm sti gm a-red u cti o n strategi es. Obesi ty S ci en ce & P racti ce. 2 0 1 7 . Jan 1 . 6 . Hebl MR, X u J. W ei gh i n g th e care: P h ysi ci an s' reacti o n s to th e si ze o f a p ati en t. Int J O besi t y . 2 0 0 1 ; 2 5 : 1 2 4 6 – 1 2 5 2 . 7 . Bertak i s KD, A zari R. Th e i m p act o f o besi ty o n p ri m ary care vi si ts. O bes Res . 2 0 0 5 ; 1 3 : 1 6 1 5 – 1 6 2 3 . 8 . F o ster GD, W ad d en TA , Mak ri s A P , et al. Primary care physicians' attitudes about obesity and its treatment. Obes Res . 2003;11:1168- 1177. 9. Schwartz MB, Chambliss HO, Brownell KD, et al. Weight bias Obesity exposes patients to the risk of embarrassment, frustration, and hopelessness. It i s real and poignant, and these indignities are not easily ameliorated, especially as many o f them are bolstered by opinions and comments of individuals close to the patients, s uch as family members, and thus are even more painful. among health professionals specializing in obesity. Obes Res. 2003;11:1033–1039. 10. Ogden J, Bandara I, Cohen H, et al. General practitioners' and patients' models of obesity: whose problem is it? Patient Educ Couns. 2001;44:227–233. 11. Pories ML, Hodgson J, Rose, MA, et al. Following bariatric surgery: An exploration of the couples' experience. Obes Surg. 2016; 26:54–60. 12. Ciao AC, Latner JD. Reducing obesity stigma: The effectiveness of cognitive dissonance and social consensus interventions. Obesity. 2011;19:1768–1774. 13. North American Association for the Study of Obesity and the National Heart, Lung, and Blood Institute. The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Bethesda, Maryland: National Institutes of Health; 2000. 14. O'Brien KS, Puhl RM, Latner JD, Mir AS, Hunter JA. Reducing anti-fat prejudice in preservice health students: A randomized trial. Obesity. 2010;18: 2138–2144. 15. Burmeister JM, Taylor MB, Rossi J, Kiefner-Burmeister A, et al. Reducing obesity stigma via a brief documentary film: a randomized trial. Stigma and Health. 2017;2(1)43–52. 16. Puhl R.– Taking a look at weight bias and the stigma of obesity. Bariatric Times. September 2009. http://bariatrictimes.com/five- minutes-with-rebecca-puhl- phd%e2%80%94taking-a-look-at- weight-bias-and-the-stigma-of- obesity/ Accessed March 30, 2017. 17. Dhurandhar NV. Obesity stigma: A persistent problem, a possible solution. Int J Obesity. 2013;37:1413–1414. FUNDING: No funding was provided. DISCLOSURES: The authors report no conflicts of interest relevant to the content of this manuscript. AUTHOR AFFILIATION: Mary Lisa Pories, PhD, LCSW, is from the Colleges of Education and Health and Human Performance, East Carolina University, Greenville, North Carolina. Mary Ann Rose, MSN, EdD, is Professor of Nursing, East Carolina University, Greenville, North Carolina. ADDRESS FOR CORRESPONDENCE: Mary Lisa Pories, PhD, LCSW, Colleges of Education and Health and Human Performance, East Carolina University; Email: poriesm@ecu.edu

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