Bariatric Times

APR 2018

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

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Review 13 Bariatric Times • April 2018 judge them due to their weight have reported having lower trust in these providers. 59 Patients with obesity are more likely to doctor shop, defined as three or more PCPs in two years, than patients with normal weight. 61 This doctor shopping, which is motivated for some patients by weight-stigmatizing experiences in the healthcare setting, 61,62 results in increased utilization of emergency services without increased hospitalization. 61 Patients who doctor shop also were more likely to report shorter durations of their current relationships with their healthcare providers. 61,62 In addition, patients with obesity might delay care because of perceived barriers due to their weight. Specifically, patients who receive appropriate referrals for cancer screening are concerned about disrespectful treatment, embarrassment at being weighed, negative clinician attitudes, unsolicited weight loss advice, and inadequate medical equipment. 30,63 These same factors also led over half of patients with obesity to report canceling a healthcare appointment. 63,64 With regard to weight loss, patients that perceive weight-related judgment by providers are more likely to try to lose weight, but not more likely to achieve a clinically significant weight loss. 65 Only patients who had a provider discuss weight loss where no judgment was perceived or where the clinician was helpful in the weight loss process achieved clinically significant weight loss. 65,66 PART 2. REVIEW OF INTERVENTIONS MITIGATING WEIGHT BIAS Few studies have tested interventions that mitigate weight bias among healthcare professionals; a recent systematic review identified only 17 trials. 67 Of these trials, only two were delivered to practicing healthcare professionals. 68,69 Most interventions addressed only short- term outcomes, and ultimately the review concluded that weight bias might persist in the face of bias-reduction interventions. 67 A second meta-analysis on weight-bias interventions in all settings included 30 studies, and concluded that weight bias interventions have had a small, but significant ameliorating effect on anti-fat attitudes and beliefs. 70 Interventions studied in these two reviews include traditional classroom and web-based instruction on causes of obesity, weight bias awareness, and bariatric sensitivity training; media- based obesity instruction including videos, audio recordings, and role- play; and experiential learning, including exposure to adult and pediatric patients with obesity. Traditional instruction regarding obesity. Traditional classroom and web-based educational curricula have focused primarily on healthcare professional students. Few studies were conducted among practicing healthcare professionals. These curricula include formal instruction about the causes of obesity, as well as awareness of how weight bias can impact patients with obesity. One study specifically examined curricula on causes of obesity, with students randomized to one of three four-week long curricula: uncontrollable causes of obesity, controllable causes of obesity, and a control arm. The authors found a decrease in implicit anti-fat bias among the uncontrollable causes arm and an increase in bias among the controllable causes arm as compared to the control. 71 Another study found similar results using single lectures rather than a prolonged curriculum in With regard to weight loss, patients that perceive weight-related judgment by providers are more likely to try to lose weight, but not more likely to achieve a clinically significant weight loss. IS YOUR BARIATRIC CENTER ACCREDITED? UNIQUE? The Bariatric Times Bariatric Center Spotlight is dedicated to featuring accrediated bariatric centers around the world, with a focus on their facilities, staff, statistics, processes, technology, and patient care. • Highlight your center today and share your best practices, unique programs, and more with the bariatric community. • Reprints with customization available—perfect for waiting rooms or office display! • Program must be accredited through the American College of Surgeons (ACS) and the American Society for Metabolic and Bariatric Surgery (ASMBS) Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP®) in order to be considered for publication. • Contact Angela Saba at asaba@matrixmedcom.com for information on how to be featured in an upcoming installment of the Bariatric Center Spotlight.

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