Day 3: Obesity Stigma and Quality of Patient Care

On the final day of the Congress, several sessions were dedicated to discussing obesity and diabetes stigma. Rebecca Puhl, PhD, Deputy Director for the Rudd Center for Food Policy and Obesity at the University of Connecticut, discussed how weight stigma can lead to decreased health care quality; increased levels of HbA1c, cortisol, and blood pressure; and negative eating and physical activity behaviors, resulting in weight gain and poor psychological and physiological health.4

According to research results, adults and youth who experienced more weight stigma were more likely to exhibit exercise avoidance and unhealthy eating behaviors, even after controlling for body mass index. Internalized weight bias, resulting from experienced stigma, was shown to be significantly associated with lower odds of maintaining weight loss. Obese patients were more likely to switch doctors, avoid health care, and report lack of empathy in providers compared with thinner patients.4

Importantly, the issue of stigma does not reside solely in the patient population. Compared with providing care to thinner patients, healthcare professionals reported shorter appointments, less discussion, less intervention, and less respect for patients with obesity.4 This lower-quality health care leads to poorer treatment adherence, less trust in providers, and worse patient outcomes.

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A presentation by Rachel Batterham, PhD, Professor of Obesity, Diabetes, and Endocrinology at University College London, revealed that this obesity bias is pervasive in medical students, nurses, dieticians, psychologists, fitness professionals, and all physician specialties that have been studied.5 To reduce explicit weight bias in health care, Dr Batterham suggests emphasizing the complex biological causes of obesity in medical education. To reduce implicit bias, raising awareness of implicit judgements and exposure to counter-stereotypical cases (ie, examples of success and intelligence) may help.5

There is also much progress to be made regarding portrayal of obesity and bariatric surgery in the media. According to Ted Kyle, RPH, MBA, founder of ConscienHealth, an organization that helps advance policy and public opinion in health and obesity, clinicians can help reduce damaging obesity narratives in the media with 3 crucial steps6:

· Provide facts to counter myths, especially that obesity is simply the result of poor choices.

· Put a human face on portrayals of obesity in the media to address bias and decreased quality of care.

· Be persistent and vigorous in advocating against stigma.

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References

1. Cummings D. Metabolic Surgery – From guidelines to implementation: presentation of executive summary and recommendations. Oral presentation at: 4th Annual World Congress on Interventional Therapies for Type 2 Diabetes; April 10, 2019; New York, NY.

2. Buse JB, Caprio S, Cefalu WT, et al. How do we define cure of diabetes? Diabetes Care. 2009;32(11):2133-2135.

3. Oh W. How remission is defined in other diseases. Oral presentation at: 4th Annual World Congress on Interventional Therapies for Type 2 Diabetes; April 9, 2019; New York, NY.

4. Puhl R. Stigma and discrimination: definitions, prevalence, and consequences. Oral presentation at: 4th Annual World Congress on Interventional Therapies for Type 2 Diabetes; April 10, 2019; New York, NY.

5. Batterham R. Stigma in the healthcare. Oral presentation at: 4th Annual World Congress on Interventional Therapies for Type 2 Diabetes; April 10, 2019; New York, NY.

6. Kyle T. Obesity: changing the narrative in the media. Oral presentation at: 4th Annual World Congress on Interventional Therapies for Type 2 Diabetes; April 10, 2019; New York, NY.