Are Anti-Stigma Films a Useful Strategy for Reducing Weight Bias Among Trainee Healthcare Professionals? Results of a Pilot Randomized Control Trial The mixed impact of medical school on medical students' implicit and explicit weight bias. Development of a brief measure to assess quality of life in obesity. A new approach to multicultural item generation in the development of two obesity-specific measures: the Obesity and Weight Loss Quality of Life (OWLQOL) questionnaire and the Weight-Related Symptom Measure (WRSM). Reducing obesity stigma: the effectiveness of cognitive dissonance and social consensus interventions. Brief intervention effective in reducing weight bias in medical students. Association between weight perception and psychological distress Weight bias among dietetics students: implications for treatment practices. Putting on weight stigma: A randomized study of the effects of wearing a fat suit on eating, well-being, and cortisol. Perceived Weight Discrimination and 10-Year Risk of Allostatic Load Among US Adults A randomized controlled trial undertaken to test a nurse-led weight management and exercise intervention designed for people with serious mental illness who take second generation antipsychotics Beyond personal responsibility: Effects of causal attributions for overweight and obesity on weight-related beliefs, stigma, and policy support Weight Bias and Weight Loss Treatment Outcomes in Treatment-Seeking Adults Electronic Tools to Assist with Identification and Counseling for Overweight Patients: a Randomized Controlled Trial Development and psychometric testing of the nurses' attitudes toward obesity and obese patients (NATOOPS) scale. Medical Student Bias and Care Recommendations for an Obese versus Non-Obese Virtual Patient A Service Learning Based Project to Change Implicit and Explicit Bias toward Obese Individuals in Kinesiology Pre-Professionals
Background : Weight bias is an important clinical issue that the educators of tomorrow 's healthcare professionals can not afford to ignore . This study , therefore , aim ed to pilot a r and omized controlled trial of the effects of educational films design ed to reduce weight stigmatization toward obese patients on trainee dietitians ' and doctors ' attitudes . Methods : A pre-post experimental design with a 6-week follow-up , which consisted of an  intervention group ( n = 22 ) and a  control group ( n = 21 ) , was conducted to assess the efficacy of brief anti-stigma films in reducing weight bias , and to test whether future , larger-scale studies among trainee healthcare professionals are feasible . Results : Participants at baseline  demonstrated weight bias , on both implicit and explicit attitude measures , as well as strong beliefs that obesity is under a person 's control . The intervention films significantly improved explicit attitudes and beliefs toward obese people , and participant evaluation was very positive . The intervention did not significantly improve implicit anti-fat bias . Conclusion : The current study suggests both that it is possible to conduct a substantive trial of the effects of educational films design ed to reduce weight stigma on a larger cohort of trainee healthcare professionals , and that brief educational interventions may be effective in reducing stigmatizing attitudes in this population CONTEXT Health care trainees demonstrate implicit ( automatic , unconscious ) and explicit ( conscious ) bias against people from stigmatised and marginalised social groups , which can negatively influence communication and decision making . Medical schools are well positioned to intervene and reduce bias in new physicians . OBJECTIVES This study was design ed to assess medical school factors that influence change in implicit and explicit bias against individuals from one stigmatised group : people with obesity . METHODS This was a prospect i ve cohort study of medical students enrolled at 49 US medical schools r and omly selected from all US medical schools within the strata of public and private schools and region . Participants were 1795 medical students surveyed at the beginning of their first year and end of their fourth year .  Web-based surveys included measures of weight bias , and medical school experiences and climate . Bias change was compared with changes in bias in the general public over the same period . Linear mixed models were used to assess the impact of curriculum , contact with people with obesity , and faculty role modelling on weight bias change . RESULTS Increased implicit and explicit biases were associated with less positive contact with patients with obesity and more exposure to faculty role modelling of discriminatory behaviour or negative comments about patients with obesity . Increased implicit bias was associated with training in how to deal with difficult patients . On average , implicit weight bias decreased and explicit bias increased during medical school , over a period of time in which implicit weight bias in the general public increased and explicit bias remained stable . CONCLUSIONS Medical schools may reduce students '  weight biases by increasing positive contact between students and patients with obesity , eliminating unprofessional role modelling by faculty members and residents , and altering curricula focused on treating difficult patients OBJECTIVE Obesity research ers have a growing interest in measuring the impact of weight and weight reduction on quality of life . The Impact of Weight on  Quality of Life question naire ( IWQOL ) was the first self-report instrument specifically developed to assess the effect of obesity on quality of life . Although the IWQOL has demonstrated excellent psychometric properties , its length ( 74 items ) makes it somewhat cumbersome as an outcome measure in clinical research . This report describes the development of a 31-item version of the IWQOL ( IWQOL-Lite ) . RESEARCH METHODS AND PROCEDURES IWQOLs from 996 obese patients and controls were used to develop the IWQOL-Lite . Psychometric properties of the IWQOL-Lite were examined in a separate cross-validation sample of 991 patients and controls . RESULTS Confirmatory factor analysis provided strong support for the adequacy of the scale structure . The five identified scales of the IWQOL-Lite  ( Physical Function , Self-Esteem , Sexual Life , Public Distress , and Work ) and the total IWQOL-Lite score demonstrated excellent psychometric properties . The reliability of the IWQOL-Lite scales ranged from 0.90 to 0.94 and was 0.96 for the total score . Correlations between the IWQOL-Lite and collateral measures supported the construct validity of the IWQOL-Lite . Changes in  IWQOL-Lite scales over time correlated significantly with changes in weight , supporting its sensitivity to change . Significant differences in IWQOL-Lite scale and total scores were found among groups differing in body mass index , supporting the utility of the IWQOL-Lite across the body mass index spectrum . DISCUSSION The IWQOL-Lite appears to be a psychometrically sound and clinical ly sensitive brief measure of quality of life in obese persons BACKGROUND Being overweight or obese has substantial effects on individuals ' perceptions of their health and quality of life ( QoL ) . Generic measures often miss important QoL information , and existing obesity-specific instruments have shortcomings with respect to cross-cultural input , application to differing levels of severity , conceptual clarity , and patient burden . OBJECTIVE This study aim ed to develop culturally sensitive measures of QoL and symptoms in overweight or obese persons , both those trying to lose weight and those not trying to lose weight . METHODS Currently accepted criteria and guidelines for question naire development were streamlined and augmented to include cross-cultural input from 5 European countries and the United States . The preliminary pool of items was created based on qualitative interviews conducted in the United States , followed by an early check of item translatability and preharmonization across all language s. Ten additional qualitative in-country interviews were then conducted to produce further culture-specific items . This was followed by 2 forward and 1 backward translation , plus cognitive debriefing interviews in each country . Finally , an exp and ed international harmonization meeting was held to ensure inclusion of appropriate new items and their acceptability across all 6 cultures . RESULTS The procedures described result ed in development of the 41-item Obesity and Weight Loss Quality of Life question naire and the 20-item Weight-Related Symptom Measure . These question naires are subject to further psychometric validation . CONCLUSIONS Augmentation of the initial item-generation and international harmonization steps of question naire development through integration of cross-cultural input allowed greater validity of cross-cultural content while meeting time , budget , and re source constraints Obese individuals experience pervasive stigmatization . Interventions attempting to reduce obesity stigma by targeting its origins have yielded mixed results . This r and omized , controlled study examined the effectiveness of two interventions to reduce obesity stigma :  cognitive dissonance and social consensus .  Participants were college undergraduate students ( N = 64 , 78 % women , mean age = 21.2 years , mean BMI = 23.1 kg/m2 ) of diverse ethnicities .  Obesity stigma ( assessed with the Antifat Attitudes Test ( AFAT ) )  was assessed at baseline ( Visit 1 ) and 1 week later , immediately following the intervention ( Visit 2 ) . Participants were r and omly assigned to one of three intervention groups where they received st and ardized written feedback on their obesity stigma levels .  Cognitive dissonance participants ( N = 21 ) were told that their AFAT scores were discrepant from their values ( high core values of kindness and e quality and high stigma ) , social consensus participants ( N = 22 ) were told their scores were discrepant from their peers ' scores ( stigma much higher than their peers ) , and control participants ( N = 21 ) were told their scores were consistent with both their peers ' scores and their own values . Following the intervention , omnibus analyses revealed significant group differences on the AFAT Physical/Romantic Unattractiveness subscale ( PRU ; F ( 2 , 59 ) = 4.43 , P < 0.05 ) . Planned contrasts revealed that cognitive dissonance group means were significantly lower than control means for AFAT total , AFAT PRU subscale , and AFAT social/character disparagement subscale ( all P < 0.05 ) . No significant differences were found between social consensus and controls . Results from this study suggest that cognitive dissonance interventions may be a successful way to reduce obesity stigma , particularly by changing attitudes about the appearance and attractiveness of obese individuals BACKGROUND Medical students are exposed to a growing number of obese patients in clinical encounters . Many medical students harbor negative attitudes and stereotypes regarding obese patients , which lead to negative interpersonal behaviors . This study pilot tested the effectiveness of an educational intervention in reducing bias toward obese patients . METHODS Second- and third-year medical students ( n=64 ) watched a 17- minute video , " Weight Bias in Health Care , " and participated in interactive discussion to share experiences with encountering obese patients . The  Beliefs About Obese Persons ( BAOP ) , Attitudes Toward Obese Persons ( ATOP ) , and Fat Phobia Scales ( FPS ) were administered before and after intervention . Change in mean scores from before to after the intervention was tested for statistical significance using the paired sample s t test . General linear models were used to examine associations of subject characteristics with mean scores for each scale . RESULTS The intervention increased beliefs that genetic and environmental factors play an important role in the cause of obesity as opposed to lack of personal control ( mean BAOP increased from 16.53 to 19.27 ) . It also decreased students ' negative stereotypes regarding obese patients ( mean FPS decreased from 3.65 to 3.45 ) . There were independent associations of subject characteristics with post-intervention ATOP scores , with more positive attitudes in younger , male , and white participants . CONCLUSIONS Implementing a short educational intervention was effective in improving medical students ' beliefs and stereotypes regarding obese patients . This widely accessible and easily replicable program can serve as a model and springboard for further development of educational interventions to reduce weight bias among medical students Background : Obesity is a well-known cause of cardiovascular disease burden and premature death , but effects on depressive symptoms remain equivocal . Depressive symptoms may be more common among the obese individuals who perceive themselves as overweight , rather than those who perceive themselves as having an acceptable weight . Our aim was to determine whether weight status and weight perceptions are independently associated with psychological distress . Methods : We conducted a cross-sectional study  using data from the Australian National Health Survey 2004–2005 ( N=17 253 ) . All variables were collected by self-report . Adjusted multinomial logistic regression analysis was conducted to generate prevalence odds ratios with 95 % confidence intervals ( 95 % CI ) for medium ( Kessler Psychological Distress Scale ( K10 ) scores of 20–29 ) and high ( K10 scores of 30–50 ) psychological distress ( compared with K10 scores of 10–19 as the reference ) associated with weight status ( st and ard body mass index ( BMI ) cutoffs for underweight , overweight and obesity vs normal weight ) , weight perception ( perceived underweight and overweight vs acceptable weight ) and weight misperception ( incorrect with BMI vs correct with BMI ) adjusting for numerous important covariates . Results : Overweight and underweight perception increased the odds of medium ( 40 and 50 % ) and high ( 50 and 120 % ) psychological distress , whereas weight status and weight misperception were not associated with psychological distress in adjusted analysis . Gender , alcohol consumed per week and post-school education were not significant covariates ( at P<0.10 level ) . Conclusions : Overweight and underweight perception rather than weight status or weight misperception are significant risk factors associated with medium and high psychological distress prevalence and effects appear to be uniform for men and women . Well- design ed prospect i ve studies are still needed to determine whether weight perceptions cause psychological distress , and if so , whether symptoms are significantly reduced following effective intervention BACKGROUND Several studies have examined attitudes about obesity among food and nutrition professionals , yielding mixed results , and no experimental research has tested the impact of dietitians ' attitudes on their treatment practice s or health evaluations with obese patients . OBJECTIVE This study investigated attitudes of dietetics students toward obese persons and tested whether a patient 's body weight influences students ' treatment decisions and health evaluations within a r and omized experiment . DESIGN Between the months of September and December 2007 , a convenience sample of 182 dietetics undergraduate students ( 92 % women ; mean age 23.1+/-5.4 years ) from colleges throughout the United States completed online self-report surveys to assess weight bias ( using the Fat Phobia Scale ) . Participants were also r and omly assigned to read one of four mock health profiles of patients who varied only by weight-related characteristics ( eg , obese or average weight ) and sex ( male or female ) , and asked to make judgments about the patient 's health status and participation in treatment . STATISTICAL ANALYSES PERFORMED To compare group data , multiple analysis of variance was used to test for an effect of the patient 's body mass index on participants ' health evaluations and their perceptions of patients in each of the four experimental conditions . Correlations were calculated between mean fat phobia scores and perceptions of patients . RESULTS Participants in all conditions expressed a moderate amount of fat phobia ( mean=3.7 ) , and students rated obese patients as being less likely to comply with treatment recommendations compared with nonobese patients ( P<0.05 ) . Results from multivariate analysis of variance tests showed students also evaluated obese patients ' diet quality and health status to be poorer than nonobese patients , despite equivalent nutritional and health information across weight categories for each sex in patient profiles . In contrast , obese and nonobese patients were rated to be similarly motivated , receptive , and successful in treatment . CONCLUSION Implication s of these findings for education and intervention in dietetics training are discussed , with emphasis on increasing awareness of weight bias in existing dietetics curricula OBJECTIVE Although a considerable amount of research has revealed connections between weight stigma and mental and physical health outcomes , no studies to date have experimentally manipulated the experience of obesity to underst and how weight stigma causally affects eating behavior , physiology , and psychological well-being . Research has also not yet identified effective strategies for reducing weight stigma . METHODS In this research , the effect of weight stigma on psychological outcomes , unhealthy eating behavior , and the stress hormone cortisol was examined by r and omly assigning participants to appear obese by wearing a fat suit or not .  It was hypothesized that the physical alteration of participants ' apparent body size would lead to similar consequences as those associated with the experience of weight stigma and reduce antifat attitudes . RESULTS Supporting these hypotheses , experimentally manipulating apparent body size led participants to consume more unhealthy foods and report higher levels of negative effect . However , the study did not show any differences in cortisol reactivity or reduction in antifat attitudes as a function of the fat suit manipulation . CONCLUSIONS These findings contribute to an underst and ing of the potentially deleterious psychological and behavioral effects of weight stigma while also informing future interventions to reduce weight stigma Background Discrimination promotes multisystem physiological dysregulation termed allostatic load , which predicts morbidity and mortality . It remains unclear whether weight-related discrimination influences allostatic load . Purpose The aim of this study was to prospect ively examine 10-year associations between weight discrimination , allostatic load , and its components among adults 25–75 years in the Midlife Development in the US Biomarker Sub study . Methods Participants with information on weight discrimination were analyzed ( n=986 ) . At both timepoints , participants self-reported the frequency of perceived weight discrimination across nine scenarios as “ never/rarely ” ( scored as 0 ) , “ sometimes ” ( 1 ) , or “ often ” ( 2 ) . The two scores were averaged and then dichotomized as “ experienced ” versus “ not experienced ” discrimination . High allostatic load was defined as having ≥3 out of 7 dysregulated systems ( cardiovascular , sympathetic/parasympathetic nervous systems , hypothalamic pituitary axis , inflammatory , lipid/metabolic , and glucose metabolism ) , which collectively included 24 biomarkers . Relative risks ( RR ) were estimated from multivariate models adjusted for sociodemographic and health characteristics , other forms of discrimination , and BMI . Results Over 41 % of the sample had obesity , and 6 % reported weight discrimination at follow-up . In multivariable-adjusted analyses , individuals who experienced ( versus did not experience ) weight discrimination had twice the risk of high allostatic load ( RR , 2.07 ; 95 % CI , 1.21 ; 3.55 for baseline discrimination ; 2.16 , 95 % CI , 1.39 ; 3.36 for long-term discrimination ) . Weight discrimination was associated with lipid/metabolic dysregulation ( 1.56 ; 95 % CI 1.02 , 2.40 ) , glucose metabolism ( 1.99 ; 95 % CI 1.34 , 2.95 ) , and inflammation ( 1.76 ; 95 % CI 1.22 , 2.54 ) , but no other systems . Conclusions Perceived weight discrimination doubles the 10-year risk of high allostatic load . Eliminating weight stigma may reduce physiological dysregulation , improving obesity-related morbidity and mortality Aim To test the effect of a nurse-led intervention on weight gain in people with serious mental illness prescribed and taking second generation antipsychotic medication . Background Weight gain and obesity has reached epidemic proportions in the general population with the prevalence of Metabolic Syndrome reaching 20–25 % of the global population . People with serious mental illness are at even higher risk , particularly those taking second generation antipsychotic medication . Design An experimental r and omized controlled trial was undertaken . Method The control group received a 12-week healthy lifestyle booklet . In addition to the booklet , the intervention group received weekly nutrition and exercise education , exercise sessions , and nurse support .  Participants ( n = 101 ) were assessed at baseline and 12 weeks . Data were collected between March 2008–December 2010 . Seven outcome measures were used : body measurements included girth ( cm ) , weight ( kg ) , height ( cm ) , and body mass index ( kg/m2 ) ; question naires included the medication compliance question naire , the Drug Attitude Inventory , the Liverpool University Neuroleptic Side Effect Rating Scale , and the Medical Outcomes Study Short Form 36 . Differences in primary outcome measures between baseline and 12 weeks follow-up were compared between intervention and control groups using st and ard bi-variate statistical tests . The study was conducted between 2008–2010 . Results The analysis of outcome measures for the control group ( n = 50 ) and intervention group ( n = 51 ) was not statistically significant . There was a mean weight change of −0·74 kg at 12 weeks for the intervention group ( n = 51 ) , while the control group ( n = 50 ) had a mean weight change of −0·17 kg at 12 weeks . Conclusion The results were not statistically significant Objective : The objective of this research was to compare the effects of different causal attributions for overweight and obesity , among individuals with overweight and obesity , on weight-related beliefs , stigmatising attitudes and policy support . Design : In Study 1 , an online sample of 95 US adults rated the extent to which they believed various factors caused their own weight status . In Study 2 , 125 US adults  read one of three r and omly assigned online passages attributing obesity to personal responsibility , biology , or the ‘ food environment . ’  All participants in both studies were overweight or obese . Main outcome measures : All participants reported beliefs about weight loss , weight-stigmatising attitudes , and support for obesity-related policies . Results : In Study 1 , biological attributions were associated with low weight-malleability beliefs and blame , high policy support , but high internalised weight bias . ‘ Food environment ’ attributions were not associated with any outcomes , while ‘ personal responsibility ’ attributions were associated with high prejudice and blame . In Study 2 , participants who received information about the food environment reported greater support for food-related policies and greater self-efficacy to lose weight . Conclusion : Emphasising the role of the food environment in causing obesity may promote food policy support and health behaviours without imposing the negative consequences associated with other attributions Background Few studies have explored the relationship between weight bias and weight loss treatment outcomes . Purpose This investigation examined the relationship between implicit and explicit weight bias and ( a ) program attrition , ( b ) weight loss , ( c ) self-monitoring adherence , ( d ) daily exercise levels and overall caloric expenditure , ( e ) daily caloric intake , and ( f ) daily caloric deficit among overweight/obese treatment-seeking adults . Methods Forty-six overweight/obese adults ( body mass index ≥ 27 kg/m2 ) participating in an 18-week , stepped-care , behavioral weight loss program completed implicit and explicit measures of weight bias .  Participants were instructed to self-monitor and electronically report  daily energy intake , exercise , and energy expenditure . Results Greater weight bias was associated with inconsistent self-monitoring , greater caloric intake , lower energy expenditure and exercise , creation of a smaller caloric deficit , higher program attrition , as well as less weight loss during the self-help phase of the stepped-care treatment . Conclusions Weight bias may interfere with overweight/obese treatment-seeking adults ' ability to achieve optimal health Background Physicians often do not recognize when their patients are overweight and infrequently counsel them about weight loss . Objective To evaluate a set of electronic health record (EHR)-embedded tools to assist with identification and counseling of overweight patients . Design R and omized controlled trial . Participants Physicians at an academic general internal medicine clinic were r and omized to activation of the EHR tools ( n = 15 ) or to usual care ( n = 15 ) . Patients of these physicians were included in analyses if they had a body mass index ( BMI ) between 27 and 29.9 kg/m2.InterventionThe EHR tool set included : a physician point-of-care alert for overweight ( BMI 27–29 . 9 kg/m2 ) ; a counseling template to help physicians counsel patients on action plans ; and an order set to facilitate entry of overweight as a diagnosis and to order relevant patient h and outs . Main Measures Physician documentation of overweight as a problem ; documentation of weight-specific counseling ; physician perceptions of the EHR tools ; patient self-reported progress toward their goals and perspectives about counseling received . Key Results Patients of physicians receiving the intervention were more likely than those of usual care physicians to receive a diagnosis of overweight ( 22 % vs. 7 % ; p = 0.02 ) and weight-specific counseling ( 27 % vs. 15 % ; p = 0.02 ) . Most patients receiving counseling in the intervention group reported increased motivation to lose weight ( 90 % ) and taking steps toward their goal ( 93 % ) . Most intervention physicians agreed that the tool alerted them to patients they did not realize were overweight ( 91 % ) and improved the effectiveness of their counseling ( 82 % ) ; more than half ( 55 % ) reported counseling overweight patients more frequently ( 55 % ) . However , most physicians used the tool infrequently because of time barriers . Conclusions EHR-based alerts and management tools increased documentation of overweight and counseling frequency ; the majority of patients for whom the tools were used reported short-term behavior change This study was design ed to develop and test an instrument to measure  nurses ' attitudes towards obesity and obese adult patients .  Items were based on an earlier version of the instrument , obesity discrimination research , and clinical experience . After content validation of items , the instrument was sent to 1,400 r and omly selected Registered Nurses . Factor analysis yielded a 5-factor solution , with 36 items reaching loadings of .4 or greater . Cronbach 's alpha was .81 for the reduced scale , with a range of .45 to .79 on the five factors . Construct validity was supported by significant differences between contrast groups on three factors and consistency with underlying theory . Overall the instrument demonstrated acceptable psychometric properties and could be used in future research Objective : This study examined the independent effect of a patient 's weight on medical students ’ attitudes , beliefs and interpersonal behavior toward the patient , in addition to the clinical recommendations they make for her care . Design : A total of 76 clinical -level medical students were r and omly assigned to interact with a digital , virtual female patient who was visibly either obese or non-obese . Methods : Interactions with the patient took place in an immersive virtual ( virtual reality ) clinical environment that allowed st and ardization of all patient behaviors and characteristics except for weight . Visual contact behavior was automatically recorded during the interaction . Afterward , participants filled out a battery of self-report question naires . Results : Analyses revealed more negative stereotyping , less anticipated patient adherence , worse perceived health , more responsibility attributed for potentially weight-related presenting complaints and less visual contact directed toward the obese version of a virtual patient than the non-obese version of the patient . In contrast , there was no clear evidence of bias in clinical recommendations made for the patient 's care . Conclusion : Biases in attitudes , beliefs and interpersonal behavior have important implication s because they can influence the tone of clinical encounters and rapport in the patient – provider relationship , which can have important downstream consequences . Gaining a clear underst and ing of the nature and source of weight bias in the clinical encounter is an important first step toward the development of strategies to address it Background : The objective of the study was to assess the efficacy of a multi-component intervention to reduce kinesiology pre-professionals ’ implicit and explicit bias . Method : A pre-post experimental design , which consisted of an  experimental group ( n = 42 ) and a control group ( n = 36 ) , was conducted to assess the efficacy of the intervention using both implicit and explicit obesity bias measures . Results : On the pre-test , participants did not display overall explicit bias on the Anti-Fat Attitudes Test ( AFAT ) but had strong implicit bias and bias on the lazy/motivated semantic differential scale . Participation in the intervention reduced explicit bias on the AFAT social character disparagement and weight control/blame subscales but not implicit bias . Conclusion : Implicit bias remains difficult to change and appears to be deep-seated in individuals ’ minds . Future interventions may need methods to make sure all participants process and connect emotionally to all information
Most question naires were brief , demonstrated adequate internal consistency , and tapped key cognitive and affective dimensions of weight bias such as stereotypes and blaming .
Background : People living with overweight and obesity often experience weight-based stigmatization .
Investigations of the prevalence and correlates of weight bias and evaluation of weight bias reduction interventions depend upon psychometrically-sound measurement .
Our paper is the first to comprehensively evaluate the psychometric properties , use of people-first language within items , and suitability for use with various population s of available self-report measures of weight bias .