Educational intervention improved weight bias among clinicians
The four-hour course on weight bias significantly reduced clinicians' self-reported negative stereotypes about obesity and increased rates of obesity diagnosis and obesity-related referrals over 12 months, a study found.
An educational intervention reduced clinicians' biases regarding obesity and prompted them to change their clinical practices regarding obesity treatment, a study found.
Researchers in a single medical center service area in California used a pre/post study design to examine self-reported weight bias among clinicians at baseline, after taking a four-hour continuing medical education class on weight bias, and at four- and 12-month follow-up. In addition, they used a post/post study design to examine obesity practice behaviors 12 months after the intervention in clinicians who attended and those who did not.
The course included patient panel discussions, faculty-led didactics, videos, question/answer periods, and simulated clinical scenarios. To change attributions of responsibility for obesity, lectures highlighted uncontrollable biological and structural factors that determine weight. To increase empathy, patients talked about their negative treatment experiences with clinicians. Clinicians increased their self-awareness by taking an Implicit Attitudes Test to determine whether they had a pro-thin, anti-fat bias. In addition, all participants were invited to sign a pledge to work on reducing weight bias and stigma of obesity in health care.
Targeted clinical practice behaviors were diagnosis of obesity for patients with obesity (BMI ≥30 kg/m2), referral of patients with obesity to healthy lifestyle programs, referral of patients with obesity to obesity medicine, and referral of patients with severe obesity (BMI ≥35 kg/m2) to bariatric surgery. The study's primary outcome for pre/post analyses was self-reported weight bias, while outcomes for analyses comparing attendees with nonattendees were electronic medical record-confirmed rates of obesity diagnosis and referrals to evidence-based obesity treatments in the 12 months after the intervention. Results of the study were published Dec. 18 by the Journal of General Internal Medicine.
Two hundred eighteen clinicians who attended the course and 89 who did not were included in the analyses. Compared with baseline, self-reported negative obesity stereotypes among clinicians were significantly reduced (P<0.001). Self-reported empathy and confidence in caring for patients with obesity were significantly increased immediately after the intervention (P=0.006 and P<0.001, respectively); these increases persisted at four and 12 months of follow-up. After adjustment for years in practice, race/ethnicity, gender, profession type, practice type, and panel size, clinicians who attended the intervention had significantly greater odds of diagnosis of obesity and obesity-related referrals in the next 12 months (range, 60% to 212%) than clinicians who did not attend.
The researchers noted that the intervention could not be randomized and that only 20% of respondents completed the weight bias survey at 12 months, among other limitations. “This intervention could be tailored for priority target populations, such as primary care physicians, who often serve as the gatekeepers to specialty care and obesity treatments,” they wrote. They concluded that an educational intervention aimed at mitigating weight bias led to improved diagnosis of obesity and referral to obesity care and may be able to change clinicians' clinical practice behaviors in other health care settings. Future research should focus on integrating use of pharmacotherapy, such as glucagon-like peptide-1 agonists, into the educational content and should examine outcomes beyond one year, the authors said.