Raising awareness of anti-fat stigma in healthcare through lived experience education: a continuing professional development pilot study.
Anti-fat attitudes
Co-design
Continuing professional development
Lived experience education
Medical education
Personal narrative
Weight bias
Weight stigma
Journal
BMC medical education
ISSN: 1472-6920
Titre abrégé: BMC Med Educ
Pays: England
ID NLM: 101088679
Informations de publication
Date de publication:
16 Jan 2024
16 Jan 2024
Historique:
received:
08
09
2022
accepted:
20
11
2023
medline:
17
1
2024
pubmed:
17
1
2024
entrez:
16
1
2024
Statut:
epublish
Résumé
Anti-fat attitudes and weight-based discrimination are prevalent in healthcare settings and among healthcare practitioners and clinical trainees, and can result in immense harm to patients. There is increasing recognition that anti-fat bias in healthcare is a critical issue that must be addressed, but there is a dearth of evidence demonstrating sustained attitude and behavioural change among clinicians, illustrating a need for more innovative educational approaches and rigorous evaluation. We describe the co-design and delivery of a narrative-based continuing professional development curriculum aimed at raising awareness of weight-based bias and stigma. Our research team of lived experience educators, clinicians and researchers collaboratively developed a series of seven podcast episodes comprised of narrative descriptions of lived experiences with and impacts of weight bias, stigma and discrimination in healthcare settings, as well as a post-podcast workshop to facilitate reflection and discussion between participants. The curriculum was piloted among 20 clinicians practicing at a large urban hospital in Mississauga, Canada. We explored feasibility, acceptability and learning impact by analyzing responses to questionnaires completed following each podcast episode and responses shared during the workshops and follow-up feedback sessions. We observed high acceptability and feasibility of the curriculum. Participants experienced the podcast as a practical and convenient learning format and the workshop as a valuable opportunity to collectively debrief and reflect. The learning impact of the curriculum was strong; participants described a range of emotions elicited by the podcasts, engaged in self-reflection, and expressed a desire to modify clinical approaches. Barriers to the application of learnings identified by participants include pervasiveness of the use of body mass index (BMI) as an indicator of risk and a criterion for referral; discomfort with difficult conversations; prevalent biomedical understandings about the association between weight and health; and clinicians' defensiveness. This pilot study yielded promising findings and demonstrated potential impact on weight bias and stigma among healthcare providers. Necessary next steps include conducting larger scale, rigorous evaluations of the curriculum among broader populations, both health professions trainees and current healthcare providers.
Sections du résumé
BACKGROUND
BACKGROUND
Anti-fat attitudes and weight-based discrimination are prevalent in healthcare settings and among healthcare practitioners and clinical trainees, and can result in immense harm to patients. There is increasing recognition that anti-fat bias in healthcare is a critical issue that must be addressed, but there is a dearth of evidence demonstrating sustained attitude and behavioural change among clinicians, illustrating a need for more innovative educational approaches and rigorous evaluation. We describe the co-design and delivery of a narrative-based continuing professional development curriculum aimed at raising awareness of weight-based bias and stigma.
METHODS
METHODS
Our research team of lived experience educators, clinicians and researchers collaboratively developed a series of seven podcast episodes comprised of narrative descriptions of lived experiences with and impacts of weight bias, stigma and discrimination in healthcare settings, as well as a post-podcast workshop to facilitate reflection and discussion between participants. The curriculum was piloted among 20 clinicians practicing at a large urban hospital in Mississauga, Canada. We explored feasibility, acceptability and learning impact by analyzing responses to questionnaires completed following each podcast episode and responses shared during the workshops and follow-up feedback sessions.
RESULTS
RESULTS
We observed high acceptability and feasibility of the curriculum. Participants experienced the podcast as a practical and convenient learning format and the workshop as a valuable opportunity to collectively debrief and reflect. The learning impact of the curriculum was strong; participants described a range of emotions elicited by the podcasts, engaged in self-reflection, and expressed a desire to modify clinical approaches. Barriers to the application of learnings identified by participants include pervasiveness of the use of body mass index (BMI) as an indicator of risk and a criterion for referral; discomfort with difficult conversations; prevalent biomedical understandings about the association between weight and health; and clinicians' defensiveness.
CONCLUSION
CONCLUSIONS
This pilot study yielded promising findings and demonstrated potential impact on weight bias and stigma among healthcare providers. Necessary next steps include conducting larger scale, rigorous evaluations of the curriculum among broader populations, both health professions trainees and current healthcare providers.
Identifiants
pubmed: 38229086
doi: 10.1186/s12909-023-04889-8
pii: 10.1186/s12909-023-04889-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
64Informations de copyright
© 2024. The Author(s).
Références
Eller GM. On fat oppression. Kennedy Inst Ethics J. 2014;24(3):219–45.
doi: 10.1353/ken.2014.0026
Stoll LC. Fat Is a Social Justice Issue. Too Human Soc. 2019;43(4):421–41.
doi: 10.1177/0160597619832051
Nutter S, Russell-Mayhew S, Alberga AS, Arthur N, Kassan A, Lund DE, et al. Positioning of Weight Bias: moving towards Social Justice. J Obes. 2016;2016:3753650.
doi: 10.1155/2016/3753650
Ramos Salas X, Forhan M, Caulfield T, Sharma AM, Raine KD. Addressing Internalized Weight Bias and Changing Damaged Social Identities for People Living With Obesity. 2019. p. 10.
Pearl RL. Weight Bias and Stigma: Public Health Implications and Structural Solutions. Soc Issues Policy Rev. 2018;12(1):146–82.
Brewis A, SturtzSreetharan C, Wutich A. Obesity stigma as a globalizing health challenge. Global Health. 2018;14(1):20.
doi: 10.1186/s12992-018-0337-x
Munro L. Everyday Indignities: Using the Microaggressions Framework to Understand Weight Stigma. J Law Med Ethics. 2017;45(4):502–9.
doi: 10.1177/1073110517750584
Puhl RM, Brownell KD. Psychosocial origins of obesity stigma: toward changing a powerful and pervasive bias. Obes Rev. 2003;4(4):213–27.
doi: 10.1046/j.1467-789X.2003.00122.x
Himmelstein MS, Puhl RM, Quinn DM. Intersectionality: An Understudied Framework for Addressing Weight Stigma. Am J Prev Med. 2017;53(4):421–31.
doi: 10.1016/j.amepre.2017.04.003
Turan JM, Elafros MA, Logie CH, Banik S, Turan B, Crockett KB, et al. Challenges and opportunities in examining and addressing intersectional stigma and health. BMC Med. 2019;17(1):7.
doi: 10.1186/s12916-018-1246-9
Saguy AC, Ward A. Coming Out as Fat: Rethinking Stigma. Soc Psychol Q. 2011;74(1):53–75.
doi: 10.1177/0190272511398190
Fox R, Park K, Hildebrand-Chupp R, Vo AT. Working toward eradicating weight stigma by combating pathologization: A qualitative pilot study using direct contact and narrative medicine. J Appl Soc Psychol. 2023;53:171–84. https://doi.org/10.1111/jasp.12717 .
Puhl R, Heuer CA. Obesity stigma: important considerations for public health. Am J Public Health. 2010;100(6):1019–28.
doi: 10.2105/AJPH.2009.159491
Tomiyama AJ, Carr D, Granberg EM, Major B, Robinson E, Sutin AR, et al. How and why weight stigma drives the obesity “epidemic” and harms health. BMC Med. 2018;16(1):123.
Wu YK, Berry DC. Impact of weight stigma on physiological and psychological health outcomes for overweight and obese adults: A systematic review. J Adv Nurs. 2018;74(5):1030–42.
doi: 10.1111/jan.13511
Daly M, Sutin AR, Robinson E. Perceived Weight Discrimination Mediates the Prospective Association Between Obesity and Physiological Dysregulation: Evidence From a Population-Based Cohort. Psychol Sci. 2019;30(7):1030–9.
doi: 10.1177/0956797619849440
Sutin AR, Stephan Y, Terracciano A. Weight Discrimination and Risk of Mortality. Psychol Sci. 2015;26(11):1803–11.
doi: 10.1177/0956797615601103
Udo T, Purcell K, Grilo CM. Perceived weight discrimination and chronic medical conditions in adults with overweight and obesity. Int J Clin Pract. 2016;70(12):1003–11.
doi: 10.1111/ijcp.12902
Puhl R, Suh Y. Health Consequences of Weight Stigma: Implications for Obesity Prevention and Treatment. Curr Obes Rep. 2015;4(2):182–90.
doi: 10.1007/s13679-015-0153-z
Vadiveloo M, Mattei J. Perceived Weight Discrimination and 10-Year Risk of Allostatic Load Among US Adults. Ann Behav Med. 2017;51(1):94–104.
doi: 10.1007/s12160-016-9831-7
Alimoradi Z, Golboni F, Griffiths MD, Broström A, Lin C-Y, Pakpour AH. Weight-related stigma and psychological distress: A systematic review and meta-analysis. Clin Nutr. 2020;39(7):2001–13.
doi: 10.1016/j.clnu.2019.10.016
Robinson E, Sutin A, Daly M. Perceived weight discrimination mediates the prospective relation between obesity and depressive symptoms in U.S. and U.K. adults. Health Psychol. 2017;36(2):112–21.
doi: 10.1037/hea0000426
Barnes RD, Ivezaj V, Grilo CM. An examination of weight bias among treatment-seeking obese patients with and without binge eating disorder. Gen Hosp Psychiatry. 2014;36(2):177–80.
doi: 10.1016/j.genhosppsych.2013.10.011
Nolan LJ, Eshleman A. Paved with good intentions: Paradoxical eating responses to weight stigma. Appetite. 2016;102:15–24.
doi: 10.1016/j.appet.2016.01.027
Vartanian LR, Porter AM. Weight stigma and eating behavior: A review of the literature. Appetite. 2016;102:3–14.
doi: 10.1016/j.appet.2016.01.034
Sabin JA, Marini M, Nosek BA. Implicit and explicit anti-fat bias among a large sample of medical doctors by BMI, race/ethnicity and gender. PLoS ONE. 2012;7(11):e48448.
doi: 10.1371/journal.pone.0048448
Puhl RM, Luedicke J, Grilo CM. Obesity bias in training: attitudes, beliefs, and observations among advanced trainees in professional health disciplines. Obesity (Silver Spring). 2014;22(4):1008–15.
doi: 10.1002/oby.20637
Bombak AE, McPhail D, Ward P. Reproducing stigma: Interpreting “overweight” and “obese” women’s experiences of weight-based discrimination in reproductive healthcare. Soc Sci Med. 2016;166:94–101.
Lee JA, Pause CJ. Stigma in Practice: Barriers to Health for Fat Women. Front Psychol. 2016;7:2063.
doi: 10.3389/fpsyg.2016.02063
Lawrence BJ, Kerr D, Pollard CM, Theophilus M, Alexander E, Haywood D, et al. Weight bias among health care professionals: A systematic review and meta-analysis. Obesity (Silver Spring). 2021;29(11):1802–12.
doi: 10.1002/oby.23266
Puhl RM, Phelan SM, Nadglowski J, Kyle TK. Overcoming Weight Bias in the Management of Patients With Diabetes and Obesity. Clin Diabetes. 2016;34(1):44–50.
doi: 10.2337/diaclin.34.1.44
Forhan M, Salas XR. Inequities in healthcare: a review of bias and discrimination in obesity treatment. Can J Diabetes. 2013;37(3):205–9.
doi: 10.1016/j.jcjd.2013.03.362
Tylka TL, Annunziato RA, Burgard D, Daníelsdóttir S, Shuman E, Davis C, et al. The Weight-Inclusive versus Weight-Normative Approach to Health: Evaluating the Evidence for Prioritizing Well-Being over Weight Loss. J Obes. 2014;2014:983495.
doi: 10.1155/2014/983495
Mauldin K, May M, Clifford D. The consequences of a weight-centric approach to healthcare: a case for a paradigm shift in how clinicians address body weight. Nutr Clin Pract. 2022;37(6):1291–306.
doi: 10.1002/ncp.10885
Paradis E, Kuper A, Reznick RK. Body fat as metaphor: from harmful to helpful. CMAJ. 2013;185(2):152–3.
doi: 10.1503/cmaj.120100
Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griffin JM, van Ryn M. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev. 2015;16(4):319–26.
doi: 10.1111/obr.12266
Alberga AS, Edache IY, Forhan M, Russell-Mayhew S. Weight bias and health care utilization: a scoping review. Prim Health Care Res Dev. 2019;20:e116-e.
doi: 10.1017/S1463423619000227
Mensinger JL, Tylka TL, Calamari ME. Mechanisms underlying weight status and healthcare avoidance in women: A study of weight stigma, body-related shame and guilt, and healthcare stress. Body Image. 2018;25:139–47.
doi: 10.1016/j.bodyim.2018.03.001
Rhee EJ. Weight Cycling and Its Cardiometabolic Impact. J Obes Metab Syndr. 2017;26(4):237–42.
doi: 10.7570/jomes.2017.26.4.237
Hunger J, Smith J, Tomiyama AJ. An Evidence-Based Rationale for Adopting Weight-Inclusive Health Policy. Soc Issues Policy Rev. 2020;14:73–107.
doi: 10.1111/sipr.12062
Gaesser GA, Angadi SS. Obesity treatment: Weight loss versus increasing fitness and physical activity for reducing health risks. iScience. 2021;24(10):102995.
doi: 10.1016/j.isci.2021.102995
Rubino F, Puhl RM, Cummings DE, Eckel RH, Ryan DH, Mechanick JI, et al. Joint international consensus statement for ending stigma of obesity. Nat Med. 2020;26(4):485–97.
doi: 10.1038/s41591-020-0803-x
Flint SW. Time to end weight stigma in healthcare. eClinicalMedicine. 2021;34:100810.
doi: 10.1016/j.eclinm.2021.100810
Wharton S, Lau DCW, Vallis M, Sharma AM, Biertho L, Campbell-Scherer D, et al. Obesity in adults: a clinical practice guideline. CMAJ. 2020;192(31):E875–91.
doi: 10.1503/cmaj.191707
Moore CH, Oliver TL, Randolph J, Dowdell EB. Interventions for reducing weight bias in healthcare providers: An interprofessional systematic review and meta-analysis. Clin Obes. 2022;12(6):e12545.
doi: 10.1111/cob.12545
Alberga AS, Pickering BJ, Alix Hayden K, Ball GD, Edwards A, Jelinski S, et al. Weight bias reduction in health professionals: a systematic review. Clin Obes. 2016;6(3):175–88.
doi: 10.1111/cob.12147
Laganá L, Gavrilova L, Carter DB, Ainsworth AT. A Randomized Controlled Study on the Effects of a Documentary on Students’ Empathy and Attitudes towards Older Adults. Psychol Cogn Sci. 2017;3(3):79–88.
Player E, Gure-Klinke H, North S, Hanson S, Lane D, Culyer G, et al. Humanising medicine: teaching on tri-morbidity using expert patient narratives in medical education. Educ Prim Care. 2019;30(6):368–74.
doi: 10.1080/14739879.2019.1670097
Kumagai A, Murphy E, Ross P. Diabetes stories: Use of patient narratives of diabetes to teach patient-centered care. Adv Health Sci Educ Theory Pract. 2008;14:315–26.
doi: 10.1007/s10459-008-9123-5
Heidke P, Howie V, Ferdous T. Use of healthcare consumer voices to increase empathy in nursing students. Nurse Educ Pract. 2018;29:30–4.
doi: 10.1016/j.nepr.2017.11.007
Leeds FS, Sommer EM, Andrasik WJ, Atwa KM, Crawford TN. A Patient-Narrative Video Approach to Teaching Fibromyalgia. J Med Educ Curric Dev. 2020;7:2382120520947068.
Gordon M, Gupta S, Thornton D, Reid M, Mallen E, Melling A. Patient/service user involvement in medical education: A best evidence medical education (BEME) systematic review: BEME Guide No. 58. Med Teach. 2020;42(1):4–16.
doi: 10.1080/0142159X.2019.1652731
Kumagai AK. A conceptual framework for the use of illness narratives in medical education. Acad Med. 2008;83(7):653–8.
doi: 10.1097/ACM.0b013e3181782e17
McFarland S. Authoritarianism, Social Dominance, and Other Roots of Generalized Prejudice. Polit Psychol. 2010;31:453–77.
doi: 10.1111/j.1467-9221.2010.00765.x
Bäckström M, Björklund F. Structural modeling of generalized prejudice: The role of social dominance, authoritarianism, and empathy. J Individ Differ. 2007;28(1):10–7.
doi: 10.1027/1614-0001.28.1.10
Batson CD, Polycarpou MP, Harmon-Jones E, Imhoff HJ, Mitchener EC, Bednar LL, et al. Empathy and attitudes: can feeling for a member of a stigmatized group improve feelings toward the group? J Pers Soc Psychol. 1997;72(1):105–18.
doi: 10.1037/0022-3514.72.1.105
Dorozenko K, Ridley S, Martin R, Mahboub L. A journey of embedding mental health lived experience in social work education. Soc Work Educ. 2016;35(8):905–17.
doi: 10.1080/02615479.2016.1214255
Gilbert P, Stickley T. “Wounded Healers”: the role of lived-experience in mental health education and practice. J Ment Health Train Educ Pract. 2012;7(1):33–41.
doi: 10.1108/17556221211230570
Happell B, Byrne L, McAllister M, Lampshire D, Roper C, Gaskin CJ, et al. Consumer involvement in the tertiary-level education of mental health professionals: a systematic review. Int J Ment Health Nurs. 2014;23(1):3–16.
doi: 10.1111/inm.12021
Happell B, Bennetts W, Harris S, Platania-Phung C, Tohotoa J, Byrne L, et al. Lived experience in teaching mental health nursing: issues of fear and power. Int J Ment Health Nurs. 2015;24(1):19–27.
doi: 10.1111/inm.12091
Meeks LM, Jain NR. Accessibility, Inclusion and Action in Medical Education: Lived Experiences of Learners and Physicians with Disabilities. Washington, D.C.: Association of American Medical Colleges; 2018. https://www.researchgate.net/publication/328839425_Accessibility_inclusion_and_action_in_medical_education_Lived_experiences_of_learners_and_physicians_with_disabilities .
Meehan T, Glover H. Telling our story: consumer perceptions of their role in mental health education. Psychiatr Rehabil J. 2007;31(2):152–4.
doi: 10.2975/31.2.2007.152.154
Kleinpell R, Ely EW, Williams G, Liolios A, Ward N, Tisherman SA. Web-based resources for critical care education. Crit Care Med. 2011;39(3):541–53.
doi: 10.1097/CCM.0b013e318206b5b5
Meade O, Bowskill D, Lymn JS. Pharmacology podcasts: a qualitative study of non-medical prescribing students’ use, perceptions and impact on learning. BMC Med Educ. 2011;11:2.
Scott K, Hsu C, Nj J, et al. Integration of social media in emergency medicine residency curriculum. Ann Emerg Med. 2014;64:396–404.
doi: 10.1016/j.annemergmed.2014.05.030
Thompson HJ, Belza B, Baker M, Christianson P, Doorenbos A, Nguyen H. Identifying and evaluating electronic learning resources for use in adult-gerontology nurse practitioner education. J Prof Nurs. 2014;30(2):155–61.
doi: 10.1016/j.profnurs.2013.08.004
Cho D, Cosimini M, Espinoza J. Podcasting in medical education: a review of the literature. Korean J Med Educ. 2017;29(4):229–39.
doi: 10.3946/kjme.2017.69
Rodman A, Trivedi S. Podcasting: A Roadmap to the Future of Medical Education. Semin Nephrol. 2020;40(3):279–83.
doi: 10.1016/j.semnephrol.2020.04.006
Mostyn A, Jenkinson CM, McCormick D, Meade O, Lymn JS. An exploration of student experiences of using biology podcasts in nursing training. BMC Med Educ. 2013;13:12.
doi: 10.1186/1472-6920-13-12
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.
doi: 10.1191/1478088706qp063oa
Flicker S, Nixon SA. The DEPICT model for participatory qualitative health promotion research analysis piloted in Canada, Zambia and South Africa. Health Promot Int. 2015;30(3):616–24.
doi: 10.1093/heapro/dat093
Government of Ontario. Data Standards for the Identification and Monitoring of Systemic Racism 2022 [Available from: https://www.ontario.ca/document/data-standards-identification-and-monitoring-systemic-racism .
Bell L. Chapter 1: Theoretical Foundations for Social Justice Education. Adams M, Bell L, editors. New York: Routledge; 2016. https://doi.org/10.4324/9781315775852 .
DiAngelo R. White fragility. Int J Critical Pedagogy. 2011;3(3):54–70.
O’Hara L, Gregg J. The war on obesity: a social determinant of health. Health Promot J Austr. 2006;17(3):260–3.
O’Reilly C, Sixsmith J. From theory to policy: reducing harms associated with the weight-centered health paradigm. Fat Stud. 2012;1(1):97–113.
Bacon L, Aphramor L. Weight science: evaluating the evidence for a paradigm shift. Nutr J. 2011;10:9.
doi: 10.1186/1475-2891-10-9
Mensinger JL, Calogero RM, Stranges S, Tylka TL. A weight-neutral versus weight-loss approach for health promotion in women with high BMI: A randomized-controlled trial. Appetite. 2016;105:364–74.
doi: 10.1016/j.appet.2016.06.006
Association for Size Diversity and Health. The Health at Every Size® (HAES®) Approach 2020 [Available from: https://asdah.org/health-at-every-size-haes-approach/ .
Greenhalgh T, Snow R, Ryan S, Rees S, Salisbury H. Six “biases” against patients and carers in evidence-based medicine. BMC Med. 2015;13:200.
de DomontSerpa O, Leal E, Munoz N. The centrality of narratives in the mental health clinic, care and research. Philosophy Psychiatr Psychol. 2019;26:155–64.
doi: 10.1353/ppp.2019.0021
Dahl-Michelsen T, Kinsella EA, Groven KS. Toward an inclusive evidence-based practice model: Embracing a broader conception of professional knowledge in health care and health care higher education. Critical Studies in Teaching and Learning. 2021;9(1):94–114.
Beames JR, Kikas K, O’Gradey-Lee M, Gale N, Werner-Seidler A, Boydell KM, et al. A new normal: integrating lived experience into scientific data syntheses. Front Psychiatry. 2021;12:763005.
Berge JM, Mendenhall TJ, Doherty WJ. Using Community-based Participatory Research (CBPR) To Target Health Disparities in Families. Fam Relat. 2009;58(4):475–88.
doi: 10.1111/j.1741-3729.2009.00567.x
Martel S, Andrews A, Griffin L, Hollahan A, Meerai S, Friedman M, et al. Raising Awareness of Weight-Based Oppression in Health Care: Reflections on Lived Experience Education as Emotional Labor. Brown HA, Ellis-Ordway N, editors. New York, N.Y.: Routledge; 2022.