Promoting Sensitivity towards the Bariatric Patient Population Module 2: The Patient Experience 036864-150710

Learning Objectives Understand the struggle and pains that people with obesity face Identify experiences which impact quality of life Recognize the need for empathy Discuss how the professional can utilize this information to best support the patient In the last module, we reviewed the definition of discrimination and discussed when and where weight discrimination occurs for individuals with obesity. In this module, we will discuss the struggles and pains that people with obesity face, hear some firsthand accounts about experiences that affect quality of life for a person with obesity, recognize the need for empathy when treating patients with obesity, and discuss how medical professionals can use the information we have learned to support the patient. This information was developed by and/or in collaboration with bariatric practice(s).  It is intended for your reference only.  Your professional judgment should dictate whether any of the information, recommendations or direction contained in this material is appropriate for your patients.

Those Directly Impacted… Obesity affects about 1 in 3 Americans. This epidemic has grown each year, but how does it really affect individuals who are dealing with the disease? Now we will watch some personal accounts of the struggles individuals face when suffering from obesity.

Meet Andi struggling This is Andi. She has been fighting to keep off 40-50 lbs for years.

Quality of Life BMI Weight cycling Individuals with obesity face the challenge of their bodies fighting against an elevated “set point.” Even if they lose weight, their body responds by holding on to more weight and making it much easier to gain the weight back. This leads to an elevated BMI and a rollercoaster of weight loss and gain, always ending with the body settling into a state of obesity. Reference 1

Meet Barbara & Gail hurt stressed struggling Next we will meet Barbara and Gail. They discuss the emotional scarring and depression that comes along with being a victim of teasing due to obesity. struggling

Children & Teens Verbal teasing by peers Physical bullying Social exclusion Children and teenagers with obesity experience verbal teasing by their peers and can be subject to physical bullying as well. They often also face social exclusion, because they are viewed as “different” or the “odd man out”. Reference 2,3

didn’t want to go out in public Meet Gail & Cheryl didn’t want to go out in public hurt treated differently Now we will hear from Gail again, and meet Cheryl, as they discuss the difference in treatment they have experienced after having bariatric surgery compared to when they suffered from obesity. struggling

Discrimination in Society Impacts… Poor self-esteem Low confidence Depression As Gail, Cheryl, and Barbara described, discrimination against individuals with obesity can cause poor self-esteem, low confidence, and depression which can last even longer than the discrimination itself.

didn’t want to go out in public Meet Ed didn’t want to go out in public hurt treated differently tired struggling Now we will hear from Ed, who will explain some of the physical struggles he faces because of his obesity.

Co-morbid Conditions & Obesity Hypertension Type 2 diabetes Heart disease Stroke Sleep apnea Ed, like many other individuals with obesity, suffers from a co-morbid condition that is caused by his obesity. Common comorbidities include hypertension, type II diabetes, heart disease, stroke, and sleep apnea, as well as conditions such as osteoarthritis. Reference 4

didn’t want to go out in public Meet Elaine didn’t want to go out in public seen as lazy treated differently tired hurt Our next personal account, Elaine, shares the prejudice she faces in the workplace because of her obesity. struggling

Obesity in the Workforce Weight bias General barrier Stereotypes Unequal treatment As Elaine mentioned, there is a general barrier for individuals with obesity in the workforce. They are often seen as lazy or less likely to be able to properly perform job duties, and lose out on promotions to individuals with normal BMI. Reference 5

Surgery not understood Meet Gail Surgery not understood Gail will now talk about how her physician didn’t believe surgery was a reasonable treatment for her obesity.

Physician Attitudes Toward Obesity Physician’s attitudes toward people with obesity "I feel uncomfortable when examining a patient with obesity" "It is difficult for me to feel empathy for a patient with obesity" Even though patients should feel comfortable receiving healthcare regardless of their weight, studies have shown that medical professionals still display discrimination towards individuals with obesity. A study was conducted in 3 parts to test the theory that there is a negative view of patients with obesity in the healthcare field. The first section focused on Physician’s attitudes toward people with obesity, and asked them to rate their views on statements such as “I feel uncomfortable when examining a [patient with obesity}” and “it is difficult for me to feel empathy for a [patient with obesity]”. Reference 6

Physician Attitudes Toward Obesity Physician’s attitude toward treatment "Obesity is a treatable condition" "Most patients with obesity will not lose a significant amount of weight.” Physician’s attitude toward obesity as a disease “Is obesity primarily caused by behavioral factors?” The second section focused on the physician’s attitude toward treatment, using statements like “obesity is a treatable condition” and “most [patients with obesity] will not lose a significant amount of weight”, and the third section focused on the physician’s attitude toward obesity as a disease, using the question “is obesity primarily caused by behavioral factors?” Reference 6

Physician Attitudes Toward Obesity 40% of physicians had a negative attitude towards patients with obesity Negative attitudes reported by: Physicians Nurses Dietitians Psychologists Medical Students The study found that 40% of physicians still have a negative attitude towards patients with obesity. Not only did physicians report negative attitudes, but nurses, dietitians, psychologists, and medical students shared in these attitudes as well. Reference 6,7

Surgery not understood Meet Virginia Surgery not understood educated physician Virginia is a woman who educated her physician about the importance of bariatric surgery to improve her life.

Educating Healthcare Professionals Surgery is an option for patients with clinically severe obesity BMI >=40 BMI >=35 with co-morbid conditions   It is important that healthcare professionals are aware that surgery is an option for patients with clinically severe obesity. This is defined as having a BMI of greater than or equal to 40, or greater than or equal to 35 with co-morbid conditions. Reference 4

Surgery not understood Meet Virginia Surgery not understood looking forward to… Educated physician Virginia shares what she is looking forward to after the surgery.

Surgery not understood last chance at a normal life Meet Leslie Surgery not understood looking forward to… last chance at a normal life Educated physician Leslie will explain that bariatric surgery is the last chance these patients have at a “normal life”.

Conclusion The Professional and Patient Team the negative perception of individuals affected by obesity held by the healthcare field and workforce should be changed A positive perception can help make healthcare and professional life a more comfortable and meaningful experience for these patients To review what we have discussed: [read bullet points]

References Mannucci E, Petroni ML, Villanova N, et al. Clinical and psychological correlates of health-related quality of life in obese. Health and Quality of Life Outcomes. 2010; 8:90. Janssen I, Craig WM, Boyce WF, Pickett W. Associations between overweight and obesity with bullying behaviors in school-aged children. Pediatrics. 2004;113(5):1187-94. Lumeng JC, Forrest P, Appugliese DP, et al. Weight Status as a Predictor of Being Bullied in Third Through Sixth Grades. Pediatrics 2010; 125(6):1301-07. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. National Institutes of Health. September 1998. Giel KE, Thiel A, Teufel M, et al. Weight Bias Work Settings. Obesity Facts. 2010. 3(1):33-40. http://www.ncbi.nlm.nih.gov/pubmed/20215793 Jay M, Kalet A, Tavinder A, et al. Physicians’ Attitudes About Obesity. BMC Health Services Research. 2009; 9:106. Brownell K, Puhl R. Stigma and Discrimination in Weight Management and Obesity. The Permanente Journal. 2003; 7(3):21-23.