1. An Association Between Provider Stigma and Metabolically Healthy
Obese Patient Outcomes: An Integrative Literature Review
Katelin Dosky, Department of Nursing, Masters Entry to Nursing Practice 2018, DePaul University
Background
Conceptual Framework
Discussion
Interaction between
Client singularity or demographics
Client-professional interaction
Health outcomes
Interaction Model of Client Behavior (IMCHB)
Obesity
Higher body weight than what is considered healthy
Measured by BMI
Weight in kilograms/(height in meters)2
Overweight = 25-30
Obese = > 30
Metabolically Healthy Obesity
Person does not possess risk factors
Elevated blood pressure
Increased lipid panels
Inflammation
High fasting blood glucose
29.2% of obese men and 35.4% of obese women in the U.S. are healthy related to their cardiometabolic risk factors
Prevention and Protection Against Metabolically Unhealthy Obesity
Weight loss via diet and exercise
Younger age
Living in a high socioeconomic status area
Provider Stigma
Creates physical and psychological health disparities
Characterized by
Identification and labeling of the human experience
Undesirable characteristics
Separation of them from us
Discrimination
Power
Provider stigma
Decreased affective support
Does not relate to the client on an emotional level
Lack of empathy
Positive Outcomes
Occur when interventions are tailored to the uniqueness of the client
Do not occur with provider stigma, which involves a level of generalization of care across patients
Less education and interventions occur when providers stigmatize and make assumptions about the patient
Providers are more likely to blame patients than provide education
Poor health outcomes for patients
Transition from MHO to metabolically unhealthy obesity
Provider stigma is a result of
Lack of education
Inability to see patient as someone who can effect change through lifestyle habits
Inconsideration for the patient’s cultural and family lifestyle
Methods
Nursing Implications
Training to Reduce Obesity Stigma
Increase knowledge related to lifestyle changes for obese patients
Healthy diet and exercise instead of weight loss
Promote changes that can be maintained and lead to better outcomes
Encourage collaboration with patients to develop mutual goals
Extend training from nurses to other healthcare professionals
Promote Overall Patient Health
Understanding and providing resources for healthy living
Advocate for legislation to prohibit weight discrimination in the healthcare setting
Encourage other providers to learn about causes, prevention, and adequate treatment options for obese patients
Problem Statement
Stigma can affect ability to gain employment, housing, and access to medical care
Decreases overall health status
Weight stigma increases health disparities among obese populations
Providers view patients as lazy, lacking willpower, and non-compliant
Hesitant to approach the topic of weight loss with patients
Conclusions
Provider stigma leads to negative outcomes for obese patients
Can promote transition from MHO to metabolically unhealthy obesity
Lack of lifestyle changes
Less frequent follow up visits
Overall decreased patient fitness
Ineffective health management and poor health outcomes
Providers are crucial in educating patients on a healthy lifestyle
Need to devote time and training to collaboration with obese patients
Work on developing emotional rapport
Further Research
Effects of provider stigma specifically on MHO patients
Why some obese patients observed provider stigma while others did not
Possibility for distinct health interventions between MHO and metabolically unhealthy obesity
Stigma-reducing educational measures for providers
Results
Reasons for Provider Stigma
Detrimental thought cycle
Perception of obesity education as worthless
Belief of inability to effect change and encourage compliance
Discomfort in discussing topic
Lack of knowledge regarding care for obese patients
Cultural and family influence
Provider assumptions
Decreased emotional rapport
Patient Outcomes
Avoidance of health promotion measures and necessary screenings
Poor outcomes regardless of actual weight
Decreased compliance
Increase in disease progress markers (HbA1c) and distress about illness
Severe caloric restriction or overeating
Research Questions
What are the reasons that health care providers have a stigma toward the overweight or obese population?
Does provider stigma affect outcomes and health-related goals among MHO patients?