Are patients with obesity “scapegoats”? The obesity prejudice levels of health care workers in Turkey

Parildar, Hülya; Tuncer, Ozge Ucman; Sahin, Mustafa Kursat; Demirpençe, Mustafa; Yilmaz, Hamiyet

doi:10.1590/1806-9282.20210692

SUMMARY

OBJECTIVE:

This study assessed obesity prejudice levels, attitudes, and perceptions of health care workers toward individuals with obesity and the relationship between health care workers’ perceptions of own and society’s weight bias, healthy lifestyle preferences, body mass index, and other factors with obesity prejudice levels.

METHODS:

This cross-sectional and descriptive study was conducted with 700 health care workers in Turkey via an online survey addressing characteristics, perceptions, and attitudes toward obesity including an obesity prejudice scale. Categorical variables were expressed as frequencies and percentages. The χ² test was applied to compare categorical variables. The distribution of the data was evaluated by the Kolmogorov-Smirnov test. Normally distributed data were compared by an independent sample t-test, while the Mann-Whitney U and Kruskal-Wallis tests were used for comparing non-normally distributed data.

RESULTS:

Participants’ mean age was 40.2±11.3 years and 67.9% were women. Notably, 57.9% worked at tertiary health care centers, 85.9% were physicians, and 64.8% were family physicians; 25% were prejudicial, while 58.1% tended to have prejudice toward individuals with obesity. Obesity prejudice scores were significantly higher among those who were in close contact with and who stated their preference for patients with obesity.

CONCLUSIONS:

Half of the participants tended to have prejudice, and one-fourth were prejudicial toward individuals with obesity. These results highlight the necessity of raising awareness of health care workers to reduce prejudicial attitudes that may negatively impact patients with obesity. Stigmatizing experiences might be detrimental, reducing the quality of life with long-term consequences for emotional and physical health.

KEYWORDS:
Obesity; Weight prejudices; Obesity bias; Stigmatization

INTRODUCTION

Obesity is a common health problem and individuals impacted by this epidemic have to struggle with concomitant disorders including low self-esteem and depression¹1 Chu DT, Nguyet NTM, Nga VT, Lien NVY, Vo DD, Lien N, et al. An update on obesity: mental consequences and psychological interventions. Diabetes Metab Syndr. 2019;13(1):155-60. https://doi.org/10.1016/j.dsx.2018.07.015
https://doi.org/10.1016/j.dsx.2018.07.01... . Despite improvements in the management of obesity, due to multifactorial etiologies including genetic, environmental, sociocultural, and psychological factors, prevention and treatment should be based on a biopsychosocial and patient-centered approach rather than a biomedical approach²2 Náfrádi L, Nakamoto K, Schulz PJ. Is patient empowerment the key to promote adherence? A systematic review of the relationship between self-efficacy, health locus of control and medication adherence. PLoS One. 2017;12(10):e0186458. https://doi.org/10.1371/journal.pone.0186458
https://doi.org/10.1371/journal.pone.018... ,³3 Rand K, Vallis M, Aston M, Price S, Piccinini-Vallis H, Rehman L, et al. “It is not the diet; it is the mental part we need help with.” A multilevel analysis of psychological, emotional, and social well-being in obesity. Int J Qual Stud Health Well-being. 2017;12(1):1306421. https://doi.org/10.1080/17482631.2017.1306421
https://doi.org/10.1080/17482631.2017.13... .

Attitudes of health care workers (HCWs) while counseling and managing the patients with obesity are crucial. Reports show that discriminative and stigmatized behavior decreases quality of life, leads to social isolation, decreases applications to health institutions, and affects individual health and society due to an increase in obesity-related problems⁴4 Puhl RM, Latner JD, O’Brien K, Luedicke J, Danielsdottir S, Forhan M. A multinational examination of weight bias: predictors of anti-fat attitudes across four countries. Int J Obes (Lond). 2015;39(7):1166-73. https://doi.org/10.1038/ijo.2015.32
https://doi.org/10.1038/ijo.2015.32... . Previous studies showed that the percentage of HCWs with prejudice toward patients with obesity was higher than estimated⁴4 Puhl RM, Latner JD, O’Brien K, Luedicke J, Danielsdottir S, Forhan M. A multinational examination of weight bias: predictors of anti-fat attitudes across four countries. Int J Obes (Lond). 2015;39(7):1166-73. https://doi.org/10.1038/ijo.2015.32
https://doi.org/10.1038/ijo.2015.32... ,⁵5 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. https://doi.org/10.1038/s41591-020-0803-x
https://doi.org/10.1038/s41591-020-0803-... . Reports show that physicians had negative feelings about patients with obesity and described them as “irresponsible,” “incompatible with the management,” or “disobeying.” Moreover, they tend to spend less time with such patients and demand more laboratory work⁴4 Puhl RM, Latner JD, O’Brien K, Luedicke J, Danielsdottir S, Forhan M. A multinational examination of weight bias: predictors of anti-fat attitudes across four countries. Int J Obes (Lond). 2015;39(7):1166-73. https://doi.org/10.1038/ijo.2015.32
https://doi.org/10.1038/ijo.2015.32... –⁶6 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. https://doi.org/10.1017/S1463423619000227
https://doi.org/10.1017/S146342361900022... .

In our country, studies that measure obesity prejudice levels of HCWs are limited and include only primary care physicians’ and medical/nursing students’ attitudes and discriminative behaviors toward patients with obesity. This study aimed to investigate the perceptions, attitudes, and opinions of HCWs in Turkey toward individuals with obesity and evaluate the relation between the obesity prejudice levels and sociodemographic characteristics, body mass index (BMI), lifestyle preferences, and other factors.

METHODS

This cross-sectional study was conducted between February and March 2021 via an online questionnaire sent to HCWs working in Turkey.

The sample size was calculated as 385 participants by using the formula, OpenEpi, version 3: n=[DEFF*Np(1-p)]/[(d²2 Náfrádi L, Nakamoto K, Schulz PJ. Is patient empowerment the key to promote adherence? A systematic review of the relationship between self-efficacy, health locus of control and medication adherence. PLoS One. 2017;12(10):e0186458. https://doi.org/10.1371/journal.pone.0186458
https://doi.org/10.1371/journal.pone.018... /Z²2 Náfrádi L, Nakamoto K, Schulz PJ. Is patient empowerment the key to promote adherence? A systematic review of the relationship between self-efficacy, health locus of control and medication adherence. PLoS One. 2017;12(10):e0186458. https://doi.org/10.1371/journal.pone.0186458
https://doi.org/10.1371/journal.pone.018... _1-α_/2*(N-1)+p*(1-p)] by accepting the total number of HCWs in Turkey as (N) 1.033.767, the percentage of obesity prejudice possibility existence (p) as 50%, confidence interval as 95%, and confidence limit (d) as 5%.

The online questionnaire form was sent to HCWs as a Google form via Whatsapp, Facebook, and email groups. The participants were first informed about the purpose of the study, the duration of the questionnaire, the identity of the researchers, and how the data would be kept. Participants who accepted to enter the study and responded positively to the consent form then completed the questionnaire.

The questionnaire was developed based on the revision of related articles, then tested on 15 HCWs, and reorganized for accuracy and clarity⁴4 Puhl RM, Latner JD, O’Brien K, Luedicke J, Danielsdottir S, Forhan M. A multinational examination of weight bias: predictors of anti-fat attitudes across four countries. Int J Obes (Lond). 2015;39(7):1166-73. https://doi.org/10.1038/ijo.2015.32
https://doi.org/10.1038/ijo.2015.32... ,⁷7 Akman M, Kıvrakog˘lu E, Cifcili S, Unalan PC. Weight bias among primary care health professionals: personal attitude matters. Obe Metab. 2010 [cited on Jun-Sep, 2010];14(2-3):63-8. Available from: https://www.researchgate.net/publication/232612694_Weight_Bias_among_Primary_Care_Health_Professionals_Personal_Attitude_Matters
https://www.researchgate.net/publication... .The self-administered questionnaire form included 53 questions to be completed in 10 min. The questionnaire consisted of two parts. The first part included questions about participants’ sociodemographic characteristics, exercise, healthy eating status, body weight and height, attitudes, and perceptions regarding obesity. The second part included questions from the Obesity Prejudice Scale (GAMS-27).

Obesity prejudice scale

The scale was developed by Ercan et al. and included 27 items⁸8 Ercan A, Ok MA, Kızıltan G, Altun S. Development of obesity prejudice scale for students of health sciences: GAMS 27-obesity prejudice scale. DBHAD. 2015;3(2):29-43. https://doi.org/10.17362/DBHAD.2015310322
https://doi.org/10.17362/DBHAD.201531032... . Twelve items included positive expressions, and 15 items included negative expressions, defined as “absolutely agree”, “agree”, “doubtful”, “disagree” and “absolutely disagree” as fivefold Likert scale. Negative expressions were evaluated by reverse scoring. The highest and lowest scores would be 135 and 27, respectively. A score of 68.00 and below was evaluated as unbiased, between 68.01 and 84.99 points tend to be biased, and above 85 points was evaluated as biased⁸8 Ercan A, Ok MA, Kızıltan G, Altun S. Development of obesity prejudice scale for students of health sciences: GAMS 27-obesity prejudice scale. DBHAD. 2015;3(2):29-43. https://doi.org/10.17362/DBHAD.2015310322
https://doi.org/10.17362/DBHAD.201531032... .

Statistical analysis

Data were evaluated by SPSS 21.0. Continuous variables were presented as mean±standard deviation or median and minimum–maximum. Categorical variables were expressed as frequencies and percentages. The chi-square test was applied to compare categorical variables. The distribution of the data was evaluated by the Kolmogorov-Smirnov test. Normally distributed data were compared by an independent sample t-test, while the Mann-Whitney U and Kruskal-Wallis tests were used for comparing non-normally distributed data. BMI of the participants was calculated from the data on SPSS, using the formula (the body weight in kilograms divided by body height in meters squared). The study was approved by Tepecik Research and Training Hospital Ethics Committee (dated January 25, 2021, decision number: 2021/01-57).

RESULTS

The study included 700 Turkish HCWs. Participants’ mean age was 40.2±11.3 years, 67.9% were women, and 66.9% were married. Notably, 57.9% of participants were working at tertiary health care centers, 85.9% were physicians, 64.8% were family physicians, and 41.6% worked for less than 10 years. According to calculated BMI values, 15.4% had obesity, 25% were prejudicial, and 58.1% showed prejudice toward individuals with obesity (Table 1). Notably, 29.1% considered losing weight as “difficult” or “very difficult,” 79% thought that society prefers thin individuals than those with obesity, 83% had relatives with obesity, 42.3% experienced obesity in their lifetime, 70.4% went on a diet previously, and 77.9% stated difficulty with dieting. In addition, 84.4% were exercising, 48.4% had healthy eating habits, and 81.7% of the participants were in close contact with individuals with obesity. Also, 15.1% were fond of providing health care to patients with obesity, and 3.4% preferred to have individuals with obesity to be around; 72.7% thought that obesity imposes a tremendous economic burden on the health system (Table 2).

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Table 1
Categorization of Study Participants’ Obesity Prejudice Scale Scores.

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Table 2
Characteristics of the study participants.

According to Obesity Prejudice Scale (GAMS-27), female HCWs (p=0.006), married HCWs (p=0.008), and those who worked more than 20 years (p<0.001) were found to be prejudicial compared with males, with those unmarried, and with the participants who worked less than 20 years, respectively. The study participants who stated not to have prejudice toward individuals with obesity (p<0.001), who preferred to have individuals with obesity around (p<0.001), who stated their interest in providing health care to the patients with obesity (p<0.001), and the respondents who did not think patients with obesity cause a great burden to the health system (p<0.001) had significantly higher scores and were found to be prejudicial. The obesity prejudice scale scores did not differ regarding the study participants’ workplace, medical specialty, BMI, attitude about society’s preference for thin or fat persons, having a relative with obesity, the experience of obesity, doing exercise, healthy eating, the experience of dieting, or having difficulty in dieting (Table 3).

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Table 3
Comparison of Obesity Prejudice Scale categories by study participants’ characteristics.

DISCUSSION

Obesity management is complex. Stigmatization, bias levels, and HCWs’ attitudes have significant roles on the effectiveness of communication with patients with obesity.
As HCWs are in the frontline of managing obesity, the awareness of their own weight bias is important in reducing prejudice.
The present study was carried out with the largest sample of HCWs in Turkey and contributes to valuable data.

Obesity prejudice among HCWs leads to extra social, psychological, and medical problems. Motivational interviewing techniques are needed for improving the adherence to treatment in obesity⁹9 Carr D, Friedman MA. Body weight and the quality of interpersonal relationships. Soc Psychol Q. 2006 [cited on Jun, 2006];69(2):127-49. Available from: http://www.jstor.org/stable/20141735
http://www.jstor.org/stable/20141735... . It is important to approach in an empathic, supportive, explanatory, realistic, and guiding way in the patient-centered and motivational interviewing model because patients avoid health care services due to negative attitudes, behaviors, and suggestions for losing weight when the patients are not ready, and failure of past treatments⁵5 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. https://doi.org/10.1038/s41591-020-0803-x
https://doi.org/10.1038/s41591-020-0803-... –⁷7 Akman M, Kıvrakog˘lu E, Cifcili S, Unalan PC. Weight bias among primary care health professionals: personal attitude matters. Obe Metab. 2010 [cited on Jun-Sep, 2010];14(2-3):63-8. Available from: https://www.researchgate.net/publication/232612694_Weight_Bias_among_Primary_Care_Health_Professionals_Personal_Attitude_Matters
https://www.researchgate.net/publication... . Studies have shown that physicians did not prefer to treat patients with obesity and stated that they did not expect the patients to be successful in losing weight due to nonadherence to treatment¹⁰10 Cox ME, Yancy Junior WS, Coffman CJ, Ostbye T, Tulsky JA, Alexander SC, et al. Effects of counseling techniques on patients’ weight-related attitudes and behaviors in a primary care clinic. Patient Educ Couns. 2011;85(3):363-8. https://doi.org/10.1016/j.pec.2011.01.024
https://doi.org/10.1016/j.pec.2011.01.02... . In our study, 31.6% of HCWs were found to have prejudice toward individuals with obesity. Akman et al. reported weight bias among physicians and nurses working at primary care but did not assess by an obesity prejudice scale⁷7 Akman M, Kıvrakog˘lu E, Cifcili S, Unalan PC. Weight bias among primary care health professionals: personal attitude matters. Obe Metab. 2010 [cited on Jun-Sep, 2010];14(2-3):63-8. Available from: https://www.researchgate.net/publication/232612694_Weight_Bias_among_Primary_Care_Health_Professionals_Personal_Attitude_Matters
https://www.researchgate.net/publication... . A study conducted with nursing students in Turkey reported prejudice scale scores as 75.54, showing that participants were prone to weight bias, and previous studies with students from health-related departments demonstrated that participants had negative attitudes and prejudice toward individuals with obesity. This suggests that studying in health-related departments may not be enough to eliminate or prevent weight bias. Our study found that obesity prejudice levels increased with the duration of work, and a study in Turkey also found that registered nurses had more negative prejudice scores toward persons with obesity than those of student nurses¹¹11 Yildiz M, Baysal HY. Prejudice against obesity in university students studying in health-related departments. Perspect Psychiatr Care. 2019;55(2):170-4. https://doi.org/10.1111/ppc.12314
https://doi.org/10.1111/ppc.12314... .

In our study, HCWs with obesity did not consider themselves as having obesity but overweight (6.8 out of 15.4%) instead. Moreover, study participants with obesity had higher prejudice scale scores than others, but this was not significant. Due to psychological disturbance, these participants might first stigmatize themselves, which might cause high prejudice levels. Internalized obesity prejudice is the acceptance of these negative attitudes by individuals with obesity, caused by the stigmatization and prejudice demonstrated by other individuals and resulted in low self-esteem, depression, impaired body image, problems related to body weight, and eating disorders¹²12 Pearl RL, Puhl RM. Measuring internalized weight attitudes across body weight categories: validation of the modified weight bias internalization scale. Body Image. 2014;11(1):89-92. https://doi.org/10.1016/j.bodyim.2013.09.005
https://doi.org/10.1016/j.bodyim.2013.09... . Similar studies showed that high BMI among HCWs was positively related to prejudice levels¹³13 Nair SC, Sheikh SM, Ibrahim H. Higher physician body mass index is associated with increased weight bias in an Arab country with high prevalence of obesity. Int J Prev Med. 2019;10:93. https://doi.org/10.4103/ijpvm.IJPVM_64_18
https://doi.org/10.4103/ijpvm.IJPVM_64_1... . Latner et al. conducted a study among overweight individuals and those with obesity and reported that those with internalized obesity prejudice had more physical, psychological, and social problems and lower quality of life¹⁴14 Latner JD, Durso LE, Mond JM. Health and health-related quality of life among treatment-seeking overweight and obese adults: associations with internalized weight bias. J Eat Disord. 2013;1:3. https://doi.org/10.1186/2050-2974-1-3
https://doi.org/10.1186/2050-2974-1-3... . Our participants who preferred to have individuals with obesity around and interested in providing health care to patients with obesity had higher prejudice scores. Moreover, HCWs who considered themselves without prejudice and did not think obesity as a burden to the health system were found to be prejudicial. In our study, obesity prejudice scale scores did not differ according to the participants having a relative with obesity.

Levels of prejudice differed according to participants’ sociodemographic characteristics. Individuals who were male, older, and had family members and friends with obesity were found to have lower hidden anti-obese prejudice. Tsai et al. observed that overweight male participants and those with obesity had a positive attitude toward their body weight compared with female participants¹⁵15 Tsai SA, Lv N, Xiao L, Ma J. Gender differences in weight-related attitudes and behaviors among overweight and obese adults in the United States. Am J Mens Health. 2016;10(5):389-98. https://doi.org/10.1177/1557988314567223
https://doi.org/10.1177/1557988314567223... . In our study, female HCWs were found to have more prejudice than males. The study participants who were married and worked more than 20 years were also more prejudicial than single ones and those who worked less than 20 years. Obesity prejudice levels increased with the duration of work, possibly the result of challenges after many years with the complexity and difficulty of obesity management. Our study revealed that most HCWs had high prejudice scores, although they stated their preference to provide health care to individuals with obesity, revealing a professional dilemma for HCWs.

Although it was not significant, among the physicians who participated in our study, primary care physicians did not have higher prejudicial scores than those working at secondary or tertiary hospitals. Many of the studies in the literature were performed with primary care physicians, and there are limited studies comparing weight bias levels of physicians from different workplaces. Bocquier et al. reported that 30% of primary care physicians showed negative attitudes toward individuals with obesity¹⁶16 Bocquier A, Verger P, Basdevant A, Andreotti G, Baretge J, Villani P, et al. Overweight and obesity: knowledge, attitudes, and practices of general practitioners in france. Obes Res. 2005;13(4):787-95. https://doi.org/10.1038/oby.2005.89
https://doi.org/10.1038/oby.2005.89... . Akman et al. also reported anti-obesity attitudes among primary care workers, including physicians and nurses, but the study sample was smaller than ours and did not include the attitudes of HCWs working in areas other than primary care⁷7 Akman M, Kıvrakog˘lu E, Cifcili S, Unalan PC. Weight bias among primary care health professionals: personal attitude matters. Obe Metab. 2010 [cited on Jun-Sep, 2010];14(2-3):63-8. Available from: https://www.researchgate.net/publication/232612694_Weight_Bias_among_Primary_Care_Health_Professionals_Personal_Attitude_Matters
https://www.researchgate.net/publication... . As a specialty, the integrative approach of family medicine is very crucial in complex diseases like obesity. Furthermore, primary care HCWs are very important for counseling and access to health care services. Although similar prejudice levels of primary care physicians are promising in this study, prejudicial attitudes of HCWs, including physicians from any kind of medical workplace, should be considered because all have different roles in the management of obesity.

This study has several limitations. First, the data were collected from individuals through Internet and social media groups. We do not know how the individuals who did not accept to participate in this study differ from these study participants. Second, in this study, we evaluated participants’ attitudes, opinions, and perceptions only via their declarations, and we might not have received information about their actual practices.

CONCLUSIONS

The present study was carried out with the largest sample of HCWs in Turkey and contributes to valuable data on prejudice levels among HCWs.
One-fourth of participants were found to be prejudicial, and half had a prejudicial tendency.
Prejudice levels did not significantly differ according to the HCWs’ specialty, workplace, or BMI.
Etiology is multifactorial and individuals with obesity deserve a better attitude from HCWs.

Since weight bias affects the quality of health care provided to individuals with obesity, it is necessary to intervene and develop strategies to reduce or prevent prejudice among HCWs. In light of our findings, HCWs with significant roles in managing obesity should undergo postgraduation education programs that should:

Use updated information about the multifactorial etiology of obesity;
Raise awareness about the effect of weight bias and stigmatization on doctor–patient relationships; and
Have realistic targets in the management of obesity and emphasize the concept of multidisciplinary approaches.

Funding: none.

REFERENCES

¹
Chu DT, Nguyet NTM, Nga VT, Lien NVY, Vo DD, Lien N, et al. An update on obesity: mental consequences and psychological interventions. Diabetes Metab Syndr. 2019;13(1):155-60. https://doi.org/10.1016/j.dsx.2018.07.015
» https://doi.org/10.1016/j.dsx.2018.07.015
²
Náfrádi L, Nakamoto K, Schulz PJ. Is patient empowerment the key to promote adherence? A systematic review of the relationship between self-efficacy, health locus of control and medication adherence. PLoS One. 2017;12(10):e0186458. https://doi.org/10.1371/journal.pone.0186458
» https://doi.org/10.1371/journal.pone.0186458
³
Rand K, Vallis M, Aston M, Price S, Piccinini-Vallis H, Rehman L, et al. “It is not the diet; it is the mental part we need help with.” A multilevel analysis of psychological, emotional, and social well-being in obesity. Int J Qual Stud Health Well-being. 2017;12(1):1306421. https://doi.org/10.1080/17482631.2017.1306421
» https://doi.org/10.1080/17482631.2017.1306421
⁴
Puhl RM, Latner JD, O’Brien K, Luedicke J, Danielsdottir S, Forhan M. A multinational examination of weight bias: predictors of anti-fat attitudes across four countries. Int J Obes (Lond). 2015;39(7):1166-73. https://doi.org/10.1038/ijo.2015.32
» https://doi.org/10.1038/ijo.2015.32
⁵
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. https://doi.org/10.1038/s41591-020-0803-x
» https://doi.org/10.1038/s41591-020-0803-x
⁶
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. https://doi.org/10.1017/S1463423619000227
» https://doi.org/10.1017/S1463423619000227
⁷
Akman M, Kıvrakog˘lu E, Cifcili S, Unalan PC. Weight bias among primary care health professionals: personal attitude matters. Obe Metab. 2010 [cited on Jun-Sep, 2010];14(2-3):63-8. Available from: https://www.researchgate.net/publication/232612694_Weight_Bias_among_Primary_Care_Health_Professionals_Personal_Attitude_Matters
» https://www.researchgate.net/publication/232612694_Weight_Bias_among_Primary_Care_Health_Professionals_Personal_Attitude_Matters
⁸
Ercan A, Ok MA, Kızıltan G, Altun S. Development of obesity prejudice scale for students of health sciences: GAMS 27-obesity prejudice scale. DBHAD. 2015;3(2):29-43. https://doi.org/10.17362/DBHAD.2015310322
» https://doi.org/10.17362/DBHAD.2015310322
⁹
Carr D, Friedman MA. Body weight and the quality of interpersonal relationships. Soc Psychol Q. 2006 [cited on Jun, 2006];69(2):127-49. Available from: http://www.jstor.org/stable/20141735
» http://www.jstor.org/stable/20141735
¹⁰
Cox ME, Yancy Junior WS, Coffman CJ, Ostbye T, Tulsky JA, Alexander SC, et al. Effects of counseling techniques on patients’ weight-related attitudes and behaviors in a primary care clinic. Patient Educ Couns. 2011;85(3):363-8. https://doi.org/10.1016/j.pec.2011.01.024
» https://doi.org/10.1016/j.pec.2011.01.024
¹¹
Yildiz M, Baysal HY. Prejudice against obesity in university students studying in health-related departments. Perspect Psychiatr Care. 2019;55(2):170-4. https://doi.org/10.1111/ppc.12314
» https://doi.org/10.1111/ppc.12314
¹²
Pearl RL, Puhl RM. Measuring internalized weight attitudes across body weight categories: validation of the modified weight bias internalization scale. Body Image. 2014;11(1):89-92. https://doi.org/10.1016/j.bodyim.2013.09.005
» https://doi.org/10.1016/j.bodyim.2013.09.005
¹³
Nair SC, Sheikh SM, Ibrahim H. Higher physician body mass index is associated with increased weight bias in an Arab country with high prevalence of obesity. Int J Prev Med. 2019;10:93. https://doi.org/10.4103/ijpvm.IJPVM_64_18
» https://doi.org/10.4103/ijpvm.IJPVM_64_18
¹⁴
Latner JD, Durso LE, Mond JM. Health and health-related quality of life among treatment-seeking overweight and obese adults: associations with internalized weight bias. J Eat Disord. 2013;1:3. https://doi.org/10.1186/2050-2974-1-3
» https://doi.org/10.1186/2050-2974-1-3
¹⁵
Tsai SA, Lv N, Xiao L, Ma J. Gender differences in weight-related attitudes and behaviors among overweight and obese adults in the United States. Am J Mens Health. 2016;10(5):389-98. https://doi.org/10.1177/1557988314567223
» https://doi.org/10.1177/1557988314567223
¹⁶
Bocquier A, Verger P, Basdevant A, Andreotti G, Baretge J, Villani P, et al. Overweight and obesity: knowledge, attitudes, and practices of general practitioners in france. Obes Res. 2005;13(4):787-95. https://doi.org/10.1038/oby.2005.89
» https://doi.org/10.1038/oby.2005.89

Publication Dates

Publication in this collection
13 Dec 2021
Date of issue
Dec 2021

History

Received
26 July 2021
Accepted
08 Sept 2021

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

[1] Funding: none.

Obesity Prejudice Scale Scores	n (%)
Non-prejudicial	118 (16.9)
Tendency for prejudice	407 (58.1)
Prejudicial	175 (25.0)

Characteristics and perceptions of HCWs	Category	n (%)
Sex	Male	225 (32.1)
Sex	Female	475 (67.9)
Marital status	Married	468 (66.9)
Marital status	Single	232 (33.1)
Duration of work	<10 years	291 (41.6)
	10–20 years	156 (22.3)
	>20 years	253 (36.1)
Medical Workplace	Primary care	189 (27.0)
	Secondary care	106 (15.1)
	Tertiary care	405 (57.9)
Occupation	Non-physician	100 (14.3)
Occupation	Physician	600 (85.7)
Medical Specialty of Physicians	Family physician	389 (64.8)
Medical Specialty of Physicians	Other than the family physician	211 (35.2)
BMI	Normal	359 (51.3)
	Overweight	233 (33.3)
	Obesity	108 (15.4)
Self-assessment of own body weight	Normal	353 (50.4)
	Overweight	287 (41.0)
	Obesity	60 (8.6)
Having difficulty in losing weight	Very difficult-Difficult	204 (29.1)
	Do not know	320 (45.7)
	Very easy-Easy	176 (25.1)
Thinking that society prefers thin individuals to fat ones	Agree	553 (79.0)
	Doubtful	88 (12.6)
	Disagree	59 (8.4)
Presence of relative with obesity	Yes	581 (83.0)
Presence of relative with obesity	No	119 (17.0)
Presence of own obesity in a lifetime period	Yes	296 (42.3)
Presence of own obesity in a lifetime period	No	404 (57.7)
Doing exercise	Yes	591 (84.4)
Doing exercise	No	109 (15.6)
Eating habits	Very healthy	339 (48.4)
	Healthy	192 (27.4)
	Unhealthy	169 (24.1)
Experience of dieting	Yes	493 (70.4)
Experience of dieting	No	207 (29.6)
Having difficulty with dieting	Yes	384 (77.9)
Having difficulty with dieting	No	109 (22.1)
Having prejudice towards individuals with obesity	Yes	221 (31.6)
Having prejudice towards individuals with obesity	No	479 (68.4)
Being in close contact with patients with obesity	Yes	572 (81.7)
Being in close contact with patients with obesity	No	128 (18.3)
Preferring individuals with obesity to be around	Yes	24 (3.4)
	Doubtful	493 (70.4)
	No	183 (26.1)
Fond of providing health care to patients with obesity	Yes	106 (15.1)
	Neutral	401 (57.3)
	No	193 (27.6)
Thinking that patients with obesity impose a tremendous economic burden on the health system	Yes	509 (72.7)
	No	191 (27.3)

Characteristics	Category	Non-prejudicial	Tendency for having prejudice	Prejudicial	p
Characteristics	Category	n (%)	n (%)	n (%)	p
Sex	Male	35 (15.6)	149 (66.2)	41 (18.2)	0.006
Sex	Female	83 (17.5)	258 (54.3)	134 (28.2)	0.006
Marital status	Married	67 (14.3)	271 (57.9)	130 (27.8)	0.008
Marital status	Single	51 (22.0)	136 (58.6)	45 (19.4)	0.008
Duration of work	<10 years	66 (22.7)	172 (59.1)	53 (18.2)	<0.001
	10-20 years	28 (17.9)	84 (53.8)	44 (28.2)
	>20 years	24 (9.5)	151 (59.7)	78 (30.8)
Workplace	Primary care	28 (14.8)	116 (61.4)	45 (23.8)	0.189
	Secondary care	12 (11.3)	61 (57.5)	33 (31.1)
	Tertiary care	78 (19.3)	230 (56.8)	97 (24.0)
Occupation	Non-physician	20 (20.0)	46 (46.0)	34 (34.0)	0.024
Occupation	Physician	98 (16.3)	361 (60.2)	141 (23.5)	0.024
Medical specialty of physicians	Family Physician(FP)	73 (18.8)	231 (59.4)	85 (21.9)	0.067
Medical specialty of physicians	Other than the FP	25 (11.8)	130 (61.6)	56 (26.5)	0.067
BMI	Normal weight	69 (19.2)	203 (56.5)	87 (24.2)	0.082
	Overweight	33 (14.2)	148 (63.5)	52 (22.3)
	Obesity	16 (14.8)	56 (51.9)	36 (33.3)
Self-assessment of own body weight	Overweight	42 (14.6)	172 (59.9)	73 (25.4)	0.201
	Normal weight	65 (18.4)	207 (58.6)	81 (22.9)
	Obesity	11 (18.3)	28 (46.7)	21 (35.0)
Having difficulty in losing weight	Very difficult- Difficult	42 (20.6)	108 (52.9)	54 (26.5)	0.048
	Do not know	43 (13.4)	189 (59.1)	88 (27.5)
	Very easy-Easy	33 (18.8)	110 (62.5)	33 (18.8)
Thinking that society prefers thin individuals to fat ones	Neutral	10 (11.4)	53 (60.2)	25 (28.4)	0.457
	Agree	100 (18.1)	316 (57.1)	137 (24.8)
	Disagree	8 (13.6)	38 (64.4)	13 (22.0)
Presence of relative with obesity	Yes	91 (15.7)	345 (59.4)	145 (25.0)	0.15
Presence of relative with obesity	No	27 (22.7)	62 (52.1)	30 (25.2)	0.15
Presence of own obesity in a lifetime period	Yes	48 (16.2)	173 (58.4)	75 (25.3)	0.925
Presence of own obesity in a lifetime period	No	70 (17.3)	234 (57.9)	100 (24.8)	0.925
Doing exercise	Yes	99 (16.8)	342 (57.9)	150 (25.4)	0.863
Doing exercise	No	19 (17.4)	65 (59.6)	25 (22.9)	0.863
Eating habits	Healthy as possible	52 (15.3)	204 (60.2)	83 (24.5)	0.371
	Healthy	30 (15.6)	115 (59.9)	47 (24.5)
	Unhealthy	36 (21.3)	88 (52.1)	45 (26.6)
Experience of dieting	Yes	84 (17.0)	284 (57.6)	125 (25.4)	0.905
Experience of dieting	No	34 (16.4)	123 (59.4)	50 (24.2)	0.905
Having difficulty with dieting	Yes	66 (17.2)	216 (56.3)	102 (26.6)	0.455
Having difficulty with dieting	No	18 (16.5)	68 (62.4)	23 (21.1)	0.455
Having prejudice towards individuals with obesity	Yes	52 (23.5)	140 (63.3)	29 (13.1)	<0.001
Having prejudice towards individuals with obesity	No	66 (13.8)	267 (55.7)	146 (30.5)	<0.001
Being in close contact with patients with obesity	Yes	90 (15.7)	332 (58.0)	150 (26.2)	0.121
Being in close contact with patients with obesity	No	28 (21.9)	75 (58.6)	25 (19.5)	0.121
Preferring individuals with obesity to be around	Yes	1 (4.2)	10 (41.7)	13 (54.2)	<0.001
	Doubtful	67 (13.6)	292 (59.2)	134 (27.2)
	No	50 (27.3)	105 (57.4)	28 (15.3)
Fond of providing health care to patients with obesity	Yes	9 (8.5)	53 (50)	44 (41.5)	<0.001
	Neutral	53 (13.2)	246 (61.3)	102 (25.4)
	No	56 (29)	108 (56)	29 (15)
Thinking that the patients with obesity impose a tremendous economic burden on the health system	Yes	96 (18.9)	310 (60.9)	103 (20.2)	<0.001
	No	22 (11.5)	97 (50.8)	72 (37.7)	<0.001

Brasil

Brasil

Are patients with obesity “scapegoats”? The obesity prejudice levels of health care workers in Turkey

SUMMARY

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSIONS:

INTRODUCTION

METHODS

Obesity prejudice scale

Statistical analysis

RESULTS

DISCUSSION

CONCLUSIONS

REFERENCES

Publication Dates

History