Brief intervention effective in reducing weight bias in medical students.

BACKGROUND: Medical students are exposed to a growing number of obese patients in clinical encounters. Many medical students harbor negative attitudes and stereotypes regarding obese patients, which lead to negative interpersonal behaviors. This study pilot tested the effectiveness of an educational intervention in reducing bias toward obese patients. METHODS: Second- and third-year medical students (n=64) watched a 17- minute video, "Weight Bias in Health Care," and participated in interactive discussion to share experiences with encountering obese patients. The Beliefs About Obese Persons (BAOP), Attitudes Toward Obese Persons (ATOP), and Fat Phobia Scales (FPS) were administered before and after intervention. Change in mean scores from before to after the intervention was tested for statistical significance using the paired samples t test. General linear models were used to examine associations of subject characteristics with mean scores for each scale. RESULTS: The intervention increased beliefs that genetic and environmental factors play an important role in the cause of obesity as opposed to lack of personal control (mean BAOP increased from 16.53 to 19.27). It also decreased students' negative stereotypes regarding obese patients (mean FPS decreased from 3.65 to 3.45). There were independent associations of subject characteristics with post-intervention ATOP scores, with more positive attitudes in younger, male, and white participants. CONCLUSIONS: Implementing a short educational intervention was effective in improving medical students' beliefs and stereotypes regarding obese patients. This widely accessible and easily replicable program can serve as a model and springboard for further development of educational interventions to reduce weight bias among medical students.

Electronic medical records are not associated with improved documentation in community primary care practices.

The adoption of electronic medical records (EMRs) in ambulatory settings has been widely recommended. It is hoped that EMRs will improve care; however, little is known about the effect of EMR use on care quality in this setting. This study compares EMR versus paper medical record documentation of basic health history and preventive service indicators in 47 community-based practices. Differences in practice-level documentation rates between practices that did and did not use an EMR were examined using the Kruskal-Wallis nonparametric test and robust regression, adjusting for practice-level covariates. Frequency of documentation of health history and preventive service indicator items were similar in the 2 groups of practices. Although EMRs provide the capacity for more robust record keeping, the community-based practices here do not use EMRs to their full capacity. EMR usage does not guarantee more systematic record keeping and thus may not lead to improved quality in the community practice setting.

Family physicians' barriers to cancer screening in extremely obese patients.

Extremely obese women are less likely than nonobese women to receive breast and cervical cancer screening examinations. Reasons for this disparity are unclear and may stem from patient and/or physician barriers. This sequential mixed-methods study used individual in-depth interviews of 15 family physicians followed by a mail survey of 255 family physicians (53% response rate) to understand the barriers they faced in performing cancer screening examinations in extremely obese women. Barriers fell into three main areas: (i) difficulty doing pelvic and breast exams; (ii) inadequate equipment; and (iii) challenges overcoming patient barriers and refusal. This led some physicians to avoid performing breast and pelvic examinations on extremely obese women. Having more knowledge about specific examination techniques was associated with less difficulty in palpating lumps on breast and pelvic examinations (P < 0.005). Physicians perceived that embarrassment, aversion to undressing, and avoidance of discussions related to their weight were the most frequent barriers extremely obese women had with getting physical examinations. Educating and/or motivating patients and addressing fears were strategies used most frequently when patients refused mammograms or Pap smears. Interventions focusing on physician barriers, such as educating them on specific examination techniques, obtaining adequate equipment and supplies, and providing resources to assist physicians in dealing with patient barriers and refusal, may be fruitful in increasing cancer screening rates in extremely obese patients. Future research studies testing the effectiveness of these strategies are needed to improve cancer outcomes in this high-risk population.

Family physicians' practices and attitudes regarding care of extremely obese patients.

Despite the growing epidemic of extreme obesity in the United States, weight management is not adequately addressed in primary care. This study assessed family physicians' practices and attitudes regarding care of extremely obese patients and factors associated with them. A cross-sectional, self-administered survey was mailed to 500 family physicians in New Jersey (NJ) during March-May 2008. Measures included knowledge, weight management approaches, attitudes toward managing obesity, challenges with examinations, availability of supplies, and strategies to improve care. Response rate was 53% (N = 255). Bariatric surgery and weight loss medications were infrequently recommended, particularly in physicians with higher volume of extremely obese patients (odds ratio (OR) 0.38; 95% confidence interval (CI) 0.23, 0.62 and OR 0.51; 95% CI 0.31, 0.85 for surgery and medications, respectively). Higher knowledge was associated with increased frequency of recommendations of weight loss medications (P < 0.0001) and bariatric surgery (P < 0.0001). There was a high prevalence of negative attitudes, particularly in younger physicians and those with lower patient volume. Increased knowledge of weight-loss diets was associated with less dislike in discussing weight loss (P < 0.0001), less frustration (P = 0.0001), less belief that treatment is often ineffective (P < 0.0001), and less pessimism about patient success (P = 0.0002). Many providers encountered challenges performing examinations on extremely obese patients. More education of primary care physicians, particularly on bariatric surgery, specific examination techniques, and availability of community resources for obese persons is needed. Further research is needed to determine if interventions to increase knowledge of physicians will lead to less negative attitudes toward weight loss and extremely obese patients.