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Including Everybody – EVERY BODY – in Health. Virginia Dicken-Gracen, MPH, MS Western Michigan University. Living Large. “Easily Fixable”.
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Including Everybody – EVERY BODY – in Health Virginia Dicken-Gracen, MPH, MSWestern Michigan University
“Easily Fixable” “Aside from being concerned for her health, I know for a fact that her weight has held her career back... I truly want the best for her and would hate to see her impeded by something so easily fixable. Is there a way to address this?”Dear Prudence advice column, March 19, 2019
Fat people are just lazy and gluttonous? • Activity Levels • Nutrition Factors • Sleep Habit Changes • Endocrine Disruptors • Central Air Conditioning • Decreased Smoking • Pharmaceuticals • Shifting Demographics • Increased Maternal Age • Epigenetic Influences • Fecundity Rates • Assortive Mating • Other Factors? Keith, S.W., Redden, D.T., Katzmarzyk, P.T., Boggiano, M.M., et al (2006). Putative contributors to the secular increase in obesity: exploring the roads less traveled. International Journal of Obesity, 30, 1585-1594.
Attitudes of Healthcare Practitioners 3 out of 4 first-year medical students display bias against large people. Phelen, S.M., Dovidio, J.F., Puhl, R.M., Burgess, D.J., Nelson, D.B. et al. (2014). Implicit and explicit weight bias in a national sample of 4,732 medical students: the medical student CHANGES study. Obesity, 22(4), 1201-1208.
Attitudes of Healthcare Practitioners Stereotypes, discrimination against “obese” people among nursing students and nurses: • Unkempt/Unhygienic • Lazy • Challenging • Lacking Self-Control • Needing Mental Health Care Johnson, W. (2018). Exploring weight bias among nursing students. (Unpublished doctoral dissertation). The University of Alabama, Tuskaloosa, Alabama. Teanneberger, A. and Ciupitu-Plath, C. (2018). Nurses' weight bias in caring for obese patients: Do weight controllability beliefs influence the provision of care to obese patients? Clinical Nursing Research, 27(4), 414-432.
Attitudes of Healthcare Practitioners Health providers increasingly likely to indicate explicit negative attitudes toward large people. Tomiyama, A.J., Finch, L.E., Incollingo Belsky, A.C., Buss, J., Finley, C. et al, (2014). Weight bias in 2001 versus 2013: Contradictory attitudes among obesity researchers and health professionals. Obesity, 23(1), 46-53.
Effect on Patients • Phelen, S.M., Burgess, D.J., Yeazel, M.W., Hellerstedt, W.L., Griffin, J.M., and van Ryn, M. (2015). Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obesity Reviews, 16(4), 319-326.
Experiences of Health Care “I have had persistent knee problems following a car accident in my early 20s… My primary care physician referred me to an orthopedist for help. I went to see him and he didn’t even physically examine my knee. He didn’t even open my file. He told me that he would not treat me until I lost weight.”
Experiences of Health Care “I have had persistent knee problems following a car accident in my early 20s… My primary care physician referred me to an orthopedist for help. I went to see him and he didn’t even physically examine my knee. He didn’t even open my file. He told me that he would not treat me until I lost weight.” “A dentist told me that the reason I had a toothache was because I didn’t eat enough healthy foods like raw veggies that would naturally clean my teeth and gums while chewing them. He ‘knew’ I didn’t eat these things because of my weight and appearance. He said I needed to have a cleaning and get my diet in order. I had an abscess and later lost the tooth.”
Experiences of Health Care “I have had persistent knee problems following a car accident in my early 20s… My primary care physician referred me to an orthopedist for help. I went to see him and he didn’t even physically examine my knee. He didn’t even open my file. He told me that he would not treat me until I lost weight.” “I went to my PCP for a mind-bogglingly painful ear infection, and all he could talk about was my weight. The doctor was so enthusiastic about berating me for being fat that he forgot to actually give me something for my ear. He made me feel so utterly disgusted with myself that I couldn’t ask anymore. My eardrum burst in the middle of the night.” “A dentist told me that the reason I had a toothache was because I didn’t eat enough healthy foods like raw veggies that would naturally clean my teeth and gums while chewing them. He ‘knew’ I didn’t eat these things because of my weight and appearance. He said I needed to have a cleaning and get my diet in order. I had an abscess and later lost the tooth.”
Experiences of Health Care “I have had persistent knee problems following a car accident in my early 20s… My primary care physician referred me to an orthopedist for help. I went to see him and he didn’t even physically examine my knee. He didn’t even open my file. He told me that he would not treat me until I lost weight.” “Years ago, my doctor wanted me to see a psychiatrist to work with my depression medication. The psychiatrist insisted that I wouldn’t be depressed if I lost weight – even though I told him repeatedly that my history of depression began when I was an underweight 4 year old.” “I went to my PCP for a mind-bogglingly painful ear infection, and all he could talk about was my weight. The doctor was so enthusiastic about berating me for being fat that he forgot to actually give me something for my ear. He made me feel so utterly disgusted with myself that I couldn’t ask anymore. My eardrum burst in the middle of the night.” “A dentist told me that the reason I had a toothache was because I didn’t eat enough healthy foods like raw veggies that would naturally clean my teeth and gums while chewing them. He ‘knew’ I didn’t eat these things because of my weight and appearance. He said I needed to have a cleaning and get my diet in order. I had an abscess and later lost the tooth.”
Attitudes of Healthcare Practitioners Health discipline students encounter negative attitudes and derogatory humor about large-bodied people • from peers (63%) • from providers (65%) • from instructors (40%) Puhl, R.M., Luedicke, J., & Grilo, C.M. (2014). Obesity bias in training: attitudes beliefs, and observations among advanced trainees in professional health disciplines. Obesity, 22(4): 1008-1015.
BMI Categories andCardiometabolic Health “Normal” BMI3 out of 10 misclassified as healthy “Overweight” BMI5 out of 10 misclassified as unhealthy Tomiyama, A.J., Hunger, J.M., Nguyen-Cuu, J., & Wells, C. (2016). Misclassification of cardiometabolic health when using body mass index categories in NHANES 2005-2012. International Journal of Obesity, 40, 883-886.
DIETS “WORK” BUT… Diabetes Prevention Program Research Group, Knowler, W. C., Fowler, S. E., Hamman, R. F., et al. (2009). 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet,374(9702), 1677-86. Shai, I., Schwartzfuchs, D., Henkin, Y., Shahar, D.R., Witkow, S. et al. (2008). Weight loss with a low carbohydrate, Mediterranean, or low-fat diet. New England Journal of Medicine, 359(3), 229-241.
WEIGHT-BASED MOTIVATIONS DON’T HELP DiBartolo, P.M., Lin, L., Montoya, S., Neal, H., & Shaffer, C. (2007). Are there “healthy” and “unhealthy” reasons for exercise? Examining individual differences in exercise motivations using the function of exercise scale. Journal of Clinical Sport Psychology, 1, 93–120. Metcalf, B.S., Hosking, J., Jeffery, A.N., Voss, L.D., Henley, W., & Wilkin, T.J. (2011). Fatness leads to inactivity, but inactivity does not lead to fatness: A longitudinal study in children (EarlyBird 45). Archives of Disease in Childhood, 96(10), 942-947.
Evidence-Based Practice Lipids Restricted Eating Blood Pressure Depression Binge Eating
Evidence-Based Practice Fruit/ Veggie Intake Lipids Restricted Eating Energy Expenditure Blood Pressure Body Image Depression Binge Eating
Evidence-Based Practice Weight BMI Fruit/ Veggie Intake Lipids Restricted Eating Energy Expenditure Blood Pressure Body Image Depression Binge Eating
Evidence-Based Practice Weight BMI Fruit/ Veggie Intake Lipids Restricted Eating Energy Expenditure Blood Pressure Body Image Depression Binge Eating
