Training cuts student medics 'anti-fat' prejudice

[Harley Quinn]

Students training to enter the health service need better teaching in order to prevent discrimination against obese patients, a study suggests.
Researchers said previous work had found high levels of "anti-fat prejudice" among health professionals.
But a trial of 159 students, reported in the Obesity journal, found this prejudice could easily be influenced.
Teaching about the effect of genes and the environment on obesity was key to cutting discrimination, it reported.
Over the past decade, prejudice among the public towards overweight people has increased by 66%, the international team of researchers said.

''Making people feel bad about their condition is not going to help
Dr Kerry O'Brien, study leader''

Some studies have shown that among those working in the health professions, including doctors and nurses, the rate of prejudice is even higher than in the general population.
In the latest study, 159 students taking a seven-week course on public health, some of whom were training to be nurses, were split into three groups.
One was taught solely about diet and exercise being the main cause and treatment for obesity.
And another group was taught about uncontrollable reasons for obesity - such as genetics and environmental factors such as junk-food advertising.
The third "control" group was taught about alcohol.
Subconscious prejudice
They then underwent a series of tests to measure subconscious or "implicit" prejudice about obesity, as well as outspoken or "explicit" views.
The results showed that those who had been taught a standard obesity programme based on diet and exercise scored 27% higher on implicit or subconscious measures of prejudice.
But those taught about genetic and environmental causes scored 27% lower on a test of implicit prejudice and there was a drop in scores on the explicit discrimination tests.
Study leader Dr Kerry O'Brien, a lecturer at the University of Manchester, said being taught solely about diet and exercise implied that obese people were just lazy and gluttonous, but to a large extent weight status is inherited and health professionals needed to be aware of other influences.
He said "blaming the individual" was not always obvious but could mean doctors or nurses spent less time with obese patients or did not take their problems as seriously.

"The key is not to be stigmatising these patients.
"Making people feel bad about their condition is not going to help."
He added: "Obese people are constantly fighting their physiology and environment.
"If professionals keep this in mind it may help in not stigmatising their clients."


http://news.bbc.co.uk/1/hi/health/8622751.stm

[CaptainObvious]

Uh...huh. And what exactly does "anti-fat" prejudice consist of? Thinking that most people are fat primarily because of their own choices? Well no, that's true. Thinking that obesity is generally the primary cause of health problems in obese people? Well no, that's true too. So... what is this "anti-fat discrimination" being combated here? Sounds suspiciously like the agenda of the study's leader showing through.

[Antares]

Not exactly sure what kind of discrimination was being encountered and how did they measure that?
They told fat people to lose weight or something? They stopped treating fat people?

[Sith Lord 13]

Uh...huh. And what exactly does "anti-fat" prejudice consist of? Thinking that most people are fat primarily because of their own choices? Well no, that's true.

Actually it's not. My friend and I did an experiment here at college. At the same foods, approximately the same amount of physical activity, nothing that should have affected our weights was different. Yet he lost ten pounds and I gained ten. Genetics plays a much bigger role in weight than most people think.

Thinking that obesity is generally the primary cause of health problems in obese people? Well no, that's true too. So... what is this "anti-fat discrimination" being combated here? Sounds suspiciously like the agenda of the study's leader showing through.

Obesity can cause major health problems, but doesn't always. Very little is known about many of the health risks that seem to be associated with weight gain. For many of them, no causal mechanism has been found.

If anyone's agenda or bias is showing, I don't believe it's the study's leader.

[CaptainObvious]

Actually it's not. My friend and I did an experiment here at college. At the same foods, approximately the same amount of physical activity, nothing that should have affected our weights was different. Yet he lost ten pounds and I gained ten. Genetics plays a much bigger role in weight than most people think.

I'm not denying that. There are many friends of mine that can eat anything and lose weight. I am unfortunately not the same. But even if someone has a harder time losing weight... so what? That doesn't resolve them of responsibility; there are exceptionally few people who, eating a healthy diet, could not maintain a reasonable weight. The fact that it's a little harder doesn't somehow make it out of their control.

Obesity can cause major health problems, but doesn't always. Very little is known about many of the health risks that seem to be associated with weight gain. For many of them, no causal mechanism has been found.

If anyone's agenda or bias is showing, I don't believe it's the study's leader.

There has not been a causal mechanism found for many things. Once again... so what? The statistical relationships all clearly suggest causation, and the fact that a specific mechanism is not known for every risk does not mean that we cannot point at a very likely cause. No, obesity doesn't always cause problems, I never said it did. Once again... so what? The fact that obesity doesn't always cause health problems doesn't mean it's somehow discriminatory to point out that generally it does and to recommend against obesity. No more discriminatory than pointing out to a smoker that they are likely damaging themselves.

[Sith Lord 13]

I'm not denying that. There are many friends of mine that can eat anything and lose weight. I am unfortunately not the same. But even if someone has a harder time losing weight... so what? That doesn't resolve them of responsibility; there are exceptionally few people who, eating a healthy diet, could not maintain a reasonable weight. The fact that it's a little harder doesn't somehow make it out of their control.

There's a difference between "a little harder" and damn near impossible.


There has not been a causal mechanism found for many things. Once again... so what? The statistical relationships all clearly suggest causation, and the fact that a specific mechanism is not known for every risk does not mean that we cannot point at a very likely cause. No, obesity doesn't always cause problems, I never said it did. Once again... so what? The fact that obesity doesn't always cause health problems doesn't mean it's somehow discriminatory to point out that generally it does and to recommend against obesity. No more discriminatory than pointing out to a smoker that they are likely damaging themselves.

No, the statistics suggest correlation, not causation. Correlation means one of three things: a causes b, b causes a, or c causes both b and a.

Could obesity cause health problems? Yes. But perhaps the early stages of these health problems cause the obesity. Or perhaps the same genetic sequences that code for obesity also code for some of these other health problems.

I personally believe it's a little bit of all three. Do I believe weight loss should be encouraged? Yes. But making an overweight person feel that their problems are all their own fault, when it's not true, will only make the situation worse. Also, doctors see someone overweight, and jump to that as the cause for all health problems. Sometimes a person can be overweight and sick, and not have the two of them be related. If doctors don't recognize that they can spend years treating the wrong problem.

[CaptainObvious]

There's a difference between "a little harder" and damn near impossible.

There is almost no one for who a healthy diet of ~1200-1500 lean calories per day combined with good intense exercise would not result in weight loss. That's not damn near impossible or really even close to it.

No, the statistics suggest correlation, not causation. Correlation means one of three things: a causes b, b causes a, or c causes both b and a.

Could obesity cause health problems? Yes. But perhaps the early stages of these health problems cause the obesity. Or perhaps the same genetic sequences that code for obesity also code for some of these other health problems.

Until a precise mechanism is found for anything one can simply plug one's ears and yell "no! it's correlation!" until the world ends. But the fact is obesity has been shown to directly cause physiological changes, and many of those changes are correlated to - or themselves constitute - cardiac disease. And in some cases, maybe there is some amount of comorbidity from uncontrollable factors.

But the bottom line of this issue is as I said above: almost anyone is capable of the kind of healthy diet and lifestyle that would allow them to maintain a healthy weight. Whether that's really easy or a little more difficult does not make it not their responsibility and decision.

[Sith Lord 13]

Until a precise mechanism is found for anything one can simply plug one's ears and yell "no! it's correlation!" until the world ends. But the fact is obesity has been shown to directly cause physiological changes, and many of those changes are correlated to - or themselves constitute - cardiac disease. And in some cases, maybe there is some amount of comorbidity from uncontrollable factors.

But the bottom line of this issue is as I said above: almost anyone is capable of the kind of healthy diet and lifestyle that would allow them to maintain a healthy weight. Whether that's really easy or a little more difficult does not make it not their responsibility and decision.

No one said anything about precise. Even a general idea would be enough.

And I didn't say that one should not try to lose weight, just that doctors should not do things to exacerbate the problem. Also, while weight should be considered during a diagnosis, it doesn't mean that it caused the problem. With many doctors, if an overweight patient comes in, they'll find someway to blame the problem on the weight and not consider other possibilities.

My final point is that weight loss for most is a struggle. It's not "a little more difficult", it's the toughest fight they'll face in their lives. And when doctors don't realize that, don't realize that their attitude makes things, it makes that fight so much harder.