Patients' and professionals' experiences and perspectives of obesity in health-care settings: a synthesis of current research.

Health expectations : an international journal of public participation in health care and health policy. 2013;16(2):119-42

Plain language summary

Obesity is a complex condition, and likely to be the result of a range of biological, psychological, and social factors, making it one of the most difficult and challenging health problems to manage. Obesity is often stigmatised, with obese people being subject to discrimination that could affect their access to therapies or the success of such therapies. This review looked at current research examining the experiences of both obese people and health‐care professionals. The authors reviewed a total of 30 studies. From the studies that explored patient experiences and perspectives, four themes emerged: i) ambivalence of health professionals towards patients’ needs leading to a sense of personal ambivalence for obese individuals in accessing and using services; ii) experience of weight-based stigma leading to feelings of powerlessness and humiliation; iii) negative experiences with health-care professionals leading to a reluctance to access services and/or engage in positive health behaviours; and iv) experiences of stigmatisation leading to poorer psychological health and negative behaviours. The studies that explored health professionals’ experiences and perspectives found differences in how professionals view obese patients that included ambivalence, and negative attitudes and beliefs towards overweight people. One study found that overweight and obese women were less likely to undergo routine cancer screening procedures such as cervical screening and mammograms. The studies presented in this review show that obesity has a strong social effect, not only on how obese individuals view themselves, but also on how they access and interact with health‐care providers. This can impact negatively on psycho‐emotional functioning, on the uptake of health care and on the experience of care of obese people. Given the rising levels of obesity, further work is essential to improve the health‐care provision for this population.

Abstract

BACKGROUND Obesity-related stigma likely influences how obese people interact with health-care professionals and access health care. AIM: To undertake a synthesis of studies examining the views and experiences of both obese people in relation to their health-care provision and health-care professionals in providing care to obese patients. SEARCH STRATEGY A systematic search of key electronic databases relating to professional or patient experiences of, or perspectives on, obesity was performed in 2008 and updated in 2010. Reference lists of article bibliographies were searched, along with hand searches of relevant journals. INCLUSION CRITERIA   Studies were screened against explicit inclusion criteria and published between 1990 and 2010. Findings were examined and organized thematically. DATA EXTRACTION   Data were extracted focusing on obesity, stigma and access to health-care services. All included studies were subject to critical appraisal to assess the quality of the research. FINDINGS Thirty studies were identified. All the studies reported obesity impacting on health-care interactions. Key themes identified were experiences of stigma and feelings of powerlessness, treatment avoidance, psycho-emotional functioning, professional attitudes, confidence and training, variations in health contact time and finally, differences in treatment options and preventative measures. CONCLUSION Obesity is a stigmatized condition that impacts negatively on the relationship between patients and health-care providers. Given the increasing prevalence of obesity and the range of therapeutic options available, further work is necessary to understand how the presence of obesity affects health-care interactions and decision making.

Lifestyle medicine

Fundamental Clinical Imbalances : Neurological
Patient Centred Factors : Mediators/Obesity
Environmental Inputs : Psychosocial influences
Personal Lifestyle Factors : Psychological
Functional Laboratory Testing : Not applicable
Bioactive Substances : None

Methodological quality

Jadad score : Not applicable
Allocation concealment : Not applicable
Publication Type : Journal Article ; Review

Metadata

Nutrition Evidence keywords : Obesity ; Stigmatisation ; Discrimination ; Overweight ; Health psychology