Search

Competing Interests: S.W.F. reports research grants from National Institute for Health Research, Office of Health Improvement & Disparities, Public Health England, Doncaster Council, West Yorkshire Combined Authority, Johnson and Johnson, Novo Nordisk and the University of Leeds, personal fees from the Royal College of General Practitioners, Institutional fees from Public Health England, and support for attendance at meetings from UK Parliament, Novo Nordisk Johnson & Johnson and Safefood. S.W.F. also reports unpaid roles with Obesity UK. R.L.B. has received grant funding to her institution from National Institute for Health and Care Research (NIHR), Sir Jules Thorn Charitable Trust, Rosetrees Trust and Novo Nordisk, and Rhythm Pharmaceuticals. R.L.B. has participated in speakers’ bureaus for Novo Nordisk, Eli Lilly, ViiV Healthcare Ltd, International Medical Press and Medscape, undertaken consultancy work for Novo Nordisk, Eli Lilly, ViiV Healthcare Ltd, Epitomee Medical Ltd and Gila Therapeutics Ltd and participated in advisory boards for Novo Nordisk, Eli Lilly, Pfizer and ViiV Healthcare Ltd. R.L.B. declares provision of placebo, liraglutide, and semaglutide for clinical trials from Novo Nordisk. R.L.B.'s current roles include Director of the UCL/UCLH BRC Obesity Theme, Royal College of Physicians' (RCP) special advisor for obesity, Chair of the RCPs Advisory Group on nutrition, weight and health, member of RCP Advisory Group on health inequalities, Council member of British Obesity and Metabolic Surgery Society, member of National Bariatric Surgery Registry, Co-chair of NHS England clinical advisory group on specialist weight management, Chair and Trustee of Obesity Empowerment Network UK, Committee member of NICE Weight Management Advisory Group and member of the European Society for Endocrinology Clinical Committee. Previous roles member of Obesity Health Alliance Strategy Group, Trustee for the Association for the Study of Obesity, Co-Chair for the International Federation for surgery for obesity and metabolic disorders.

Background: Weight bias exhibited by health care students may continue into their future practice, compromising the provision of care that people living with overweight or obesity receive. This highlights the need to comprehensively examine the extent to which weight bias is present among health care students and the factors that may be associated with students' weight bias., Methods: In this cross-sectional study, Australian university students enrolled in health care courses were invited via social media advertisements, snowball and convenience sampling, and by making direct contact with universities to complete an online survey. Students provided demographic information including discipline of study, perceived weight status, and state of residence. Students then completed several measures which assessed their explicit and implicit weight bias, and empathy. Descriptive statistics established the presence of explicit and implicit weight bias, and ANCOVAs, ANOVA, and multiple regression analyses were conducted to examine the potential factors associated with students' exhibited weight bias., Findings: Between March 08, 2022, and March 15, 2022, 900 eligible health care students attending 39 Australian universities participated in the study. Students reported varying levels of explicit and implicit weight bias, with minimal differences between disciplines on most outcome measures. Students who identified as men (vs. women) exhibited higher of both explicit and implicit bias (Beliefs About Obese Persons (BAOP): p  = 0.0002, Antifat Attitudes Questionnaire (AFA)-Dislike: p  = 0.019, AFA Willpower p  < 0.0001, Empathy for Obese Patients: p  = 0.0011, Implicit Association Test: p  = 0.022), and students who displayed greater (vs. less) empathic concern exhibited lower levels of explicit bias (BAOP, AFA Dislike and Willpower, and Empathy for Obese Patients: p  < 0.0001). Having witnessed the enactment of weight stigma sporadically (vs. regularly) by role models was associated with greater attribution of the causes of obesity to willpower (a few times a month vs. daily: p  = 0.020, a few times a year vs. daily: p  = 0.022), and less time spent with people living with overweight or obesity outside of study was associated with more dislike (a few times a month vs. daily: p  = 0.0048, once a month vs. daily: p  = 0.0002) and less fear of fat (once a month vs. daily: p  = 0.036, and once a month vs. a few times a week: p  = 0.0028)., Interpretation: Results demonstrate the presence of both explicit and implicit weight bias among Australian health care students. Several characteristics and experiences of students were associated with their weight bias. Validity of the exhibited weight bias should be established in practical interactions with people living with overweight or obesity and novel interventions should be developed to ameliorate weight bias., Funding: Research Training Program (RTP) Scholarship, Australian Government, Department of Education., Competing Interests: S.W.F. reports research grants and support for attending meetings from UK National Institute for Health Research, Public Health England, UK Office of Health Improvement & Disparities, UK Doncaster Council, West Yorkshire Combined Authority, Novo Nordisk, Johnson & Johnson, University of Leeds UK, the UK Royal College of General Practitioners, UK Parliament, and UK Safefood, as well as an unpaid leadership role at Obesity UK. E.H. reports receiving royalty fees for a book published on the topic of weight stigma. All declared interests relate outside the submitted manuscript. R.S.J., M.O., and B.J.L. declare no competing interests., (© 2023 The Author(s).)

Background: Research has demonstrated that healthcare professionals are not immune to weight stigma attitudes, with evidence showing that people living with overweight or obesity may experience direct and indirect stigma and discrimination. This can impact the quality of care provided and impact patients' engagement in healthcare. Despite this, there is a paucity of research examining patient attitudes towards healthcare professionals living with overweight or obesity, which can also hold implications for the patient-practitioner relationship. Thus, this study examined whether healthcare professionals' weight status impacts patient satisfaction and recalled advice., Methods: In this prospective cohort study, using an experimental design, 237 participants (113 women, 125 men) aged 32 ± 8.92 with a body mass index of 25.87 ± 6.79 kg m 2 were recruited through a participant pooling service (ProlificTM), word of mouth, and social media. The majority of participants were from the UK: 119, followed by participants from the USA: 65, Czechia: 16, Canada: 11, and other countries (N = 26). Participants completed an online experiment consisting of questionnaires assessing satisfaction with healthcare professionals and recalled advice after exposure to one of eight conditions assessing the impact of healthcare professional weight status (lower weight or obesity), gender (woman or man) and profession (psychologist or dietitian). A novel approach to creating the stimuli was used to exposure participants to healthcare professionals of different weight status. All of the participants responded to the experiment hosted on Qualtrics™ in the period from June 8, 2016 to July 5, 2017. Study hypotheses were examined using linear regression with dummy variables and follow up post-hoc analysis to estimate marginal means with adjustment for planned comparisons., Findings: The only statistically significant result was a difference with a small effect in patient satisfaction, where satisfaction was significantly higher in healthcare professional who was a women living with obesity compared to healthcare professional who was a man living with obesity (estimate = -0.30; SE = 0.08; df = 229; ωₚ 2  = 0.05; CI = -0.49 to -0.11; p < 0.001), and healthcare professional who was a women living with lower weight compared to healthcare professional who was a man living with lower weight (estimate = -0.21; SE = 0.08; df = 229; CI = -0.39 to -0.02; ωₚ 2  = 0.02; p = 0.02). There were no statistically significant differences in satisfaction of healthcare professionals and recall of advice in the lower weight compared to obesity conditions., Interpretation: This study has used novel experimental stimuli to examine weight stigma towards healthcare professionals which is vastly under-researched and holds implications for the patient-practitioner relationship. Our findings showed statistically significant differences and a small effect where satisfaction with healthcare professionals both living with obesity and with a lower weight were higher when the healthcare professional was a woman compared to man. This research should act as a stimulus for further research that aims to examine the impact of healthcare professional gender on patient responses, satisfaction and engagement, and weight stigma from patients towards healthcare professionals., Funding: Sheffield Hallam University., Competing Interests: SWF reports research grants from 10.13039/501100000272National Institute for Health Research, the Office of Health Improvement & Disparities, 10.13039/501100002141Public Health England, Doncaster Council, West Yorkshire Combined Authority, 10.13039/100004331Johnson and Johnson, 10.13039/501100004191Novo Nordisk and the 10.13039/501100000777University of Leeds, personal fees from the 10.13039/100010334Royal College of General Practitioners, Institutional fees from 10.13039/501100002141Public Health England, and support for attendance at meetings from UK Parliament, Novo Nordisk Johnson & Johnson and Safefood. SWF also reports unpaid roles with Obesity UK. MC, SL, and BJL declare no competing interests., (© 2023 The Author(s).)

Background: People living with overweight or obesity (PLwO) can be stigmatised by healthcare professionals (HCPs). Reducing focus on weight is a proposed strategy to provide less threatening healthcare experiences. Given the lack of research on weight bias within obesity services, this study aimed to explore implicit bias among obesity specialist HCPs and explore views on non-weight focused approaches., Methods: Obesity specialist HCPs were invited to a webinar, "An exploration of non-weight focused approaches within bariatric services", held in October 2021. Implicit weight bias was examined using the BiasProof mobile device test, based on the Implicit Association Test. Poll data was analysed descriptively, and qualitative data was analysed using framework analysis., Findings: 82 of the 113 HCPs who attended the webinar consented to contribute data to the study. Over half (51%) had an implicit weight bias against PLwO. Most (90%) agreed/strongly agreed that obesity services are too weight focused and that patients should not be weighed at every appointment (86%). Perceived benefits of taking a non-weight focused approach included patient-led care, reducing stigma and supporting patient wellbeing, while perceived barriers included loss of objectivity, inducing risk and difficulty demonstrating effectiveness., Interpretation: Our findings indicate that half of obesity specialists HCPs in our sample of 82 providers, who are primarily dieticians and psychologists, have an implicit weight bias against PLwO. HCPs feel that a weight-focused approach within services was a barrier to patient care, but that there is a lack of alternative non-weight focused measures. Further research is needed into substitute outcome measures for clinical practice, also seeking the views of PLwO, and into interventions to address implicit weight bias., Funding: Johnson & Johnson funded the BiasProof licence and publication open access charge., Competing Interests: S.A. has received speaker honorarium from Johnson & Johnson for educational events and support for attendance at academic meetings from Novo Nordisk and British Dietetic Association GET Fund. S.A. reports research grants from British Dietetic Association Obesity Specialist Group. E.S. has received speaker honorarium from Johnson & Johnson for educational events. P.C. has received speaker honorarium from Johnson & Johnson for educational events. S.W.F. reports research grants from National Institute for Health Research, Public Health England, Doncaster Council, West Yorkshire Combined Authority, Johnson and Johnson, Novo Nordisk and the University of Leeds, personal fees from the Royal College of General Practitioners, Institutional fees from Public Health England, and support for attendance at academic meetings from Novo Nordisk and Johnson & Johnson. H.M.P. has received speaker honoraria from Johnson & Johnson and Novo Nordisk for educational events. Honoraria received for participating in the development of an algorithm for the management of obesity in primary care supported by arm's length sponsorship from Novo Nordisk. Co-author on a publication of UK data from a study funded by Novo Nordisk (no honorarium). H.M.P. reports research grants from National Institute for Health Research, Public Health England and the Office for Health Improvement and Disparities., (© 2022 The Author(s).)

Competing Interests: SWF reports grants from Novo Nordisk, grants from Johnson & Johnson, other from Novo Nordisk, other from Johnson & Johnson, outside the submitted work.

Evidence has accumulated to demonstrate the pervasiveness, impact and implications of weight stigma. As such, there is a need for concerted efforts to address weight stigma and discrimination that is evident within, policy, healthcare, media, workplaces, and education. The continuation of weight stigma, which is known to have a negative impact on mental and physical health, threatens the societal values of equality, diversity, and inclusion. This health policy review provides an analysis of the research evidence highlighting the widespread nature of weight stigma, its impact on health policy and the need for action at a policy level. We propose short- and medium-term recommendations to address weight stigma and in doing so, highlight the need change across society to be part of efforts to end weight stigma and discrimination., Funding: None., Competing Interests: Outside of the submitted work, AB reports research grants from National Institute for Health Research, Rosetrees Trust, Medical Research Council and Novo Nordisk, personal fees from Novo Nordisk and Obesity UK, institutional fees from Public Health England, support for attendance at meetings from Novo Nordisk and stocks at Reset Health Clinics Ltd. AB also reports unpaid roles with the British Dietetics Association, Obesity Policy Engagement Network, British Nutrition Foundation, All-Party Parliamentary Group on Obesity, and the Obesity Policy Engagement Network. SWF reports research grants from National Institute for Health Research, Public Health England, Doncaster Council, West Yorkshire Combined Authority, Johnson and Johnson, Novo Nordisk and the University of Leeds, personal fees from the Royal College of General Practitioners, Institutional fees from Public Health England, and support for attendance at meetings from Novo Nordisk and Johnson & Johnson. SWF also reports unpaid roles with Obesity UK. RLB reports research grants from National Institute for Health Research, Rosetrees Trust, and Sir Jules Thorn Trust, and personal fees from Novo Nordisk, ViiV Healthcare Ltd, Pfizer, Gila Therapeutics, GLWL Research, International Medical Press. RLB also reports unpaid roles with Royal College of Physicians, the Association for the Study of Obesity, British Obesity and Metabolic Surgery Society, National Bariatric Surgery Registry, BSR, International Federation for the Surgery of Obesity and Metabolic Disorders, European Society of Endocrinology and Obesity Empowerment Network., (© 2022 The Author(s).)

Background: Ensuring that patients have high quality, equitable experiences in healthcare is a high priority in the UK. As such, identifying and addressing areas where patient experiences are unsatisfactory and inequitable is of high priority, and has been included as part of the National Health Service (NHS) England equity objectives., Methods: The healthcare experiences of people who identified as living with overweight or obesity were gathered from freely available websites using the Patient Experience Platform (PEP). PEP was used to gather and analyse all comments from NHS UK, Google, Facebook and Twitter that related to care experiences of people who identified as living with overweight or obesity across all NHS Acute and Specialist Trusts and all general practitioners (GPs) in England from 01/01/2018 to 31/12/2020. These healthcare experiences were analysed to provide care quality metrics, a comparison of care across regions of England, and to explore associations between behavioural clusters of personality attributes, values and sentiment with care quality metrics., Findings: Perceptions of the quality of care were significantly lower for people who identified as living with overweight or obesity compared to people who didn't identify as living with overweight or obesity across all regions for 'Effective Treatment' and 'Emotional Support'. The perceived quality of care metrics can be predicted by the behavioral clusters, where for instance, the experiences of people who identified as living with overweight or obesity in the negative behavioral cluster have a lower overall perceived quality of care score. Themes arising from the data also highlighted that barriers quality care experienced by people who identified as living with obesity include the speed of access, effective treatment, and emotional support, with stigmatising healthcare experiences are reported., Interpretation: The findings of this study provide insights into the experiences reported via freely available websites, of people who self-identified as living with overweight or obesity in healthcare in England. These insights demonstrate that the perceived quality of care was lower for people who identified as living with overweight or obesity compared to the general population, and that there is regional variation in care quality. The study has also shown that patient experiences differ based on personality attributes, values and sentiment, highlighting the need for patient-centred care and personalised approaches. These findings hold important considerations for healthcare and policy makers aiming to address healthcare inequity., Competing Interests: SWF and MK are employed by Scaled Insights. ML and AG are employed by Patient Experience Platform. SWF reports research grants from Johnson and Johnson, research grants from Novo Nordisk, and personal fees to support attendance at meetings from Novo Nordisk, outside of the submitted work., (© 2021 The Authors. Published by Elsevier Ltd.)

Background: Coronavirus disease 2019 (COVID-19) has led to unprecedented changes in the way we live, particularly for people at higher risk of severe illness from COVID-19. People with pre-existing health conditions have been markedly impacted and, in some instances, left unsupported due to reduced provision of routine healthcare services. People living with obesity (PLWO) are identified as at higher risk of severe illness from COVID-19 infection. Currently, there is a paucity of evidence about the impact of the first COVID-19 lockdown on PLWO, including those accessing weight management and bariatric surgery services (WMS)., Methods: 543 adults (16-80 years) with obesity (BMI ≥ 30 kg/m 2 ) were recruited between 14th May and 9th July 2020 through social media advertisements, professional and patient obesity organisations and WMS. Participants completed an online survey regarding the impact of the first COVID-19 lockdown upon, mental health, well-being, health-related behaviours, risk mitigating behaviours, access to WMS and weight stigma., Findings: During the first COVID-19 lockdown, the majority of PLWO reported deterioration of their mental health and health-related behaviours such as diet, physical activity (PA) and sleep. With 55% reporting an unhealthier diet, 61% reduced PA and 80% worsening of their sleep. Higher depression and lower wellbeing scores were found to associate with the greatest adverse impact upon health-related behaviours. PLWO who were attending WMS prior to the first lockdown reported a greater deterioration of their diet, with nearly 50% reporting worsening of their diet and PA worsening compared to PLWO who were not attending WMS. Most participants took two or more risk mitigating actions (73%). PLWO attending WMS reported reduced access (44%) with insufficient information (49%) from their clinical service providers. The majority of participants reported no change in perceived weight stigma., Interpretation: This study shows the detrimental impact of the first COVID-19 lockdown on PLWO in relation to health-related behaviours, mental health and access to WMS. Our findings show that PLWO with poor mental health and those attending WMS were most adversely impacted and highlights the need for greater mental health support and continued provision of support from WMS for PLWO during future lockdowns., Funding: This research was funded through National Institute for Health Research University College London Hospitals Biomedical Research Centre funding., Competing Interests: AB reports grants from Cambridge Weight Plan, outside the submitted work; and is the Vice Chair of Specialist Obesity Group of the BDA, on the Strategic Council for APPG Obesity and on the Medical Advisory Board and shareholder of Reset Health Clinics Ltd. RLB reports personal fees from Novo Nordisk, other from Novo Nordisk, personal fees from Pfizer, personal fees from International Medical Press, personal fees from Boehringer Ingelheim, personal fees from ViiV, outside the submitted work. SWF reports grants from Johnson & Johnson, grants from Novo Nordisk, personal fees from Novo Nordisk, outside the submitted work. MOK reports personal fees from Novo Nordisk, outside the submitted work. SW reports non-financial support from Novo Nordisk, outside the submitted work. AZK has nothing to disclose. There are no other declarations of interest., (© 2021 The Authors.)

Competing Interests: Dr. Flint reports grants from Johnson & Johnson, grants from Novo Nordisk, personal fees from Novo Nordisk, outside the submitted work.