The Effect of Physician Held Stigmas and Bias on the Health Outcomes of Patients with Obesity: A Review of The Literature

9 The Effect of Physician Held Stigmas and Bias on the Health Outcomes of Paitents with Obesity: A Review of the Literature Cohen and Jones Journal of Health Disparities Research and Practice Volume 12, Issue 6, Winter 2019, pp. 9-18 © 2011 Center for Health Disparities Research School of Community Health Sciences University of Nevada, Las Vegas The Effect of Physician Held Stigmas and Bias on the Health Outcomes of Patients with Obesity: A Review of the Literature Rachel Cohen, Tulane University School of Medicine Catherine Jones, Tulane University School of Medicine Corresponding Author: Rachel Cohen, ABSTRACT Obesity is a growing epidemic that continues to garner attention throughout healthcare. The goal of this study was to review the literature on physician bias and stigmas surrounding obesity to assess the current state of research on connections between obesity-related stigma and the health outcomes and care of patients with obesity. A specific search string was used to obtain articles via PubMed and psychINFO, yielding 14 studies found that investigate these connections. The studies were categorized into three distinct pathways leading from physician stigma and biases to differing health outcomes of patients with obesity. These three pathways- perceptions, patient interaction, and clinical practice- are a novel way to look at the ways provider bias affects patients with obesity. This system allowed us to highlight significant health disparities among patients experiencing obesity. We propose several areas for future research to reduce physician bias, further characterize the impacts of provider bias on outcomes, and identify interventions for change. Keywords: Obesity; Physician Held Stigma; Disparities of Healthcare INTRODUCTION Obesity is a growing international health problem with ramifications throughout healthcare. People with obesity have elevated risk for a host of other health problems such as diabetes, heart disease and some gynecologic cancer (Apovian, 2016). Obesity poses multiple challenges for physicians across specialties. However, the obesity epidemic creates more than just direct challenges for patients’ health. A growing body of research has shed light on the systemic bias and stigma held against people who suffer from obesity (Phelan et al., 2015). Obesity stigmas and bias are pervasive in our mainstream culture. The biases associated with obesity include “laziness”, “sloppiness”, and “unpleasant”. Biases can be implicit (not readily known by the individual who holds them) or explicit in nature. Both implicit and explicit bias have shown to impact behavior towards individuals who are on the receiving end of bias (Flint, Hudson, & Lavallee, 2015). Journal of Health Disparities Research and Practice Volume 12, Issue 6, Winter 2019 http://digitalscholarship.unlv.edu/jhdrp/ Follow on Facebook: Health.Disparities.Journal Follow on Twitter: @jhdrp 10 The Effect of Physician Held Stigmas and Bias on the Health Outcomes of Paitents with Obesity: A Review of the Literature Cohen and Jones Unfortunately, physicians are not immune to these biases. Research has shown that physicians also harbor implicit and explicit biases against individuals with obesity (Bacon, Scheltema, & Robinson, 2001; Schwartz, Chambliss, Brownell, Blair, & Billington, 2003; Vartanian & Fardouly, 2013). New research has begun to focus on problems provider bias can cause throughout the healthcare system. For one, research has shown that fear of bias can cause patients reluctance to seek out necessary healthcare (Thomas, Hyde, Karunaratne, Kausman, & Komesaroff, 2008). The aim of this literature review was to assess the current research on physician bias/stigmas against obesity and the effects of bias upon the health outcomes and care of patients with obesity. To our knowledge, no other reviews have investigated the impact of provider bias upon the health outcomes of patients experiencing obesity. This review offered a fresh look at how physician bias relates to the health of patients with obesity, and provided several avenues for future study. METHODS The methods of collecting data and formatting of this review were modeled after a literature review on a similar topic by (Mold & Forbes, 2013). This review was accomplished in three steps: search and identification of studies; content extraction and appraisal of suitability for review; and synthesis of compiled content. Step 1: Search and Identification of Studies Electronic searches were done using key words/synonyms in PubMed and PsycINFO. Figure 1 shows the search terms and the ultimate search string that was used for both Pubmed and PsycINFO. No limits in the date range were used and no limits on language or paper type were set. All the papers in the search were considered for inclusion in the review except for ones that met the exclusion criteria. Exclusion criteria were papers that had some mention of childhood, adolescence, or pregnancy, as well as studies investigating non-physician healthcare provider. Step 2: Content Extraction and Appraisal of Suitability for Review After removal of the papers in the exclusion criteria, the rest of the articles’ abstracts were read. Each abstract was assessed for meaningful discussion of an association between bias and health outcomes. To be selected for further consideration for study inclusion, the papers’ abstracts must have included mention of assessment of physician bias/ stigma, patients with obesity, and differences in outcomes involving the healthcare of patients with obesity. In this study “changes in health outcomes” was broadly defined as “any aspect of a person’s health that changed due to stigma or bias”. Some studies populated from this search string were not related to this subject in any way. Additionally, many studies that populated from this search string did not contain one or more of the inclusion criteria. Step 3: Synthesis of Compiled Content The studies that met the criteria were read and verified for relevance. Some papers were discarded for lack of congruence with the search criteria. The remaining papers were synthesized for common themes. Finally, all the themes were taken together to look at the overall contribution to obesity bias research at large. Journal of Health Disparities Research and Practice Volume 12, Issue 6, Winter 2019 http://digitalscholarship.unlv.edu/jhdrp/ Follow on Facebook: Health.Disparities.Journal Follow on Twitter: @jhdrp 11 The Effect of Physician Held Stigmas and Bias on the Health Outcomes of Paitents with Obesity: A Review of the Literature Cohen and Jones Figure 1: Search criteria for literature review and final search string. RESULTS There were 607 search results populated in PubMed and 213 in PsycINFO. From the cumulative 820 abstracts, 112 abstracts were read after removing papers with exclusion criteria in the title. Many of the 213 PsycINFO results overlapped, as most of the resulting papers were also in the PubMed sea (...truncated)