Treating obese patients - what influences our clinical decisions?

Background: The obesity pandemic is resulting in premature mortality and increased morbidity and healthcare costs. Prevention is a global health priority but effective management for established obesity is also important. It is known that clinicians often have anti-fat attitudes and assumed that this adversely affects care (Puhl et al 2009). However there is a paucity of research linking anti-fat attitudes to clinical behaviour. Aims: to assess the attitudes of multidisciplinary clinicians to obese individuals and identify variables influencing decision-making.Methods: Online vignettes were generated via a Factorial Survey Design method to assess clinical decision making and were combined with the obesity Implicit Association Test (IAT) to assess subconscious anti-fat bias. Data were collected anonymously from a voluntary convenience sample during 2011-2012 in a virtual research lab managed by Project Implicit®. Multiple gatekeepers in 2 health trusts and 2 universities emailed invitations to registered nurses and students, medical doctors and students, dieticians and students. Participants used a hyperlink to self-administer eight randomly generated unique vignettes with integrated patient photographs, a demographic questionnaire and the IAT. Vignette responses (n = 3,416) were analysed using Multivariate Regression and the questionnaires by descriptive statistics. The IAT score was calculated from the standardised differences in mean response times on 2 key IAT conditions (Greenwald et al 2003). Results: 427 clinicians participated, 79% being female. Disciplines represented were nurses (38%), student nurses (14%), doctors (19%), medical students (20%), dieticians (7%) and dietetic students (2%). Preliminary vignette analysis identified patient and clinician variables influencing motivation to treat, likelihood of addressing weight, and time with the patient The mean IAT score was 0.6854 (95% confidence Intervals 0.6399-0.7309) indicating a strong anti-fat bias.Discussion & conclusion: Our study suggests there may be both patient and clinician variables that impact on effective treatment interventions for clinical management of obese patients.