Hales Caz, Gray Lesley, Russell Lynne, MacDonald Carol
Ostomy Wound Manage. 2018 Jan;64(1):18-24.
Extremely obese patients pose significant challenges for those who strive to provide care. The prevalence and consequences of weight bias and stigma in health care have been well documented, but research on how to reduce weight bias and stigma is limited. To assess the impact of simulating obesity on the attitudes and perceptions of health professionals toward extreme obesity, a qualitative study involving 6 registered nurses and 1 registered physiotherapist was conducted between November 2015 and May 2016. Health professionals who had regular contact with persons with obesity were recruited through poster advertisement in 1 hospital and 2 universities. Participants completed a demographic survey that included their physical measurements (height, weight, and waist circumference). They then wore a suit simulating the shape and size of a person with extreme obesity for approximately 2 hours and engaged in activities such as taking public transport or visiting a café. Audiotaped, semistructured interviews were conducted before and after the suit exercise and transcribed verbatim for conventional content analysis that identified 3 main categories: 1) insights into the physical challenges facing people with extreme obesity; 2) awareness of social consequences for people with extreme obesity; and 3) changes in participants' attitudes toward people with extreme obesity. Following the exercise, personal attitudes were found to be less judgmental and more empathetic. Using a simulation suit may increase awareness among health professionals regarding issues facing persons with obesity and may be a positive influence on diffusing weight stigma and bias in health care settings, particularly in the area of wound prevention and management where excess weight often requires additional nursing care that may exacerbate existing biases. Ethical guidance needs to be developed in conjunction with further research to explore the risks and benefits of using simulation suits in clinical practice and education.
极度肥胖的患者给那些致力于提供护理的人带来了重大挑战。医疗保健中体重偏见和污名化的患病率及后果已有充分记录，但关于如何减少体重偏见和污名化的研究却很有限。为了评估模拟肥胖对医护人员对极度肥胖态度和看法的影响，于2015年11月至2016年5月开展了一项定性研究，涉及6名注册护士和1名注册物理治疗师。通过在1家医院和2所大学张贴海报招募经常接触肥胖患者的医护人员。参与者完成了一项人口统计学调查，包括他们的身体测量数据（身高、体重和腰围）。然后，他们穿上一套模拟极度肥胖者体型和大小的服装，持续约2小时，并参与乘坐公共交通工具或去咖啡馆之类的活动。在穿着服装活动前后进行了录音的半结构化访谈，并逐字转录以进行传统内容分析，确定了3个主要类别：1）对极度肥胖者面临的身体挑战的见解；2）对极度肥胖者社会后果的认识；3）参与者对极度肥胖者态度的变化。活动之后，发现个人态度变得更少评判性且更具同理心。使用模拟服装可能会提高医护人员对肥胖者所面临问题的认识，并且可能对在医疗保健环境中消除体重污名和偏见产生积极影响，特别是在伤口预防和管理领域，超重往往需要额外的护理，这可能会加剧现有的偏见。需要结合进一步的研究制定伦理指南，以探讨在临床实践和教育中使用模拟服装的风险和益处。
