West Madeline L, Rathbone Joanne A, Bilal Maria, Fernando Anne Nileshni, Sharp Gemma
Department of Neuroscience, Monash University, Melbourne, VIC, Australia.
School of Medicine and Psychology, Australian National University, Canberra, ACT, Australia.
J Gen Intern Med. 2025 Feb;40(2):309-317. doi: 10.1007/s11606-024-09202-x. Epub 2024 Nov 22.
Weight bias is characterised by negative attitudes towards people with a higher weight and is widespread in healthcare. Primary care professionals sometimes avoid discussing weight with patients due to concerns about upsetting them, insufficient training, resources, or referral pathways. There is, however, a responsibility for primary care professionals to address the health needs of patients, which may require discussing weight.
The current study aimed to understand primary care professionals and trainee perceptions of the appropriateness of weight-centric, weight-inclusive/holistic, and avoidant approaches for discussing weight with higher weight individuals when patients were and were not seeking weight management advice.
Mixed methods design.
Primary care professionals and trainees (N = 112) within Australia.
Participants first completed an online survey and provided demographic data and completed measures of implicit and explicit weight bias. Secondly, participants viewed simulated patient consultations, reflecting each of the three approaches (weight-centric, weight-inclusive/holistic, and avoidant) in a weight-related and non-weight related context. Participants then evaluated the appropriateness of the language and strategies used.
The participants showed, on average, low to moderate levels of explicit weight bias but high levels of implicit weight bias. For the consultations, language and strategies of the holistic approach were considered the most appropriate in both contexts. In the weight-related consultation, language used in the weight-centric and avoidant approaches were deemed equally inappropriate. However, weight-centric strategies were considered more appropriate than avoidant strategies. In the non-weight related consultation, the language and strategies of the avoidant approach were considered more appropriate than those of the weight-centric approach.
Primary care professionals and trainees favoured the holistic approach to discussing weight when patients presented with weight-related or non-weight related concerns. These findings have potential practical implications for health professional education.
体重偏见的特点是对体重较高的人持有消极态度，且在医疗保健领域普遍存在。初级保健专业人员有时会因担心让患者不安、培训不足、资源有限或转诊途径不畅而避免与患者讨论体重问题。然而，初级保健专业人员有责任满足患者的健康需求，这可能需要讨论体重问题。
本研究旨在了解初级保健专业人员和实习生对于在患者寻求和未寻求体重管理建议时，采用以体重为中心、包含体重/整体以及回避的方法与体重较高的个体讨论体重问题的适宜性的看法。
混合方法设计。
澳大利亚境内的初级保健专业人员和实习生（N = 112）。
参与者首先完成一项在线调查，提供人口统计学数据，并完成内隐和外显体重偏见的测量。其次，参与者观看模拟患者咨询，这些咨询在与体重相关和非体重相关的情境中分别体现了三种方法（以体重为中心、包含体重/整体、回避）。然后，参与者评估所使用的语言和策略的适宜性。
参与者平均表现出低到中度的外显体重偏见，但内隐体重偏见水平较高。对于咨询，整体方法的语言和策略在两种情境中都被认为是最适宜的。在与体重相关的咨询中，以体重为中心和回避方法所使用的语言被认为同样不合适。然而，以体重为中心的策略比回避策略被认为更适宜。在非体重相关的咨询中，回避方法的语言和策略比以体重为中心的方法被认为更适宜。
当患者提出与体重相关或非体重相关的问题时，初级保健专业人员和实习生倾向于采用整体方法来讨论体重问题。这些发现对健康专业教育具有潜在的实际意义。
