Velazquez Amanda, Coleman Karen J, Kushner Robert F, Nadglowski Joseph F, Nece Patricia M, Zhang Jing, Tomiyama A Janet
Center for Weight Management and Metabolic Health, Jim and Eleanor Randall Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA.
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
J Gen Intern Med. 2025 Jun;40(8):1720-1727. doi: 10.1007/s11606-024-09212-9. Epub 2024 Dec 18.
Weight bias is pervasive in healthcare and leads to worse patient outcomes. A uniquely designed 4-h continuing medical education (CME) intervention was assessed for changing healthcare professionals' (HCPs') weight biases and clinical practice behaviors.
The intervention used a (1) pre/post design examining CME attendees' self-reported weight bias at baseline, after, and 4- and 12-month follow-up, and (2) post/post design examining obesity practice behaviors 12 months after intervention in attendees and non-attendees.
Single medical center service area within Kaiser Permanente Southern California.
All HCPs (n = 472) from the target service area were eligible to attend. Analyses were done with 218 HCPs who attended and 89 who did not.
The intervention contained theory-based elements of changing attributions of responsibility of obesity, increasing empathy, creating self-awareness of weight bias, and creating a bias-free culture. For pre/post analyses, the primary outcome was self-reported weight bias. For comparative analyses of CME attendees and non-attendees, the outcomes were electronic medical record-confirmed rates of obesity diagnosis and referrals to evidence-based obesity treatments in the 12 months following the CME intervention.
Self-reported negative obesity stereotypes were significantly reduced compared to baseline while self-reported empathy and confidence in caring for patients with obesity were significantly increased immediately post intervention and were maintained at 4- and 12-month follow-up. After adjusting for years in practice, race/ethnicity, gender, profession type, practice type, and panel size, HCPs who attended the CME intervention had significantly increased odds (range 60-212%) of diagnosis and obesity-related referrals in the 12 months following the CME intervention when compared to HCPs who did not attend.
This intervention has promise to be a scalable program that goes beyond impacting HCP's self-reported weight bias and also changes HCPs' clinical practice behaviors related to obesity treatment.
体重偏见在医疗保健领域普遍存在，并导致患者预后更差。对一项精心设计的4小时继续医学教育（CME）干预措施进行评估，以改变医疗保健专业人员（HCP）的体重偏见和临床实践行为。
该干预措施采用了（1）前后设计，在基线、干预后以及4个月和12个月随访时检查CME参与者自我报告的体重偏见；（2）后后设计，在干预12个月后检查参与者和非参与者的肥胖症实践行为。
南加州凯撒医疗集团内的单一医疗中心服务区。
目标服务区的所有HCP（n = 472）均有资格参加。对218名参加者和89名未参加者进行了分析。
该干预措施包含基于理论的要素，即改变对肥胖责任的归因、增强同理心、提高对体重偏见的自我认知以及营造无偏见的文化。对于前后分析，主要结果是自我报告的体重偏见。对于CME参与者和非参与者的比较分析，结果是CME干预后12个月内电子病历确认的肥胖症诊断率和转介至循证肥胖症治疗的比率。
与基线相比，自我报告的负面肥胖刻板印象显著减少，而自我报告的同理心以及照顾肥胖患者的信心在干预后立即显著增加，并在4个月和12个月随访时保持。在对从业年限、种族/族裔、性别、职业类型、执业类型和小组规模进行调整后，与未参加CME干预的HCP相比，参加CME干预的HCP在CME干预后12个月内诊断和肥胖相关转介的几率显著增加（范围为60%-212%）。
该干预措施有望成为一个可扩展的项目，不仅能影响HCP自我报告的体重偏见，还能改变HCP与肥胖症治疗相关的临床实践行为。
