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Digging deep into historical, structural, and individual bias in our care of patients with obesity, with obesity medicine physician-scientist Dr. Fatima Cody Stanford.
Click here to claim CME credit for listening to the episode through ACP! |
Learning Objectives
1. Define obesity.
2. Summarize concerns about the origin and use of BMI, and the need for modified utilization in some patient groups.
3. Describe why people-first language surrounding obesity is important.
4. Explain how bias, whether explicit or implicit, leads to health disparities between patients with and without obesity.
2. Summarize concerns about the origin and use of BMI, and the need for modified utilization in some patient groups.
3. Describe why people-first language surrounding obesity is important.
4. Explain how bias, whether explicit or implicit, leads to health disparities between patients with and without obesity.
Show Notes
[0:00-1:23] Introduction
- Introduction to co-hosts and episode
[1:23-3:23] Introduction to Guest
[3:23-5:23] Dr. Stanford Defines Obesity
[5:23-9:15] History and Flaws of the BMI
Adolphe Quetelet and the Evolution of Body Mass Index (BMI)
The Racial Origins of Fat Phobia : Short Wave
[9:15-16:41] Weight-Based Biases and Stigma
Impact of weight bias and stigma on quality of care and outcomes for patients with obesity
[16:41-21:29] Tailoring Clinical Spaces to Patients with Obesity
[21:29-25:47] Resources to Mitigate Bias
[25:47- 28:14] Dr. Stanford’s Final Words
[28:14-29:51] Closing
Course Director and Senior Producer: Dr. Maggie Kozman
Co-Hosts: Dr. Brittäne Parker and Sanika Walimbe
Guest: Dr. Fatima Cody Stanford
Production Assistant: Lynn Nguyen
Special thanks to Dr. Davoren Chick, Monica Lizarraga, Dr. Charles Hamori, Dr. Tammy Lin,
Dr. Tiffany Leung, and Darian Harris for helping to make this project possible.
- Introduction to co-hosts and episode
[1:23-3:23] Introduction to Guest
- Dr. Fatima Cody Stanford, an obesity medicine physician-scientist, educator, and policymaker
- ACP 2021 Obesity Management Learning Series, created by a committee chaired by Dr. Stanford
[3:23-5:23] Dr. Stanford Defines Obesity
- The BMI is the most widely used, albeit imperfect, metric used to identify adult patients at risk for obesity.
- While BMI uses height and weight, it does not provide us with the characteristic of that weight.
[5:23-9:15] History and Flaws of the BMI
- Articles/media about the BMI’s history:
Adolphe Quetelet and the Evolution of Body Mass Index (BMI)
The Racial Origins of Fat Phobia : Short Wave
- Originally only meant as a population-level standard based on Caucasian European men
- Dr. Stanford co-authored a Letter to the Editor in the Mayo Clinic Proceedings Journal (2019) discussing BMI thresholds based on sex and race/ethnicity.
- Weight curves and standards vary based on race and sex (there are variations in metabolic response to excess weight).
[9:15-16:41] Weight-Based Biases and Stigma
- Healthcare providers often have biases against patients with obesity.
- Providers’ implicit weight bias negatively impacts patients’ quality of care:
Impact of weight bias and stigma on quality of care and outcomes for patients with obesity
- The importance of using person-first language: “patients with obesity” instead of “obese patients”, “severe obesity” instead of “morbid obesity”
- Harmful non-verbal/verbal communication and clinic/hospital infrastructure can cause patients with obesity to feel unwelcome in healthcare spaces.
- More information on best practices when discussing weight can be found in Module 1 of the ACP obesity management curriculum.
[16:41-21:29] Tailoring Clinical Spaces to Patients with Obesity
- Wider doors to accommodate patients with excess weight and any assistive devices they need
- Clinic chairs without arms or benches
- Medical equipment such as blood pressure cuffs and measuring tapes that accommodate patients of all sizes
- Addressing negative self-talk during clinic visits
[21:29-25:47] Resources to Mitigate Bias
- Harvard Implicit Association Test (Weight)
- Psychologist Patricia Devine’s steps for fighting implicit race bias
- 2020 Psychology, Health and Medicine article discussing the positive effects of counterstereotypic exposure in the context of obesity
- Dr. Stanford’s recommendations:
- Dr. Rebecca Puhl and the UConn Rudd Center for Food Policy and Obesity provide excellent tools and research for clinicians to use.
- Obesity Action Coalition acts as a support center for patients with obesity.
[25:47- 28:14] Dr. Stanford’s Final Words
- Refer to resources for education on treatment of patients with obesity. The ACP Obesity Management Learning Series is one such resource among many others.
- We should all continue to seek knowledge on the treatment of obesity in order to be the best source of information for our patients.
[28:14-29:51] Closing
- Website: www.thedeishift.com
- Twitter/Instagram: @TheDEIShift
- Theme Music: www.chrisdingman.com
Course Director and Senior Producer: Dr. Maggie Kozman
Co-Hosts: Dr. Brittäne Parker and Sanika Walimbe
Guest: Dr. Fatima Cody Stanford
Production Assistant: Lynn Nguyen
Special thanks to Dr. Davoren Chick, Monica Lizarraga, Dr. Charles Hamori, Dr. Tammy Lin,
Dr. Tiffany Leung, and Darian Harris for helping to make this project possible.
