Treating obese patients - what influences our clinical decisions?

Toni McAloon, Vivien Coates, Donna Fitzsimons

Research output: Contribution to conferenceAbstractpeer-review


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 and Conclusion: Our study suggests
there may be both patient and clinician variables
that impact on effective treatment interventions
for clinical management of obese patients.
Original languageEnglish
Number of pages1
Publication statusPublished - 2013
EventRoyal College of Nursing International Research Conference - Belfast, United Kingdom
Duration: 20 Mar 2013 → …


ConferenceRoyal College of Nursing International Research Conference
Country/TerritoryUnited Kingdom
Period20/03/2013 → …


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