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The Effect of Patient BMI and Stigma on Type 2 Diabetes

11 June 2019


Weight stigma was examined in the context of how it might impact medical provider perception of treatment adherence in populations diagnosed with type 2 diabetes mellitus (T2D). The authors also investigated whether gender or body mass index (BMI) would affect provider confidence of treatment adherence, as well as the likelihood of referral to adjunctive interdisciplinary providers. Participants consisted of medical providers and students (i.e., DO, MD, ND, NP, PA), ages 18-65, who provide treatment to patients with T2D. Each participant was randomly assigned to read one of four clinical vignettes, which varied by gender (female or male) and BMI (28 or 45). The participants were asked to indicate which, if any, exams and tests they would order, advice or counseling they would offer; and referral recommendations they would make. In addition, their perceived confidence of treatment adherence was measured using the Physicians Adherence Questionnaire (PAQ; Lutfey & Ketcham, 2005). Lastly, the participants completed the Beliefs About Obese People Scale (BOAP; Allison, Basile, and Yuker, 1991) to assess for the degree of weight stigma. Results of an independent samples t-test revealed no significant effect of weight stigma on provider perception of patient treatment adherence. Further, results of a chi-square test of independence indicated that obese patients with T2D were no more or less likely to be referred to adjunctive treatment than their non-obese counterparts. However, a multiple linear regression analysis did reveal a main effect of patient gender on provider confidence, such that providers reported significantly more confidence in female patients as compared to their male patient counterparts (β = -.25, p = .047). In addition, there was a significant relationship between weight bias and the type of license held (or being pursued) by the participants, with DO providers reporting the highest level of weight bias. These findings have implications for clinical practice and suggest that gender bias and stereotypes may affect providers’ impression of patients in healthcare settings, which could result in differential care. In addition, weight bias may be more prevalent within some healthcare professions than others, indicating that it may be useful to target programs to reduce stigma to specific professions where the need is greater.


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