Study shows training cuts weight bias and improves clinical practice in obesity care

Key Takeaways:

• A four-hour continuing medical education (CME) intervention significantly reduced healthcare professionals’ negative stereotypes towards people living with obesity, while increasing empathy and confidence – effects that persisted up to 12 months.
• The intervention led to tangible changes in clinical practice, including higher rates of obesity diagnosis and referrals to lifestyle programmes, obesity medicine, and bariatric surgery.
• Experts argue more such training is urgently needed, given widespread weight bias in healthcare and the chronic, complex nature of obesity.
  

Introduction: Confronting bias in healthcare

Many healthcare professionals (HCPs) hold negative attitudes towards people living with excess weight or obesity. This weight bias is not merely a social issue – it can significantly undermine patient care. Now, new research demonstrates that clinicians’ views and behaviours can be reshaped through targeted education.

In a study published in the Journal of General Internal Medicine, researchers led by Dr Amanda Velazquez of the Centre for Weight Management and Metabolic Health and the Jim and Eleanor Randall Department of Surgery at Cedars-Sinai Medical Center in Los Angeles found that a structured four-hour CME programme could meaningfully shift both attitudes and practice.

The educational intervention

In April 2021, a single-site symposium was held within the Kaiser Permanente Southern California healthcare system. It invited a broad cross-section of 472 eligible HCPs across specialties – from plastic surgeons and obstetricians to nurses and emergency medical technicians.

Dr Velazquez highlighted the rationale:

“There is a considerable gap in the education of healthcare professionals about obesity,” she told Medscape Medical News.
“Our study was unique in that it had a broad target group and invited professionals across all specialties… Our goal was to move the needle toward greater comfort in referring their patients to appropriate obesity management.”

She noted that many health conditions treated outside obesity medicine – including psoriasis, cardiometabolic disease and impaired fertility – are worsened by excess weight.

Measuring and shifting attitudes

Participants completed a 16-item questionnaire originally developed by Robert F. Kushner and colleagues to assess three aspects of weight bias:

• Negative stereotypes, such as “Individuals with obesity have themselves to blame”
• Empathy, such as recognising that “People with obesity feel stigmatized by the medical profession”
• Confidence, such as feeling comfortable discussing weight.
  

Immediately after the programme, results showed statistically significant improvements:

• Negative stereotypes dropped from 2.81 ± 0.47 to 2.50 ± 0.46 (P < .001).
• Empathy increased from 3.33 ± 0.64 to 3.47 ± 0.63 (P = .006).
• Confidence rose from 3.10 ± 0.86 to 3.85 ± 0.79 (P < .001).
  

These positive shifts persisted at both four- and twelve-month follow-up.

Tangible changes in clinical practice

Beyond self-reported attitudes, the researchers examined real-world clinical behaviour by comparing electronic medical record data for 218 participants and 89 non-participants over the following year.

After adjusting for factors such as years in practice, race/ethnicity, gender, profession type, practice type, and patient panel size, those who attended the CME were significantly more likely to:

• Diagnose obesity (OR, 1.60; 95% CI, 1.54–1.66),
• Refer to healthy lifestyle programmes (OR, 1.27; 95% CI, 1.19–1.36),
• Refer to obesity medicine specialists (OR, 1.87; 95% CI, 1.63–2.14),
• And, for patients with a BMI ≥ 35, refer for bariatric surgery (OR, 2.12; 95% CI, 1.70–2.67).
  

In contrast, the comparison group’s rates largely remained unchanged or decreased.

Dr Velazquez admitted she was not prepared for the scale of change.

“The increase in the number of referrals to obesity care was so overwhelming, we had to change the BMI eligibility criterion to handle the influx,” she explained.
With referrals to the obesity clinic doubling, they raised the threshold for new referrals from BMI ≥ 30 to BMI ≥ 35.

Broader expert views

Leslie Heinberg, PhD, professor of medicine and vice chair for psychology at the Cleveland Clinic, praised the work:

“It’s an interesting and comprehensive study that goes beyond previous work in attitudinal change to look at change in actual practice behaviour around obesity.”

While she was unsurprised by the immediate shift in attitudes – noting, “We all know the right answers to give” – she found it notable that the change persisted.

“In my practice, patients often report experiencing weight stigma during interaction with their HCPs. But healthcare should be sensitive to patients across the entire weight spectrum.”

Heinberg added that most HCPs receive little or no training on obesity.

“They might get one lecture during training, but 40% of the patients they treat will have obesity.”
At her institution, all new clinical staff undergo onboarding in obesity bias, with annual refreshers.

Dr Carolynn Francavilla, an obesity medicine specialist in Colorado, also applauded the findings.

“As someone who dedicates a significant amount of my time to developing CME and educating clinicians, I find it very encouraging that this study was able to demonstrate both reduced weight bias and improved referrals for care,” she told Medscape Medical News.
“While most physicians are now aware of treatment options, many do not understand the chronic nature of the disease and many still believe that willpower is enough to treat obesity.”

Next steps for research and practice

The authors concluded that carefully designed CME can reduce HCPs’ weight bias and encourage better use of the full spectrum of obesity treatments.

“We’re hoping to apply the intervention in other groups to see if it has the same positive impact on practice,” said Dr Velazquez.
However, she noted that since the original study was run before the rise of GLP-1 therapies, future programmes will need updating.

The researchers called for additional trials to explore long-term changes beyond one year and to incorporate pharmacotherapy into the educational content.

Funding and disclosures

This work was funded by the Southern California Permanente Medical Group, with open access support from the Statewide California Electronic Library Consortium.

Dr Velazquez serves on advisory boards for WW, Eli Lilly, and Intellihealth and consults for Novo Nordisk. Coauthor A. Janet Tomiyama’s work was supported by the NIH and NSF. Dr Kushner consults for Altimmune, Pfizer, Eli Lilly and serves on advisory boards for Novo Nordisk and WW. Joseph Nadglowski is employed by the Obesity Action Coalition. Dr Francavilla is a speaker and adviser for Eli Lilly and holds personal investments in Eli Lilly and Novo Nordisk. Dr Heinberg declared no relevant conflicts.

CCH Insight:

This is an impressive study, which shows what impact even a short training course in obesity care can achieve. Around the globe there is a general lack of training of health professionals in obesity care, and the lack of understanding of obesity as a complex, chronic condition manifests as not just a lack of confidence and self-efficacy to treat obesity, but also a continuation of long-held stereotypes and stigmatisation of people living with obesity. High quality obesity care training for health professionals is essential if we are to improve access to care and outcomes for people with obesity.