How Bias Gets in the Way of Effective Obesity Care - Ted Kyle, RPh, MBA March 4, 2021 World Obesity Day Obesity Care Week
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How Bias Gets in the Way of Effective Obesity Care
Ted Kyle, RPh, MBA
March 4, 2021
World Obesity Day • Obesity Care Week
Disclosures • Ted Kyle is presenting on behalf of Ethicon. The presentation reflects the opinions of the individual presenter, and the steps described may not encompass the complete steps of the procedure. Additionally, other surgeons may prefer different techniques, approaches, etc., as individual surgeon experience in his/her clinical practice, as well as patient needs, may dictate variation in procedure steps. Accordingly, results from any case studies reported in this presentation may not be predictive of results in other cases. • Before using any medical device, review all labeling, including without limitation; the Instructions For Use (IFU), and relevant package inserts with particular attention to the indications, contraindications, warnings and precautions, and steps for use of the device(s). • This presentation is not accredited for CE/CME. • Ted Kyle is compensated by and presenting on behalf of Ethicon and must present information in accordance with applicable regulatory requirements.
Disclosures
• Professional fees • Personal biases that favor:
– Gelesis – Evidence-based interventions,
– Novo Nordisk® both prevention and treatment
– Nutrisystem® – Respect for people living with obesity
– Critical thinking about all evidence
https://youtu.be/PrL5Vq8bhrk
Presentation Objectives
• Describe how bias corrupts our
response to obesity and its
complications
• Review data on public perceptions
and biases about:
– Obesity
– Metabolic surgery
Source: Pawel Loj / flickr
Why Is the Utilization of
Metabolic and Bariatric Surgery So Low?
Two primary factors
• Fear of surgery
• Bias about
– Obesity
– People living with it
– Obesity treatment
Blind Justice, photograph by Tim Green / Wikimedia Commons
Bias Comes from Selective Blindness to Facts
Bias is an inclination or outlook to present or hold a partial
perspective, often accompanied by a refusal to
consider the possible merits of alternative points of
view. Biases are learned implicitly within cultural contexts.
People may develop biases toward or against an
individual, an ethnic group, a nation, a religion, a social
class, a political party, theoretical paradigms and
ideologies within academic domains, or a species.
– Adapted from
Psychology: Contemporary Perspectives
Paul Okami
Blind Justice, photograph by Tim Green / Wikimedia Commons
Two Kinds of Bias
Corrupt Our Response to Obesity
• Intellectual bias
favoring personal convictions
• Weight bias
directed at people with obesity
God Judging Adam, Etching by William Blake / WikiArt
What Is Weight Bias? • Negative attitudes – Attitudes – Beliefs – Judgments – Stereotypes – Discriminatory acts • Based solely on weight • Subtle or overt • Explicit or implicit Listen Up, photograph © Obesity Action Coalition / OAC Image Gallery
People Typically
View Obesity as the Result of Poor Choices
Environment • Choices • Genes
70%Long Viewed as a Matter of Choice
“Which phrase comes closest to describing the type of
problem that you think obesity is?” (Feb 2013)
• Bad personal choices was the
dominant explanation in 2013
Medical 18%
Community, • Data from ongoing tracking
Bad Food,
Something Inactivity 24% • Respondents asked to pick one
Else 24%
Personal Problem, Bad Choices 44%
Five Groups That Understand Obesity Is More Than Personal. ConscienHealth. 2013. Accessed February 19, 2021. https://conscienhealth.org/2013/11/five-
groups-understand-obesity-is-more-than-personal/The Truth Is That
Obesity Is a Highly Heritable Chronic Disease
Personal • Heredity plays a dominant role in obesity risk
Choices
• But environmental factors serve to activate it
Environmental • Then, people can choose what to do about it
Triggers
Heritability 70%
Musani SK, Erickson S, Allison DB. Obesity--still highly heritable after all these years. Am J Clin Nutr. 2008 Feb;87(2):275-6.Obesity Grows from Complex, Adaptive Systems
Personal Psychology
Social Psychology
Food Production
Physical Activity
Food Consumption
Physiology
Vandenbroeck P, Goossens J, Clemens M. Tackling Obesities: Future Choices - Obesity System Atlas - Welcome to Foresight For Development.
https://www.foresightfordevelopment.org/sobipro/54/1231-tackling-obesities-future-choices-obesity-system-atlas. Published 2007. Accessed February 19, 2021.Misunderstanding Obesity Fosters
Demeaning Stereotypes About People with Obesity
• Lazy
• Stupid
• Undisciplined
• Sloppy
• Awkward
• Losers
• Dishonest
• Won't follow directions
• Uniformly unhealthy
• Ignorant about nutrition
• Lives spent gorging on junk food
In the Kitchen, photograph © Obesity Action Coalition / OAC Image GalleryLiving with Bias & Stigma Makes People Sicker
Pathways from
stress to obesity
Tomiyama AJ. Stress and Obesity. Annu Rev Psychol. 2019 Jan 4;70:703-718.Web and Smartphone Samples
Obtained via Google Consumer Surveys
Sample Size
• 3,024 total
• U.S. and U.K
• Fielded in Feb 2019
Source: Google Surveys research by ConscienHealth and OACPeople Have
Unrealistic Expectations for Obesity Self-Help
Source: Google Surveys research by ConscienHealth and OACMany People Think
Bariatric Surgery Is Simply Too Risky for Them
• Only 32% with class III obesity
would even consider surgery
• Most often because they
considered it too risky
• Minimization of their own health
risks seems to be a factor, too
Stanford FC, Kyle TK, Claridy MD, Nadglowski JF, Apovian CM. The influence of an
individual's weight perception on the acceptance of bariatric surgery. Obesity (Silver
Spring). 2015 Feb;23(2):277-81.This Bias Makes It Easy for Health Plans
to Discourage People from Seeking Obesity Care
• Routine policy exclusions for obesity
“Regardless of any potential health benefit”
• Lifetime procedure caps
• High out of pocket costs
Saving Cash, photograph © 401(K) 2012 / flickr • Problematic reimbursement rates
and procedures
• But, obesity complications are fully coveredWhy Is the Utilization of
Metabolic and Bariatric Surgery So Low?
Two primary factors
• Fear of surgery
• Bias about
– Obesity
– People living with it
– Obesity treatment
Blind Justice, photograph by Tim Green / Wikimedia CommonsCOVID-19 Concerns for People with Obesity
• Patients avoiding healthcare
• Increased fear of being discounted
• Extreme fear of infection and
hospitalization
• Concerns about changes in eating
habits, exercise, weight gain
Let’s Get Real, photograph © Obesity Action Coalition / OAC Image GalleryWeight Bias Surfaces in Unexpected Ways
Explicit Bias Is Down, But Implicit Bias Is Growing
Dimension Explicit Bias Trend 2007-2016 Implicit Bias Trend 2001-2016
Sexuality Down Down
Race Down Down
Skin Tone Down Down
Age Down Flat
Disability Down Flat
Weight Down Up
Charlesworth TES, Banaji MR. Patterns of Implicit and Explicit Attitudes: I. Long-Term Change and Stability From 2007 to 2016. Psychol
Sci. 2019 Feb;30(2):174-192.Public Views Are Slowly Shifting
“Obesity is a personal problem of bad choices”
45%
• Fewer people think of obesity as a
problem of bad personal choices
40%
• People are shifting toward more
Percent of Respondents
35% diverse views of obesity
30%
25%
20%
Jan-13 Jul-13 Jan-14 Jul-14 Jan-15 Jul-15 Jan-16 Jul-16 Jan-17
Source: ConscienHealth/OAC weight bias tracking research, 2017.05What’s Required for Progress?
Progress will require:
• Objectivity to replace bias
• Curiosity about obesity and the
people it affects
• Care for these people
Progress Coffee, photograph © dingatx / flickrMore Information
stopweightbias.com
conscienhealth.org/news
@ConscienHealth
Facebook.com/ConscienHealth
For these slides:
https://conscienhealth.org/wp-content/uploads/2021/03/WOD.pdf
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