Weight-related Communication Research Articles

Female Perspectives Regarding Quality of Care and Weight-Related Communication in Obstetrics-Gynecology and Family Practices

Female Perspectives Regarding Quality of Care and Weight-Related Communication in Obstetrics-Gynecology and Family Practices

“Be more positive and more kind to your own bodies”: Adolescent and young adult preferences for how parents can support their children with weight-related pressures

Body dissatisfaction is a key factor contributing to the development of disordered eating, and body dissatisfaction is often influenced by media, peer, and parental pressures during adolescence. Little research has explored ways in which parents can help their children manage pressures from social media and their peers. The present study used the MyVoice National Poll of Youth, a large text-message cohort of young people (14–24 years old) in the United States, to collect and examine qualitative data about their experiences with parental weight-related communication and how they think parents can best support their children regarding messages they see/hear surrounding weight, body shape and size by their peers and media sources. 801 participants responsed to at least one question. Results from the present study suggest that young people want their parents to model healthy relationships with food and their body, teach body neutrality/acceptance, and normalize all body types. Findings suggest that there are many proactive, practical approaches parents can adopt to help support their children and offset weight-related pressures from other sources.

Weight Bias Among Certified Nurse-Midwives and Certified Midwives: Findings From a National Sample.

Weight bias toward individuals with higher body weights permeates health care settings in the United States and has been associated with poor weight-related communication and quality of care as well as adverse health outcomes. However, there has been limited quantitative investigation into weight bias among perinatal care providers. Certified nurse-midwives (CNMs)/certified midwives (CMs) attend approximately 11% of all births in the United States. The aims of this study were to measure the direction and extent of weight bias among CNMs/CMs and compare their levels of weight bias to the US public and other health professionals. Through direct postcard distribution, social media accounts, professional networks, and email listservs, American Midwifery Certification Board (AMCB)-certified midwives were solicited to complete an online survey of their implicit weight bias using the Implicit Association Test and their explicit weight bias using the Antifat Attitudes Questionnaire, Fat Phobia Scale, and Preference for Thin People measure. A total of 2257 midwives participated in the survey, yielding a completion rate of 17.7%. Participants were mostly White and female, with a median age of 46 years and 11 years since AMCB certification. More than 70% of midwives have some level of implicit weight bias, although to a lesser extent compared with previously published findings among the US public (P <.01) and other health professionals (P <.01). In a subsample comparison of female midwives to female physicians, implicit weight bias levels were similar (P >.05). Midwives also express explicit weight bias, but at lower levels than the US public and other health professionals (P <.05). This study provides the first quantitative research documenting weight bias among a national US sample of perinatal care providers. Findings can inform educational efforts to mitigate weight bias in the perinatal care setting and decrease harm.

Parent–child communication about weight: Priorities for parental education and support

Approximately 2/3 of parents talk about body weight with their children, which can include negative comments that have adverse health implications for youth. To identify ways to improve supportive parent-child communication about weight, we assessed parent and youth perspectives of barriers to weight communication, preferences for educational resources and support, and whether perspectives differ across demographic groups and weight status. In Fall 2021, online surveys were completed by two independent, unrelated samples of parents (N= 1936) and youth (N= 2032). Participants were asked about their perceived barriers to talking about weight, and what kinds of information and support would be most useful to them in fostering supportive communication. Parent and youth-reported barriers to weight communication included discomfort and lack of knowledge about weight, and views that weight does not need to be discussed. Most parents wanted guidance on how to navigate multiple weight-related topics with their children, including promoting positive body image and healthy behaviours, reducing weight criticism, focusing more on health and addressing weight-based bullying. Youth preferences for how their parents can be more supportive of their weight included avoiding weight-related criticism and pressures, increasing sensitivity and encouragement, and emphasizing healthy behaviours rather than weight. Few differences emerged based on sex and race/ethnicity, although several differences emerged for youth engaged in weight management. Parent and youth perspectives indicate a need for education to help parents engage in supportive conversations about body weight. Findings can inform efforts to reduce barriers and increase supportive weight-related communication in families.

O.O.1.5 - (IT) A 3D-virtual learning tool to improve weight-related communication for healthcare professionals: Presenter(s): Fiona Quigley, Ulster University, United Kingdom

O.O.1.5 - (IT) A 3D-virtual learning tool to improve weight-related communication for healthcare professionals: Presenter(s): Fiona Quigley, Ulster University, United Kingdom

The Mediating Role of Social Control in the Relationship between Family Communication Patterns and Emerging Adults’ Weight-Related Outcomes

ABSTRACT Emerging adults leaving home face an important transition. Despite increased independence, parent communication continues to influence weight/body perceptions. Emerging adults (N = 202) reported on a parent’s use of Family Communication Patterns (FCP) and social control to predict three outcomes: weight concern, body dissatisfaction, and weight-related communication apprehension (WRCA). Mediation analysis revealed that participants from conformity-oriented families reported greater weight concern and WRCA through a parent’s use of greater negative social control. Participants from conversation-oriented families reported lower weight concern and WRCA through a parent’s use of lower negative social control. Theoretical implications are offered to explain how FCP climates are associated with body-concept outcomes via social control behaviors, and practical implications are offered for family-focused health practitioners.

Pet owners' and companion animal veterinarians' perceptions of weight-related veterinarian-client communication.

To compare pet owners' and veterinarians' perceptions of veterinarian-client conversations concerning pet weight and identify challenges related to communication about weight. Veterinarians (n = 24) and pet owners (27) in southern Ontario, Canada. 3 veterinarian and 5 pet owner focus groups were conducted with a semistructured interview format. Thematic analysis of verbatim transcripts was conducted. Pet owners valued weight as an important health indicator for pets yet did not expect to discuss weight extensively at every appointment. Owners expected veterinarians to provide options and tailor recommendations when discussing weight management. Owners appeared more concerned with underweight animals, whereas veterinarians focused on obese animals. Veterinarians identified communication challenges, including the perception that owners are uninterested in discussing weight and conversations can become adversarial. Veterinarians reported various benefits and challenges of using humor to address pet weight and emphasized that weight-related conversations often depend on the existing veterinarian-client relationship. Some perceptions of pet owner expectations expressed by veterinarians in this study align with owner preferences, yet several opportunities exist for changes to veterinarians' approaches to weight-related communication with clients.

Exploring veterinary professionals' perceptions of pet weight-related communication in companion animal veterinary practice.

Pet obesity is commonly encountered by veterinary professionals, yet little is known about their perception of communicating about pet weight. The objective of this study was to explore veterinary professionals' perception of discussing pet obesity with clients. An online survey targeting veterinary professionals was distributed via social media and veterinary organisation newsletters. Topics included respondents' perceptions of weight-related communication, factors related to approaching weight conversations and implicit weight bias. A total of 102 respondents to the survey were included in the final analysis. Avoidance of discussing pet obesity with certain clients was common (53.9%; 55/102). The most endorsed term for describing pets with excess weight to clients was 'overweight' (97.1%; 99/102). The pet's body condition score was rated the most important factor to consider when deciding how to approach a weight discussion with clients. Although only 29 participants completed the implicit association test (IAT), most of these participants were identified as having an unconscious preference for thin people. The small sample size limited the vignette analysis to descriptive only, and the IAT results should be interpreted cautiously. This exploratory, cross-sectional study provides early insight into veterinary professionals' perceptions of pet obesity-related communication and suggests the presence of weight bias in the profession that warrants further investigation.

Veterinary professionals' weight-related communication when discussing an overweight or obese pet with a client.

Pet weight may be difficult for veterinary professionals to address with clients, particularly when pets are overweight or obese. The objective of this study was to characterize the communication processes and content of weight-related conversations occurring between veterinary professionals and clients. Audio-video recordings of 917 veterinarian-client-patient interactions involving a random sample of 60 veterinarians and a convenience sample of clients. Companion animal veterinarians in southern Ontario, Canada, were randomly recruited, and interactions with their clients were audio-video recorded. Interactions were reviewed for mentions of weight, then further analyzed by means of a researcher-generated coding framework to provide a comprehensive assessment of communication specific to weight-related interactions. 463 of 917 (50.5%) veterinary-client-patient interactions contained an exchange involving the mention of a single patient's (dog or cat) weight and were included in final analysis. Of the 463 interactions, 150 (32.4%) involved a discussion of obesity for a single patient. Of these, 43.3% (65/150) included a weight management recommendation from the veterinary team, and 28% (42/150) provided clients with a reason for pursuing weight management. Findings illustrate opportunities to optimize obesity communication to improve the health and wellbeing of veterinary patients.

Adolescents' Exposure to and Experiences of Weight Stigma During the COVID-19 Pandemic.

ObjectiveThe COVID-19 pandemic has increased attention to the proliferation of pediatric obesity amidst significant changes in weight-related health functioning (e.g., compromised physical activity, limited food access, increased stress). The present cross-sectional study investigated adolescents’ feelings about their bodies and perceived changes in weight stigma from peers, parents, and social media during the pandemic.MethodsFour hundred fifty-two adolescents (11–17 years old) completed an online survey during the Fall of 2020. Measures assessed perceived changes in exposure to weight stigmatizing social media content (stress eating jokes, weight gain memes) and experiences of weight stigma (weight-based bullying, teasing, hurtful comments) by parents and peers, as well as body dissatisfaction, during the COVID-19 pandemic. Weight status and gender were examined as individual difference variables.ResultsThe majority (53%) of adolescents reported increased exposure to at least one form of weight stigmatizing social media content during the pandemic. Additionally, pandemic-related increases in body dissatisfaction were prevalent (41%), especially among girls with higher body mass index (≥85th percentile; 67%). On average, the extent to which adolescents experienced weight-based mistreatment from parents and peers remained consistent with their pre-pandemic experiences.ConclusionsOverall, these findings highlight changes in the social messages that adolescents receive about their bodies, as well as their subjective body satisfaction, during the pandemic. Results underscore the need for healthcare providers and mental health professionals to be aware of the potential rise in weight stigma during the pandemic, and encourage families and schools to engage in supportive, rather than stigmatizing, weight-related communication with youth.

Predictors of weight discussion in primary care consultations: A multilevel modeling approach

ObjectiveTo understand how primary care weight-related communication processes are influenced by individual differences in primary care practitioner (PCP) and patient characteristics and communication use. MethodsTwo multilevel logistic regression models were calculated to predict the occurrence of 1) weight-related discussion and 2) weight-related consultation outcomes. Coded communication data (Roter Interaction Analysis System) from 218 video-recorded consultations between PCPs and patients with overweight and obesity in Scottish primary care practices were combined with their demographic data to develop the multilevel models. ResultsWeight-related discussions were more likely to occur when a greater proportion of PCP’s total communication was partnership building and activating communication. More discrete weight discussions during a consultation predicted weight-related consultation outcomes. Patient BMI positively predicted both weight-related discussion and consultation outcomes. ConclusionThis work demonstrates that multilevel modeling is a viable approach to investigating coded primary care weight-related communication data and that it can provide insight into the impact that various patient and PCP factors have on these communication processes. Practice implicationsThrough the increased use of partnership building and activating communications, and by engaging in shorter, but more frequent, discussions about patient weight, PCPs may better facilitate weight-related discussion and weight-related consultation outcomes for their patients.

Comparison of obstetrician-gynecologists and family physicians regarding weight-related attitudes, communication, and bias

ObjectivesTo assess physician perceptions regarding weight-related communication, quality of care, and bias in obstetrics-gynecology (OBGYN) and family physician (FP) practices. MethodsA cross-sectional survey study based on a convenient sampling of OBGYN and FP was conducted. Physicians completed a 40-question survey assessing perceived obesity management and weight bias in caring for female patients with body mass index ≥25kg/m2. ResultsReponses from 51 physicians (25 OBGYN and 26 FP) were received. There was no difference between specialties in satisfaction with care or level of confidence in treating patients with obesity. However, OBGYNs reported more negative perceptions of patients with obesity (mean score 19.2±3.3 vs. 15.0±4.0, p<0.001) and greater weight bias (11.8±2.0 vs. 9.7±2.5, p<0.01) compared to FPs. OBGYNs were also more likely to expect less favorable treatment outcomes (13.3±2.5 vs. 15.5±2.8. p<0.01). Physicians between 31−50 years old displayed a significantly higher perception of weight bias in their profession when compared to the reference 21−30year olds, and for each unit increase in self-reported BMI there was a 0.18 average increase in the composite score for perceived weight bias. ConclusionsOBGYN physicians reported significantly higher levels of weight bias than FP physicians, indicating a need for improved education in OBGYN training. Clinical trial registrationN/A.

The Mother-Daughter Body Image Connection: The Perceived Role of Mothers’ Thoughts, Words, and Actions

ABSTRACT This study explored whether daughters’ perceptions of their mother’s weight-related attitudes, communication, or actions were most strongly associated with their body image issues. The results revealed that daughters’ perceptions of their mother’s frequency of fat talk (communication) and her enactment of extreme weight-loss behaviors (actions) are important factors in both daughters’ body dissatisfaction and motivation to lose weight. Mothers’ fat talk appears to have the possibility to be especially detrimental, even more so than their extreme weight-loss behaviors. Given these findings, mothers are encouraged to be especially mindful of their critical language regarding their own bodies.

A systematic review of weight-related communication trainings for physicians.

Obesity is a leading cause of preventable death in the USA. Given the high number of adults seeking routine health care services, physicians have an opportunity to address weight loss during routine clinical encounters. It's often reported that physicians lack the training to address weight. Training programs are implemented in medical settings to prepare physicians to have conversations with patients. Yet, the degree of consistency among training programs and factors associated with better outcomes is unclear. The purpose of this study is to systematically review literature in physician communication trainings related to weight-to compare the content, outcomes, and implementation of existing studies examining weight-related communication training programs for physicians and determine factors associated with physician and patient outcomes. Articles were extracted from PubMed, Proquest, and Embase. Search terms included: health communication, physician training, weight, and obesity. Studies implementing a training program addressing weight among physicians were included. Trainings using either motivational interviewing (MI) or 5 As (Ask, Advise, Assess, Assist, and Arrange) framework found improvements in physicians' communication skills. A small number of trainings including experiential components were also associated with improvements in positive physician outcomes. Findings suggest trainings based in MI or 5 As framework improve physicians' communication skills, but few programs affected patient outcomes. Gaps remain with trainings that can demonstrate weight loss in patients. While work is needed to enhance the effects of these trainings on patient outcomes, data suggest that trainings should be longer in duration and include an experiential component.

Female adolescents with overweight and obesity share their perspectives on the clinical setting and weight management.

The clinical setting remains a strategic environment for early assessment, identification and treatment of adolescents with obesity. Yet, healthcare providers' (HCPs) efforts have been unsuccessful in improving physical activity, nutritional intake or body mass index in adolescents with obesity. Obesity is a chronic condition that influences how patients interact with HCPs and experience ambulatory healthcare appointments. However, it is unknown how female adolescents with obesity perceive the clinical setting, especially regarding weight management. The purpose of this study was to explore the perceptions of female adolescents with obesity regarding health and weight management in the clinical setting. Using a qualitative design, 28 English-speaking female adolescents, 13 to 19 years of age, with a body mass index ≥85th percentile for height and weight participated in individual interviews. Results demonstrate that adolescents with obesity desire to be recognized as unique individuals and to be involved in their own health conversations. The participants reported that their health care was inadequate when they received impersonal and vague advice from HCPs on weight loss. Weight-related communication was best received in a kind and empathetic manner, with a focus on improving one's health (instead of losing weight). Adolescents in this study articulated the components of healthy eating and physical exercise, yet were unable to synthesize this knowledge into specific dietary practices and daily physical activities. The insights derived from female adolescents with obesity provide guidance on how HCPs can improve their relationship and engage the adolescent in weight-based discussions. Concrete, actionable recommendations are provided for providers who work with female adolescents who are overweight or obese.

Assessing Parents' Communication of Weight and Weight Management from Clinic to Home.

Background: Family-oriented therapies are the gold standard of childhood obesity treatment, yet little is known about if or how information gathered by one parent from a health care provider is translated to the home. We assessed how families of children and adolescents with overweight and obesity communicate weight-related information received from their provider to family members not present at the visit. Methods: Parents and children (9-18 years old, N = 112) completed the McMaster's Family Assessment Device Communication Subscale (FADc) and investigator-derived questions describing weight-related communication practices with family members. We used descriptive statistics to describe communication practices and separate logistic regression models to assess associations of communication practices with parent-reported FADc, child BMI z-score, child sex, parent BMI, household income, and site. Results: Most parents discuss with other family members: their child's weight (60.4%) or weight management discussions with the child's provider (57.9%). Median parent FADc score was 2.0 (IQR 0.5). The most common facilitator to weight-related conversations was understanding what the provider said (95.1%). Higher FADc score (worse communication) was associated with whether parents ask other family members' opinions about weight information received from their child's provider [odds ratio 0.22 (95% confidence interval 0.05-0.99)]. Higher income was associated with many healthy communication practices. Conclusions: Slightly more than half of parents discuss with family members what their provider said regarding their child's weight. More effort must be placed on aiding parents in relaying information from the provider to other family members in the home to encourage family lifestyle changes and alleviate childhood obesity.

An analysis of directly observed weight communication processes between primary care practitioners and overweight patients

ObjectiveTo analyse weight-related communication prevalence and processes (content/context) between primary care practitioners (PCPs) and overweight patients within routine primary healthcare consultations. MethodsConsultations between 14 PCPs and 218 overweight patients (BMI ≥ 25 kg/m2) were video recorded. Weight communication was coded using the Roter Interaction Analysis System (RIAS) and the novel St Andrews Issue Response Analysis System (SAIRAS). Communication code frequencies were analysed. ResultsWeight discussion occurred in 25% of consultations with overweight patients; 26% of these had weight-related consultation outcomes (e.g. weight-related counselling and referrals, stated weight-related intention from patients). Weight discussions were more likely to occur if PCPs provided space to patient attempts to discuss weight (p = 0.013). Longer weight discussions (p < 0.001) and contextualising weight as problematic when PCP/patient-initiated weight discussion (p < 0.001) were associated with weight-related consultation outcomes. ConclusionWeight was rarely discussed with overweight patients, however PCP space provision to patient weight-discussion initiation attempts increased weight discussion. When weight was discussed, increased time and/or contextualising weight as a problem increased the likelihood of weight-related consultation outcomes. Practical implicationPCP use of specific communication approaches when discussing, contextualising and responding to patient weight may facilitate weight-related discussion and consultation outcomes and could lead to more effective patient weight management.

Multiple stakeholder views of pre-school child weight management practices: A mixed-methods study

Objective:With the increasing prevalence of unhealthy weight status in pre-school children, this study sought to understand pre-school child weight management practices in Blackburn with Darwen, UK, with a view to informing appropriate intervention strategies.Design:Mixed-methods study (semi-structured interviews, quantitative survey).Setting:Urban–rural borough with high ethnic diversity in the North West of England.Methods:Phase 1 involved 15 semi-structured interviews with public health/service managers, health professionals and children’s centre staff to explore current pre-school weight management practices, challenges and perceived training needs. Phase 2 involved a quantitative survey of multi-disciplinary health professionals ( n = 30) who work with pre-school children. Data were analysed thematically and perceived challenges organised into individual, interpersonal and organisational levels of the socio-ecological model.Results:Current pre-school child weight management practices appeared to be inconsistent, and staff were unable to locate clear protocols or referral pathways. Challenges most commonly related to individual family factors (e.g. families not perceiving child’s weight status to be a problem) and organisational factors (e.g. lack of time). Perceived training needs differed between professions and included body mass index calculation and interpretation, weight-related communication and pre-school nutrition/physical activity guidelines.Conclusion:Inconsistencies in practice and a lack of clear pathways limited pre-school child weight management practices in Blackburn with Darwen. Although many challenges were attributed as external to the individual, potential steps to help practitioners cope with these demands are outlined.

Communication between patients and primary care physicians after behavioural weight loss: an observational study.

Primary care physicians can play a key role in supporting patients after behavioural weight loss, though little is known about communication between patients and physicians during this time. Adults (n=139) in a behavioural weight loss trial (delivered outside of primary care) who attended a primary care appointment after an initial weight loss period were surveyed to assess weight-related communication at their most recent appointment. Most participants (78%) reported discussing weight with their physician. Participants who discussed weight, compared to those who did not, lost more weight, had higher blood pressure, and were more likely to be male. Most (89%) reported that their physician was supportive of their weight loss, but only a few participants (6.9%) reported that their physician gave feedback on medical parameters. Areas for improvement identified include physicians providing universal support for modest weight changes and providing interpretation of medical measurements that changed due to weight loss.

Fostering positive weight-related conversations between health care professionals, children, and families: Development of a knowledge translation Casebook and evaluation protocol.

Health care professionals (HCPs) must communicate with children and families about weight management in a sensitive and nonstigmatizing manner. However, HCPs receive little training in weight-related communication and have requested resources, but these are scarce. This article details the development process of a knowledge translation (KT) Casebook and outlines the proposed protocol for its implementation and evaluation. Guided by the knowledge-to-action cycle, a KT Casebook aimed at HCPs integrated findings from a comprehensive scoping review with experiential and contextual evidence gathered through stakeholder workshops to provide guidance to HCPs communicating with children and families around weight-related issues. It was structured around five questions: (a) Who should participate in weight-related discussions? (b) When and how should the topic of weight be broached? (c) What terminology should be used? (d) How can HCPs enhance family engagement in weight-related discussions? (e) What specific communication techniques have been recommended? Checklists, evidence summaries, case studies, sentence starters, simulations, and other resources were clustered under each question. A dissemination strategy was developed using KT best practices and a pilot evaluation protocol designed. The Casebook was launched in November 2017 and has been presented at pediatric rehabilitation and obesity conferences. A communication strategy targeted multidisciplinary experts and organizations with weight management within their scope of practice. These efforts have resulted in 2,497 downloads across five countries to date. A practical and engaging KT Casebook was created to help foster positive weight-related conversations between HCPs, children, and their families. A pilot implementation study examining the impact of the Casebook on clinical practice will provide critical information for embedding the Casebook in a range of health care settings.