Attitudes to obesity : health professionals' views and practice

Abstract

The purpose of this thesis was to study health professionals' views and practice in relation to overweight and obesity. In particular, the aims were: to explore the key cognitions of health professionals, with a view to describing their obesity stereotype and related attitudes; to explore the same cognitions among dieters; to compare and contrast the views of health professionals and dieters; to explore the relationship between health professionals' cognitions and practices; and to investigate the way in which health professionals' practice may be improved. Four studies were undertaken. The first was a survey of health professionals' views of overweight and obese people, compared to their views of smokers. In an independent, factorial design, participants responded to questions about moderately or extremely overweight people, or moderate or heavy smokers. Two hundred and fifty-five health professionals took part. Health professionals' beliefs and attitudes were mixed, but of the four groups, attitudes towards obese people were most negative. The obesity stereotype appeared to be differentiated from the overweight stereotype by perceptions of reduced self-esteem, sexual attractiveness and health. The second study examined dieters' cognitions of overweight and obesity. In another independent, factorial design, dieters' views about moderately or extremely overweight people were examined as a function of their own body weight (normal weight, moderately and extremely overweight). Two hundred and three people participated. The findings showed that dieters of different body weights had the same kinds of cognitions about both overweight and obese people. The key cognitions underpinning the overweight stereotype among dieters were that mood-related factors were viewed as important in causing overweight, and that overweight people were seen as ordinary people, but with reduced self-esteem, sexual attractiveness and health. A direct comparison of health professionals' and dieters' responses was undertaken using data from Studies 1 and 2. There were many similarities in the perceptions of the two groups, but dieters tended to have slightly more traditional views of the causes of overweight (mood, lack of willpower) and the responsibilities of overweight people. The pattern of attitudes for both groups was mixed, but health professionals' responses were more likely than dieters' to be influenced by the level of severity of the weight problem. The third study explored the relationship between cognitions and practices among 187 dietitians. Respondents' views of overweight were similar to those of the health professionals in the first study. In addition, belief that a lack of willpower was important in causing obesity (but not general attitudes or beliefs about responsibility) was associated with a number of reported practice choices. The final study investigated strategies for improving health professionals' management of obesity and the delivery of health care for overweight and obese people, through a systematic review of the evidence. Twelve studies were included, but due to the limited quality of many of the studies, there is currently very little information on how obesity practice may be improved and whether this will result in improved outcomes for patients. Overall, the findings indicate that cognitions about overweight and obese people were mixed. Although some negative perceptions may exist among health professionals, these may be less negative than previously documented. Significant level effects among health professionals suggest that where they exist, they are more likely to be directed at obese people than moderately overweight people. As obese people are at a greater health risk, the implications for improving practice need to be explored in detail. The findings of the systematic review suggest that where practice does need to be improved, currently very little is known about what strategies may be effective