Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Obesity. Show all posts
Showing posts with label Obesity. Show all posts

Monday, August 17, 2020

It’s in Your Control: Free Will Beliefs and Attribution of Blame to Obese People and People with Mental Illness

Chandrashekar, S. P. (2020).
Collabra: Psychology, 6(1), 29.
DOI: http://doi.org/10.1525/collabra.305

Abstract

People’s belief in free will is shown to influence the perception of personal control in self and others. The current study tested the hypothesis that individuals who believe in free will attribute stronger personal blame to obese people and to people with mental illness (schizophrenia) for their adverse health outcomes. Results from a sample of 1110 participants showed that the belief in free will subscale is positively correlated with perceptions of the controllability of these adverse health conditions. The findings suggest that free will beliefs are correlated with attribution of blame to people with obesity and mental health issues. The study contributes to the understanding of the possible negative implications of people’s free will beliefs.

Discussion

The purpose of this brief report was to test the hypothesis that belief in free will is strongly correlated with attribution of personal blame to obese people and to people with mental illness for their adverse health outcomes. The results showed consistent positive correlations between the free will subscale and the extent of blame to obese individuals and individuals with mental illness. The study employed both generic survey measures of internal blame attributions and a survey that measured the responses based on a person described in a vignette. The current study, although correlational, contributes to recent work that argues that belief in free will is linked to processes underlying human social perception (Genschow et al., 2017). Besides theoretical implications, the findings demonstrate the societal consequences of free-will beliefs. Perception of controllability and personal responsibility is a well-documented predictor of negative stereotypes and stigma associated with people with mental illness and obesity (Blaine & Williams, 2004; Crandall, 1994). Perceptions of controllability related to people with health issues have detrimental social outcomes such as social rejection of the affected individuals (Crandall & Moriarty, 1995), and reduced social support and help from others (Crandall, 1994). The current study underlines that belief in free will as an individual-level factor is particularly relevant for developing a broader understanding of predictors of stigmatization of those with mental illness and obesity.

Monday, August 5, 2019

Ethical considerations in assessment and behavioral treatment of obesity: Issues and practice implications for clinical health psychologists

Williamson, T. M., Rash, J. A., Campbell, T. S., & Mothersill, K. (2019).
Professional Psychology: Research and Practice. Advance online publication.
http://dx.doi.org/10.1037/pro0000249

Abstract

The obesity epidemic in the United States and Canada has been accompanied by an increased demand on behavioral health specialists to provide comprehensive behavior therapy for weight loss (BTWL) to individuals with obesity. Clinical health psychologists are optimally positioned to deliver BTWL because of their advanced competencies in multimodal assessment, training in evidence-based methods of behavior change, and proficiencies in interdisciplinary collaboration. Although published guidelines provide recommendations for optimal design and delivery of BTWL (e.g., behavior modification, cognitive restructuring, and mindfulness practice; group-based vs. individual therapy), guidelines on ethical issues that may arise during assessment and treatment remain conspicuously absent. This article reviews clinical practice guidelines, ethical codes (i.e., the Canadian Code of Ethics for Psychologists and the American Psychological Association Ethical Principles of Psychologists), and the extant literature to highlight obesity-specific ethical considerations for psychologists who provide assessment and BTWL in health care settings. Five key themes emerge from the literature: (a) informed consent (instilling realistic treatment expectations; reasonable alternatives to BTWL; privacy and confidentiality); (b) assessment (using a biopsychosocial approach; selecting psychological tests); (c) competence and scope of practice (self-assessment; collaborative care); (d) recognition of personal bias and discrimination (self-examination, diversity); and (e) maximizing treatment benefit while minimizing harm. Practical recommendations grounded in the American Psychological Association’s competency training model for clinical health psychologists are discussed to assist practitioners in addressing and mitigating ethical issues in practice.

Monday, June 27, 2016

In treating obese patients, too often doctors can’t see past weight

By Jennifer Adaeze Okwerkwu @JenniferAdaeze
STAT
Originally published June 3, 2016

Here is an excerpt:

An earlier survey of primary care physicians and cardiologists showed a similar pattern. Though heart disease is the leading cause of death among women, the study found only 39 percent of physicians were “extremely concerned” about this issue, whereas 48 percent of physicians were “extremely concerned” about women’s weight.

“We haven’t really thought about this before” but we need to explore the issue “because women are dying,” said study leader Dr. Noel Bairey Merz, medical director of the Barbra Streisand Women’s Heart Center at Cedars-Sinai Heart Institute.

It’s not just heart disease. Another study has found that other types of preventative care, including breast exams and pap smears, are often delayed by obese women. While obesity is associated with a variety of health conditions, if the medical profession fails to provide a safe space for patient care, these missed opportunities for intervention may be partly to blame.

The article is here.

Thursday, July 30, 2015

If obesity is a moral failing, then our morals have failed.

By Anke Snoek
Aeon Magazine - Ideas
Originally published July 6, 2015

Here is an excerpt:

But there’s another reason to be cautious about calling obesity a moral failing. The lay vision is that obese people act on their desires rather than on their better judgment, but recent research of Nora Volkow shows some striking parallels between addiction and obesity. Evolutionarily, we are wired to find certain foods and activities – the ones that contribute more to our survival – more attractive than others. That’s why when we engage in positive social relationships, sex, or eat food with high fat, sugar or salt content, dopamine is released in the brain. Dopamine is often associated with pleasure. We get a pleasurable feeling when we eat good food, but dopamine also contributes to conditioned learning and so-called incentive sensitization. That is, we become sensitive to cues linked to rewarding behaviour or food which was important but scarce in the distant past.  In prehistoric times we learned which cues predict, for instance, where the best fruit trees grow.

The entire article is here.

Monday, May 19, 2014

Very overweight teens face stigma, discrimination, and isolation

From a synopsis in the British Medical Journal

Here is an excerpt of the synopsis of the article:

In general, young people thought that individuals were responsible for their own body size. They associated excess weight with negative stereotypes of laziness, greed, and a lack of control. And they felt that being overweight made an individual less attractive and opened them up to bullying and teasing.

Young people who were already overweight tended to blame themselves for their size. And those who were classified as very overweight said they had been bullied and physically and verbally assaulted, particularly at school. They endured beatings, kickings, name-calling, deliberate and prolonged isolation by peers, and sniggering/whispering.

Some young people described coping strategies, such as seeking out support from others. But the experiences of being overweight included feeling excluded, ashamed, marked out as different, isolated, ridiculed and ritually humiliated. Everyday activities, such as shopping and socialising, were difficult.

The entire synopsis is here.

A link to the study is here.

Wednesday, March 26, 2014

The Fat Drug

By Pagan Kennedy
The New York Times
Originally published March 8, 2014

Here is an excerpt:

Nonetheless, experiments were then being conducted on humans. In the 1950s, a team of scientists fed a steady diet of antibiotics to schoolchildren in Guatemala for more than a year,while Charles H. Carter, a doctor in Florida, tried a similar regimen on mentally disabled kids. Could the children, like the farm animals, grow larger? Yes, they could.

Mr. Jukes summarized Dr. Carter’s research in a monograph on nutrition and antibiotics: “Carter carried out a prolonged investigation of a study of the effects of administering 75 mg of chlortetracycline” — the chemical name for Aureomycin — “twice daily to mentally defective children for periods of up to three years at the Florida Farm Colony. The children were mentally deficient spastic cases and were almost entirely helpless,” he wrote. “The average yearly gain in weight for the supplemented group was 6.5 lb while the control group averaged 1.9 lb in yearly weight gain.”

The entire article is here.

Tuesday, October 29, 2013

Preventing Weight Bias: A Toolkit for Professionals in Clinical Practice

Yale Rudd Center
Resource for Clinicians

Weight bias jeopardizes patients' emotional and physical health. As the majority of Americans are now overweight or obese, this is an important clinical concern, one that no provider can afford to ignore.

This toolkit is designed to help clinicians across a variety of practice settings with easy-to-implement solutions and resources to improve delivery of care for overweight and obese patients. The resources are designed for busy professionals and customized for various practice settings. They range from simple strategies to improve provider-patient communication and ways to make positive changes in the office environment , to profound ones, including self-examination of personal biases.

The entire 8 Module Toolkit is here.

Monday, September 16, 2013

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it.

By Sheryl Cash
amdnews.com
Originally posted August 26, 2013

The University of Pennsylvania Health System and its affiliates recently joined Cleveland Clinic and other hospitals in banning the employment of smokers. Proponents say such policies lower health care costs and improve employee and community health. Others believe these restrictions may be the beginning of a slippery ethical slope in which employees can be fired or banned for personal decisions and activities unrelated to their specific jobs.

The question is: Will and can private physician practices soon follow suit, banning or disciplining employees not only for smoking but also for other outside activities deemed detrimental to the image of the group? What about obesity, social media presence, hobbies and other after-work activities? Are there legitimate situations where the needs and mission of the practice, and the protection of its patients, outweigh the individual rights of the employee and potential employee? In general, are these types of bans legal and ethical?

The entire story is here.

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity.

By Kevin B. O'Reilly
amdnews.com
Originally posted September 2, 2013

Here is an excerpt:

Because few physicians, medical students or others will admit openly to bias, researchers have developed a tool to plumb their unconscious attitudes. The Weight Implicit Association Test asks participants to pair images of “thin” or “fat” people with negative or positive words. The faster the test-taker links the type of person to a negative attribute, the stronger the unconscious negative attitude. The validated survey tool has been used to measure implicit biases related to race, age, gender, sexuality and other areas.

The vast majority of the people who take the Web-based test exhibit a strong preference for thin people and associate the fat people with negative words, and nearly 2,300 physicians scored about the same as the general populace, said a study published Nov. 7, 2012, in PLoS One. A survey of 620 U.S. doctors found that more than half viewed obese patients as “awkward, unattractive, ugly and noncompliant with therapy,” said a study published October 2003 in Obesity Research.

The entire article is here.

Sunday, July 28, 2013

Peter Attia: What if we're wrong about diabetes?

As a young ER doctor, Peter Attia felt contempt for a patient with diabetes. She was overweight, he thought, and thus responsible for the fact that she needed a foot amputation. But years later, Attia received an unpleasant medical surprise that led him to wonder: is our understanding of diabetes right? Could the precursors to diabetes cause obesity, and not the other way around? A look at how assumptions may be leading us to wage the wrong medical war.




Saturday, May 11, 2013

Physicians build less rapport with obese patients

By K.A. Gudzune, M.C. Beach, D.L. Roter, & L.A. Cooper
Obesity (Silver Spring). 2013 Mar 20. doi: 10.1002/oby.20384.

Abstract

Objective: 
Physicians' negative attitudes towards patients with obesity are well documented. Whether or how these beliefs may affect patient-physician communication is unknown. We aimed to describe the relationship between patient BMI and physician communication behaviors (biomedical, psychosocial/lifestyle, and rapport building) during typical outpatient primary care visits.

Design and Methods: 
Using audio-recorded outpatient encounters from 39 urban PCPs and 208 of their patients, we examined the frequency of communication behaviors using the Roter Interaction Analysis System. The independent variable was measured patient BMI and dependent variables were communication behaviors by the PCP within the biomedical, psychosocial/lifestyle, and rapport building domains. We performed a cross-sectional analysis using multilevel Poisson regression models to evaluate the association between BMI and physician communication.

Results: 
PCPs demonstrated less emotional rapport with overweight and obese patients (IRR 0.65, 95%CI 0.48-0.88, p=0.01; IRR 0.69, 95%CI 0.58-0.82, p<0.01, respectively) than for normal weight patients. We found no differences in PCPs' biomedical or psychosocial/lifestyle communication by patient BMI.

Conclusions:
Our findings raise the concern that low levels of emotional rapport in primary care visits with overweight and obese patients may weaken the patient-physician relationship, diminish patients' adherence to recommendations, and decrease the effectiveness of behavior change counseling.

And, click here for a blog post on this article, with the excerpt below:

Are Doctors Nicer to Thinner Patients?

By TARA PARKER-POPE
The New York Times - Well Column
Originally published April 29, 2013

Here is an excerpt:

“When there is increased empathy by the doctor, patients are more likely to report they are satisfied with their care, and they are more likely to adhere to recommendations of physicians,” Dr. Gudzune said. “There is evidence to show that after visits with more empathy, patients have improved clinical outcomes, so patients with diabetes have better blood sugar control or cholesterol is better controlled.”

Dr. David L. Katz, director of the Yale-Griffin University Prevention Research Center, says that overweight patients often complain to him that doctors appear judgmental about their weight, at the expense of other health concerns.

“You come in with a headache, and the doctors say, ‘You really need to lose weight.’ You have a sore throat, and the doctor says, ‘You really need to lose weight,’ ” he said. “These patients feel like the doctor doesn’t help them and they insult them, and so they stop going.”

In dealing with patients who are overweight, Dr. Katz added, doctors often show the same biases and prejudices as the culture at large. The problem may be compounded by the fact that doctors are trained to deal with immediate medical problems that have specific solutions, like a pill to lower blood pressure or emergency treatment for a heart attack. But obesity is a far more complex problem that isn’t easy to solve, and that can be frustrating to doctors.

“When we can’t fix what is broken we tend to behave badly,” he said.


Friday, September 28, 2012

Unchecked Obesity Rates Could Bankrupt Nation

By Merrill Goozner
The Fiscal Times
Originally published September 19, 2012

Obesity rates have doubled over the past two decades and will almost double again over the next two decades unless the public comes to grips with its swelling waistlines, a new study says.

The rising tide of obesity threatens to send health care costs soaring. Already, the nation spends an estimated $147 billion to $210 billion per year on obesity-related diseases including Type 2 diabetes, hypertension, heart disease, and arthritis. Unless the projections are altered dramatically, additional medical costs associated with treating preventable, obesity-related diseases could swell by another $48 billion to $66 billion by 2030, the report said.

“We have this middle-aged cohort who are obese today and in the next 10 to 20 years will become quite costly,” said Jeffrey Levi, executive director of Trust for America’s Health, which co-authored the report with the Robert Wood Johnson Foundation. “They’re the really tough nuts to crack when it comes to combating obesity.”

The entire story is here.

Government Can Play Important Role in Obesity Epidemic, Expert Argues

ScienceDaily
Originally published September 18, 2012

Addressing the obesity epidemic by preventing excess calorie consumption with government regulation of portion sizes is justifiable and could be an effective measure to help prevent obesity-related health problems and deaths, according to a Viewpoint in the September 19 issue of JAMA, and theme issue on obesity.

Thomas A. Farley, M.D., M.P.H., Commissioner of the New York City Department of Health and Mental Hygiene, presented the article at a JAMA media briefing.

"Americans consume many more calories than needed, and the excess is leading to diabetes, cardiovascular disease, and premature mortality. Since the 1970s, caloric intake has increased by some 200 to 600 calories per person per day. Although it is unclear how important changes in physical activity are to the surge in obesity prevalence, it is quite clear that this increase in calorie consumption is the major cause of the obesity epidemic—an epidemic that each year is responsible for the deaths of more than 100,000 Americans and accounts for nearly $150 billion in health care costs," writes Dr. Farley.

The entire story is here.

Saturday, June 23, 2012

Getting Fat and Fatter

By Kim McPherson
The Lancet
doi:10.1016/S0140-6736(12)60966-0

Book Review
Fat Fate and Disease: Why Exercise and Diet Are Not Enough
By Peter Gluckman and Mark Hanson
Oxford University Press

"We need a public debate about what it means to keep markets in their place. And to have this debate, we have to think through the moral limits of markets. We need to recognise that there are some things that money can't buy and other things that money can buy but shouldn't."

Michael Sandel, “Market and Morals”

We live in a world where it is increasingly apparent that markets have all sorts of unwanted consequences, but they remain the bedrock of our civilisation. That we should relentlessly pursue economic growth is unquestioned, while the planet is drying up and we are becoming increasingly obese. And by a dominant political account the way to grow is to liberate the markets wherever we can. Thus the planet nears extinction more quickly and the prevalence of type 2 diabetes increases alarmingly across the globe. So is some kind of consensual good will required, as Michael Sandel suggested in his 2009 Reith Lecture?

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We have yet to discover an acceptable way to make markets properly balance all the pay-offs caused by unhealthy production, one of which is to suffer loss at the point of production commensurate with the harm of causing bad health in the longer term. We are not even close. Good will and responsible citizenship are not, I suspect, going to solve this problem simply because profit and growth trump everything.

The entire review and commentary are here.

Saturday, November 5, 2011

Weight Loss Surgery Benefits Entire Family

By Anahad O'Connor
The New York Times - Health

Having gastric bypass surgery has a ripple effect that causes family members to lose weight, eat better and exercise more, a new study shows.

The research found that spouses, relatives and even the children of patients who underwent the procedure dropped significant amounts of weight, doubled their activity levels and had other improvements that were still evident a year after the surgery. The findings suggest that doctors who perform gastric bypass operations may want to look at the procedure as a way to bring about change in entire families in need of help with their weight and exercise habits, said Dr. John Morton, the director of bariatric surgery at the Stanford School of Medicine and an author of the study, which appeared in The Archives of Surgery.

“If you have a committed and involved family,” he said, “you’re going to have better outcomes for the patient, and also by the same token, the family members can have a collateral benefit.”

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“Obesity is a family disease,” he said, “and we do need to treat everyone involved and start thinking about bariatric surgery as a platform for change.”

The entire story can be read here.

Many Don't Believe Their Obesity is Unhealthy

By Jenifer Goodwin
Health Daily Reporter
MedicineNet.com

Many overweight and obese patients seen in hospital emergency departments don't believe their weight poses a risk to their health, and many say doctors have never told them otherwise, a new study finds.

Researchers asked 450 randomly selected patients who were seen in the emergency department at Shands at the University of Florida two questions: Do you believe your present weight is damaging to your health, and has a doctor or other health professional ever told you that you are overweight?

Of those who reported that their weight was unhealthy, only 19% said they'd ever discussed it with a health care provider. And only 30% of those who reported being told by their health care provider that their weight was unhealthy agreed with that opinion, according to the study.

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Ryan recommends that patients leave the ER with referrals to dieticians and other weight-loss specialists, and that primary care doctors make sure to take the time to broach the issue with patients.

Gans agreed. Though emergency room physicians are pressed for time, when patients are sick and worried about their health may be an opportune moment to encourage changes.

"Unfortunately nothing happens until a patient becomes fearful," Gans said. "I see that all too often. I'll ask them, 'Do you need to wait until you have diabetes until you start to lose weight? Do you need to suffer a heart attack? And some people will actually say 'Yes.'"

The whole story can be read here.