Academic journal article The Qualitative Report

Stigmatization of Overweight Patients by Nurses

Academic journal article The Qualitative Report

Stigmatization of Overweight Patients by Nurses

Article excerpt

According to the Centers for Disease Control and Prevention (CDC, 2009a), a person with a Body Mass Index (BMI) of 30 or greater is defined as obese. The number of persons in the United States who meet this definition of obesity has been dramatically increasing over the past 20 years. In 2008, only one state, Colorado, had an obesity prevalence rate of less than 20%. Six states, including Alabama, Mississippi, Oklahoma, South Carolina, Tennessee, and West Virginia, had obesity prevalence rates of 30% or higher (CDC, 2009b).

As the number of obese persons has risen in the United States, so have reports of discrimination against those who suffer from obesity. Puhl, Andreyeva, and Brownell (2008) found that 40% of a nationally representative sample of adults in the United States who had a BMI of 35 and above reported having experienced some type of weight-height discrimination. The data showed an overall increase in experiences of weight-height discrimination among all adults, regardless of BMI, when compared to findings from a similar research study conducted in 1995-1996. In the earlier study, ten percent of adults surveyed reported having experienced some type of weight-height discrimination. In the more recent study, 12% of adults reported having experienced such discrimination. The findings of weight-height discrimination were similar for rates of discrimination based on race. Researchers have also reported that discrimination of obese persons occurs in a variety of environments, including work, school, and health care settings (Brownell & Puhl, 2003).

There is a growing body of research to support the view that health care providers are biased in their approach to caring for obese persons. Brown (2006) in a study of nurses, found a significant bias towards obese patients. The researcher suggested that the nurses' attitudes reflected the stereotypes within our Western culture, such as an obese person is lazy, unattractive, lacks self control, and lacks motivation. The focus of this research study was to uncover the lived experience of stigmatization by nurses as perceived by obese persons.

Purpose of the Study

Nurses are often the frontline health care providers for obese persons, and the care provided by nurses may influence the attitudes of obese persons toward health care providers in general and their health care seeking or health care avoidance behaviors. The focus of this research study was the exploration of the phenomenon of stigmatization of obese persons by nurses. A better understanding of the meaning of stigmatization by nurses as perceived by obese persons may contribute to the development of nursing practices and health care environments to better meet the needs of obese persons, improve access to health care for all persons regardless of body size, and achieve more positive health outcomes.

Review of the Literature

Obesity and Stigma

Puhl and Brownell (2003) reported that the stigma of obesity has been well documented. Areas of living where stigma related to obesity are commonly seen include education, employment, and health care. In an effort to explain the origins of obesity stigmatization, Puhl and Brownell examined two possible theoretical approaches: attribution theory and social consensus theory. These authors offered the following description of attribution theory, using a psychological framework as a basis for the development of stigmatization of obese persons:

   Attribution theory suggests that people attempt to search for
   information that determines the cause of uncertain outcomes. When
   approaching a person with a stigmatized condition like obesity,
   people search for the cause and in turn form their reaction to the
   obese person. Stigmas therefore are representations of society's
   negative perceptions about particular groups. This knowledge is
   used to categorize information about social groups and to form
   impressions and expectations of individuals. … 
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