"Unfortunately, our healthcare systems tend to be more reactive than proactive, so they tend to treat things as they happen instead of thinking about how we could make things better sooner." - Ian Patton, PhD
Shireen: Ian Patton is a patient engagement specialist working with obesity Canada, a national health charity focused on research, education and advocacy and is a patient advocate and combines his academic training along with his personal lived experience to help influence change for individuals living with obesity. Hi, Dr. Patton, how are you?
Dr. Patton: I'm great. Thanks for having me.
Shireen: An absolute pleasure. So I want to dive in. And I want to start out by asking what led you to become an expert in weight bias in patient centered care?
Dr. Patton: Yeah, I guess my, my start began with my academic training. So I got interested in Kinesiology and the body and how the body moves and the science of, of activity. So I started my training in Kinesiology and kind of progressed that through into an interest into obesity research. So I went on and continued on to a PhD in, in obesity research. And from there got involved in a number of organizations, obesity, Canada was one of them at the time. We were under a different name. So it was called the Canadian obesity network at the time. And I started volunteering and participating in some of their activities. That way, as a, as a trainee, all the while, I was also living with severe obesity myself. So I had both the academic training and the lived experience that got me really interested in this field. And as I went through my treatment for my own obesity, we had bariatric surgery in 2014, I realized that there is a need for this patient centered care and the involvement of the patient voice in all the things that we were trying to do with obesity, Canada. So there was a big shift in our organization around that time. And I was part of that, and I've kind of continued on. So hopefully elevating the voice of individuals living with obesity and, and trying to empower them to seek out and access the care that they need.
Shireen: Now, why does this weight bias exist in health care? And can you give us an example to just help us understand what that looks like?
Dr. Patton: Yeah, weight bias is something that's pretty prevalent throughout all of our society, but it's especially evident when we look at health care itself. Doctors and, and health care professionals, oftentimes aren't actually trained a whole lot in obesity management, specifically, they're experts in you know, health and well being but obesity is one of these things that they're just not trained in, generally. So there's a lack of understanding about what's available, what's evidence based in terms of treatment and management of obesity, and, and even just the lack of understanding of obesity as a chronic disease in and of itself. So it creates this kind of environment where there's a lot of shame and blame placed on the individual for something that is not entirely under their control, we generally think about obesity as a simple equation of eat less move more calories in calories out. And it's just not that simple. There's biological and physiological factors, there's genetic factors that influence it. And there's environmental and psychological factors. And a lot of these things are outside of the individual's control. And so we're oversimplifying a very complex problem. And I think that's kind of the basis of weight bias in healthcare. And to give you an example of what that looks like, it's, there's lots of instances where people are just not treated fairly, or they're treated differently because of their size and their weight and their end, obesity. There's one example here in Canada, that inspires me. And there's this woman who was living with obesity, and she had been complaining about her health to her doctor, she was trying to get care for some issues that she was having. And her concerns were brushed off simply is if you lost weight, you'd be fine. And you'll feel better. And there is no investigation into what was actually causing her her issues and the pain and the stuff that she was experiencing. And this went on for a couple years. And it ended up being that she had a tumor growing inside of her. And she ended up passing. So by the time they figured out what it was it was too late, and she just wasn't treated fairly by our healthcare system. And she actually made some noise about it because in her obituary, she wrote an article about it in her obituary and kind of called out the weight bias in the health care system. And so this is one of these instances that got a lot of attention. I guess. And so a lot of people started talking about it. But it certainly isn't the only case of weight bias. This stuff happens all the time to us when we're accessing the healthcare system. And it's something that inspires me to hopefully make change.
Shireen: What a story and it, I think it makes you sort of think about how many instances of this is happening around us. Where, when we're not aware. And that just when you talked about that blame and shame, that really manifested to say, Okay, well, the provider doesn't have any of this is all on me. Right? And so that shift, and now you're sort of stuck in the cycle of shame and blame, because that's it, we'll just continue doing that. Yeah. What are, as you mentioned that the consequence of this late bias in healthcare, can you speak to specifically for those people with chronic diseases, specifically for diabetes or heart disease?
Dr. Patton: Yeah, its weight bias kind of shows itself in a couple different ways. It manifests in three different ways. There's the explicit way bias, there's the implicit way bias, and then the internal way bias, and all three of them have their own consequences and impact on individuals with chronic disease. And so the implicit weight bias is the stuff like the doctors having internalized beliefs themselves about their patients who are living with obesity, and, you know, thinking that they're lazy or non compliant and not wanting to or having less expectations of them. So that belief impacts how they go into that room with that patient and treat them and so they get less quality of care, and less time with the doctor. And you know, there are other concerns are kind of brushed off and, and not taken seriously. And society impacts their overall care. Their explicit way, bias is the more kind of overt and in your face type of weight bias. So the shaming and blaming and the nasty stories that we hear from patients and their interactions with health care providers. And a lot of times that is going to make an individual avoid healthcare altogether. So you can imagine someone with diabetes or heart condition or any other chronic disease that is not comfortable and not wanting to go into the doctor's office, those conditions along with their obesity are going to progress and get worse before they actually get the treatment that they need. So that's a big problem. And then finally, that internalized weight bias is the bias that we hold on ourselves and our beliefs about ourselves. And so I can tell you, like myself, this is something where we think that this is a condition or a problem that we should be able to manage on our own. And we aren't worthy of care and help and those sorts of things. And so again, we avoid healthcare, we don't ask for help, we bottle it up and keep it quiet. And, again, that just adds to the progression of all of our disease states. And, and let it get farther along than it needs, needs to be.
Shireen: We understand that it's an especially focused on diabetes, just because that's the work that we do. But we see sort of obesity SS risk factor that progresses along into many other diseases, including diabetes. And they wonder there then from what you were mentioning, if there's a point of intervention from a pre-diabetes from sort of this upstream into obesity that can prevent it, if we can provide better quality of care, we can essentially prevent more of the downstream heart disease and diabetes as a result.
Dr. Patton: Yeah, absolutely. And it's something that I've heard it talked about before, as obesity treatment is actually diabetes prevention. And so some people can look at it that way. And it makes sense, you know, if we can manage and treat obesity earlier on and prevent the progression of obesity early on, that's going to have a big impact on the progression and of other chronic diseases like diabetes and heart disease and those sorts of things. So there's, like he said that downstream approaches could be very beneficial. Unfortunately, our healthcare systems tend to be more reactive than proactive, so they tend to treat things as they happen instead of thinking about how we could make things better sooner.
Shireen: Can you speak to emerging research concerning the emphasis and importance of health behaviors in comparison to a solely weight focused approach?
Dr. Patton: Yeah, that's a, that's a great question. And I think what we need to do is kind of reframe what we, how we think about healthy behaviors. And so when we're talking about obesity, we look at these healthy behaviors so you're eating well your exercise and activity, sleep hygiene and those sorts of things. They tend to be looked at as the treatment, this is how we're going to fix this problem. And it's the treatment for, for this condition. And that's what it is. And it's not quite right. There are new clinical practice guidelines that were published last year actually reframe how it's looked at. And so those healthful behaviors are things that everyone should do everyone on the planet, regardless of your size, weight, disease status, should be eating healthier, should be moving more and should be, you know, doing those healthful behaviors better, and it can be beneficial for population health. But it's not the only way or it shouldn't be the only approach to management of a chronic disease. So when it comes to obesity, the clinical practice guidelines kind of frame those healthful behaviors as kind of a mental that everyone should be trying to achieve. They should be doing those healthful behaviors, the treatments that the evidence supports, are the pillars that are going to hold up that mantle. So for obesity management, it's psychological intervention. So cognitive behavioral therapy and looking at the root causes of obesity. for that individual, it could be pharmacological therapy. So medications that help support that individual to be able to maintain healthful behaviors. And the other option is bariatric surgery, which is one of the treatment options available to individuals living with BC. So those three pillars when used and not all of those are going to be the right choice for each individual, everyone's going to be different, there might be a combination of therapies that those three pillars support that individual being able to maintain that healthful behaviors that we want everyone to do. So that healthy eating and the activity. Without those we haven't had success with those behaviors being the treatment options for people living with obesity is just it hasn't been an effective treatment for obesity in and of itself.
Shireen: And what role does this research play in patient centered care for those with chronic illnesses?
Dr. Patton: I think it's important, the role that it plays is changing the narrative, I think of obesity and our understanding of weight and obesity so that people can start to manage their chronic diseases a little bit more effectively. So if we if we can get the information out there and change the conversation surrounding obesity through this research, the knowledge translation that comes with this research, I think it helps individuals living with disease, the chronic diseases, kind of have a better understanding of their conditions, take more control of their conditions have more of a collaborative approach in the the care process with their health providers. So just be more informed and, and having a bit more input there is going to make those interventions stick a little bit better.
Shireen: Flipping to the healthcare provider, how can a health care provider reflect this in their practice?
Dr. Patton: Yeah, I think that's a good question. And something complete, definitely are trying to do up here with obesity Canada is trying to train more health professionals and improve their understanding of obesity and these chronic diseases. I think the best way they can reflect it is how they treat their patients that are living with obesity. So making a more collaborative approach, making their environment that they're bringing patients into a little bit more accessible and comfortable. Like maybe thinking about the needs of people living with obesity, you can imagine there's a lot of environments, especially in healthcare settings, where it's just not accessible for larger bodies, everything from the chairs and the waiting room to the placement of the scales or you know, the rooms that we're going into, and just not being overly accessible for individuals living with obesity. And that in of itself is a barrier that stops everything dead right at the stop or at the start story. Whereas if healthcare professionals are, you know, understanding this research and staying up to date on it, maybe the first thing they do is make that environment a little bit more accessible, and it opens up the conversation. It allows that collaborative approach with the patient, and it's going to make a big difference in reducing that weight bias.
Shireen: Now, can you tell us about your work with the development of patient centered obesity clinical practice guidelines? I'd love to learn a little bit more about that, how you went about creating that? And also what does that look like on the other side? And how are you sort of imparting that to the community?
Dr. Patton: Yeah. Last year, in the summer, we published our new clinical practice guidelines for the treat of obesity, which was the result of about three years of work is a massive project, we've reviewed over 500,000 journal articles, and they serve as kind of a framework or guideline for healthcare practitioners on what are the evidence based best practices for obesity treatment. So that's what we set out to do. The, what made these guidelines a little bit different and got a lot of attention was that we used a patient centered approach. So they included the input of individuals living with obesity, through all the aspects of the development of the guidelines, I was one of the members that was involved in, the in the committee that oversaw it and the steering committee for this. And so it's just making sure that those voices, their input, and the patient journey was kind of the central focus for the recommendations that were coming out of the guidelines. And so we asked all the authors to think about the patient perspective. And, and it was the first guidelines that we're aware of that have done that for obesity. And it also placed a heavy focus on weight bias and weight stigma, which, again, obesity guidelines have never done, we, we recognize that we can give all these recommendations with the, about the treatments and what's available. But unless we address the actual weight bias and stigma that is the barrier, we're not going to get anywhere with making any change. So that was a central focus for what we were doing.
Shireen: How do we and just switching back to the, to the healthcare side, how do we all as a healthcare community really begin to shift that conversation? From a weight focus to a health promotion focus?
Dr. Patton: Yeah, another great question. And I think, I mean, it could be a long conversation, in and of itself. But I think the easiest way to think about it, and maybe the first step would be changing our language and how healthcare providers speak about obesity and seek about their patients. And so we talked about using patient first language, or person first language. So an individual isn't going to be defined by their disease, they're not their disease, they happen to have their disease. So me, I'm an individual that lives with obesity, I'm not an obese person, my obesity doesn't define me. And that little shift in the language, especially coming from healthcare providers, and using that person first language really opens up a more comfortable narrative about obesity, it makes it a little bit more engaging. And for us patients, it also makes us a little bit less defensive because it doesn't feel like we're being attacked and blamed for conditions. So it's a good first step, I would say.
Shireen: Well, with that Dr. Patton, we're towards the end of the episode. How can our listeners really connect with you and learn more about your work?
Dr. Patton: Yeah, they, we can always be found at obesity canada.ca. That's our website. We're also on most of the social media platforms. And for individuals who are living with obesity, there is a closed community that we have called OC Connect, which can also be found through our website, but it's a place for peer support, education and empowerment. So there's lots of ways to connect with us.
Shireen: Lovely, lovely. So with that, I thank you so very much for coming on these, on this episode. And joining us today was an eye opener and I think great food for thought for us to take into our everyday lives and be conscious about thank you for your time.
Dr. Patton: Thank you for having me.
Shireen: So to our listeners, thank you for joining us on another episode. We'd love to ask you and learn from you if you have experienced weight bias, either in healthcare or even in your everyday life. To answer this, join us on our social media on our Instagram and Facebook. We'll see you there.