'Beyond the Scale': A Qualitative Exploration of the Impact of Weight Stigma Experienced by Patients With Obesity in General Practice.

OBJECTIVE: Obesity is a complex, chronic, relapsing disease that requires an individualised approach to treatment. However, weight stigma (WS) experienced in healthcare settings poses a significant barrier to achieving person-centred care for obesity. Understanding the experiences of people living with obesity (PwO) can inform interventions to reduce WS and optimise patient outcomes. This study explores how patients with obesity perceive WS in general practice settings; its impact on their psychological well-being and health behaviours, and the patients suggestions for mitigating it. METHODS: In-depth semistructured interviews were conducted with 11 PwO who had experienced WS in general practice settings in Ireland. The interviews were conducted online via Zoom between May and August 2023; interviews lasted between 31 and 63 min (M = 34.36 min). Interviews were audio-recorded, transcribed verbatim and analysed using inductive reflexive thematic analysis. RESULTS: Three overarching themes specific to participants' experience of WS in general practice were generated: (1) shame, blame and 'failure'; (2) eat less, move more-the go-to treatment; (3) worthiness tied to compliance. A fourth theme: (4) the desire for a considered approach, outlines the participants' suggestions for reducing WS by improving the quality of patient-provider interactions in general practice. CONCLUSION: The findings call for a paradigm shift in the management of obesity in general practice: emphasising training for GPs in weight-sensitive communication and promoting respectful, collaborative, and individualised care to reduce WS and improve outcomes for people with obesity. PATIENT OR PUBLIC CONTRIBUTION: PPI collaborators played an active and equal role in shaping the research, contributing to the development of the research questions, refining the interview schedule, identifying key themes in the data, and granting final approval to the submitted and published version of the study.

Factors that influence general practitioners' obesity-related clinical practices and determinants of behavior to target to promote best practice in obesity care: A qualitative exploration.

Introduction: General practitioners (GPs) have been identified as pivotal in the identification and initiation of treatment for obesity, yet effective obesity management remains challenging in general practice. Despite the growing prevalence of obesity and the central role of GPs, there is a dearth of research exploring their experiences and challenges in managing the disease. Objective: This study aimed to understand these challenges by exploring GPs' experiences and to identify factors influencing their obesity management practices to inform the development of targeted intervention strategies. Method: In-depth interviews were conducted with 10 GPs. Data were analyzed using abductive thematic analysis underpinned by the theoretical domains framework (TDF). Findings were mapped to the behavior change wheel (BCW) and the behavior change taxonomy to identify potential future intervention strategies. Findings: Participants described multiple barriers to effective obesity management, including knowledge gaps, lack of training, patient factors, and systemic challenges. Key themes identified were the need for increased support, improved patient engagement, and system-level changes. Conclusion: This study offers valuable insights into the challenges GPs encounter when managing obesity in general practice. Application of the TDF and BCW frameworks identified complex interactions between knowledge, beliefs, and environmental factors influencing GP behavior. These findings highlight key areas for targeted interventions to enhance obesity care and drive best practice.

Assessing the physiological effect of non-driving-related task performance and task modality in conditionally automated driving systems: A systematic review and meta-analysis.

In conditionally automated driving, the driver is free to disengage from controlling the vehicle, but they are expected to resume driving in response to certain situations or events that the system is not equipped to respond to. As the level of vehicle automation increases, drivers often engage in non-driving-related tasks (NDRTs), defined as any secondary task unrelated to the primary task of driving. This engagement can have a detrimental effect on the driver's situation awareness and attentional resources. NDRTs with resource demands that overlap with the driving task, such as visual or manual tasks, may be particularly deleterious. Therefore, monitoring the driver's state is an important safety feature for conditionally automated vehicles, and physiological measures constitute a promising means of doing this. The present systematic review and meta-analysis synthesises findings from 32 studies concerning the effect of NDRTs on drivers' physiological responses, in addition to the effect of NDRTs with a visual or a manual modality. Evidence was found that NDRT engagement led to higher physiological arousal, indicated by increased heart rate, electrodermal activity and a decrease in heart rate variability. There was mixed evidence for an effect of both visual and manual NDRT modalities on all physiological measures. Understanding the relationship between task performance and arousal during automated driving is of critical importance to the development of driver monitoring systems and improving the safety of this technology.

Assessing the physiological effect of non-driving-related task performance in conditionally automated driving systems: A systematic review and meta-analysis protocol.

Background: Level 3 automated driving systems involve the continuous performance of the driving task by artificial intelligence within set environmental conditions, such as a straight highway. The driver's role in Level 3 is to resume responsibility of the driving task in response to any departure from these conditions. As automation increases, a driver's attention may divert towards non-driving-related tasks (NDRTs), making transitions of control between the system and user more challenging. Safety features such as physiological monitoring thus become important with increasing vehicle automation. However, to date there has been no attempt to synthesise the evidence for the effect of NDRT engagement on drivers' physiological responses in Level 3 automation. Methods: A comprehensive search of the electronic databases MEDLINE, EMBASE, Web of Science, PsycINFO, and IEEE Explore will be conducted. Empirical studies assessing the effect of NDRT engagement on at least one physiological parameter during Level 3 automation, in comparison with a control group or baseline condition will be included. Screening will take place in two stages, and the process will be outlined within a PRISMA flow diagram. Relevant physiological data will be extracted from studies and analysed using a series of meta-analyses by outcome. A risk of bias assessment will also be completed on the sample. Conclusion: This review will be the first to appraise the evidence for the physiological effect of NDRT engagement during Level 3 automation, and will have implications for future empirical research and the development of driver state monitoring systems.

Weight stigma experienced by patients with obesity in healthcare settings: A qualitative evidence synthesis.

Weight stigma research is largely focused on quantifiable outcomes with inadequate representation of the perspectives of those that are affected by it. This study offers a comprehensive systematic review and synthesis of weight stigma experienced in healthcare settings, from the perspective of patients living with obesity. A total of 1340 studies was screened, of which 32 were included in the final synthesis. Thematic synthesis generated three overarching analytical themes: (1) verbal and non-verbal communication of stigma, (2) weight stigma impacts the provision of care, and (3) weight stigma and systemic barriers to healthcare. The first theme relates to the communication of weight stigma perceived by patients within patient-provider interactions. The second theme describes the patients' perceptions of how weight stigma impacts upon care provision. The third theme highlighted the perceived systemic barriers faced by patients when negotiating the healthcare system. Patient suggestions to reduce weight stigma in healthcare settings are also presented. Weight stigma experienced within interpersonal interactions migrates to the provision of care, mediates gaining equitable access to services, and perpetuates a poor systemic infrastructure to support the needs of patients with obesity. A non-collaborative approach to practice and treatment renders patients feeling they have no control over their own healthcare requirements.