The Stigma of Obesity: Examining the Relationship Between BMI and the Treatment of Pain in Surgery Patients

There is a growing epidemic of obesity in the United States and a corresponding increase in the number of morbidly obese patients receiving healthcare. Despite the increasing focus and research on obesity over the years, the prevalence of obesity in the United States has continued to worsen. A stigma against obesity exists in the general public including among healthcare professionals. Attitudes and bias of healthcare professionals against obesity can negatively affect judgment and choices related to the enactment of care, affecting both the quality of healthcare delivered and patient outcomes. Studies have shown that stigmatization against groups of patients such as minorities affects healthcare outcomes, however there is a paucity of research related to outcomes of stigmatization against obese individuals. The purpose of the study was to determine if there is a difference in quality of nursing care as measured by medicating for pain between obese and non-obese post-surgical patients. It was hypothesized that obese individuals will receive less pain medication than non-obese individuals. An underlying assumption based on the literature was that stigmatization of obesity by nurses would be reflected in reduced administration of post-surgical pain medication. The greater the stigma present, the less pain medication will be administered. This study used a retrospective chart review of the electronic medical record of three hospitals within a single healthcare system to compare non-bariatric post- surgical pain treatment among normal weight, over-weight, and obese adult patients as a measure of nurses’ stigma. The final data set contained a total of 1704 cases, with 21.4% (n=365) normal weight, 21.4% (n=365) overweight, 21.4% (n=365) obesity class I, 17.1% (n=291) obesity class II, and 18.7% (n=318) obesity class III individuals. BMI scores ranged from 18.5 to 185.9 (M = 33.1, SD = 11.1). Findings showed differences in total dose of day one post-surgical pain medication among the normal, overweight, obesity class I, II, and III patients. Obesity class III patients received less pain medication than the obesity class I and class II patients and significantly less than the overweight patients. Simple linear regression analyses were used to determine the relationship between BMI and pain medication administration on postoperative day one and day two. Hierarchical linear regression was used to determine the relationship between dose on day one and day two and BMI, while taking into account other variables associated with stigma. The relationship between dose of pain medications and BMI was significant and negatively related. For every 1% increase in BMI there was a .17% decrease in the total morphine equivalent dose of narcotic given on postoperative day one. When controlling for other factors related to stigma, there was a .25% decrease in dose for every 1% increase in BMI. Further research is needed to measure attitudes and biases of nurses along with their administration of pain medication to obese patients. Addressing nurses’ stigma of obesity is essential to improving the quality of care of obese patients