Obesity Surgery

, Volume 29, Issue 7, pp 2078–2086 | Cite as

Video Teaching Leads to Improved Attitudes Towards Obesity—a Randomized Study with 949 Participants

  • Felix NickelEmail author
  • Christian Tapking
  • Laura Benner
  • Svenja Schüler
  • Gregor B. Ottawa
  • Katja Krug
  • Beat P. Müller-Stich
  • Lars Fischer
Original Contributions



Obesity is a rising social and economic burden. Patients with obesity often suffer from stigmatization and discrimination. Underrecognition of obesity as a disease could be a contributing factor. The present study aimed to compare attitudes towards obesity with other chronic diseases and to evaluate the recognition of need of professional treatment.


Nine hundred and forty-nine participants (subgroups: general population, patients with obesity, nurses in training, nurses, medical students, physicians) were randomized to video teaching on obesity and control. Questionnaires on the burden and influence of obesity on daily life compared to other chronic diseases and the fat phobia scale (FPS) were answered.


Burden of obesity was rated low (4.2 ± 1.3; rank 9 of 11) compared to other diseases. Bowel cancer (5.5 ± 0.9) had the highest and caries the lowest (2.7 ± 1.4) estimated impact. Females (p = 0.011) and older people (p < 0.001) rated burden of obesity high whereas general population (p < 0.001) and control (p < 0.001) rated it low. Females (p = 0.001) and people with higher BMI (p = 0.004) rated the influence of obesity on daily life high; the general population (p < 0.001; reference physicians) and the control group (p < 0.001) rated it low. FPS was lowest in patients with obesity (3.2 ± 0.7) and highest in the general population (3.6 ± 0.4) and medical students (3.6 ± 0.5; p < 0.001; compared to physicians).


Obesity is underestimated as a disease compared to other chronic diseases and attitudes towards obesity are rather negative in comparison. Video teaching showed positive effects so a focus in medical education and public campaigns should aim to improve prevention and treatment of obesity.


Obesity Stigmatization Burden of disease Chronic diseases Discrimination Fat phobia scale 



We would like to thank the study program “Interprofessional Health Care” of the Academy of Health Professions at the University of Heidelberg for their support in designing and conducting the study. We furthermore thank Mr. Berend Schlüter of the Nursing School at the Hospital Mittelbaden for his support in conducting the study. We thank Danny Tran for proofreading of the manuscript.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in the present study.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethical approval was obtained from the local ethics committee (S-381/2016).


  1. 1.
    Hyde R. Europe battles with obesity. Lancet. 2008;371(9631):2160–1.CrossRefGoogle Scholar
  2. 2.
    Effertz T et al. The costs and consequences of obesity in Germany: a new approach from a prevalence and life-cycle perspective. Eur J Health Econ. 2015:1–18.Google Scholar
  3. 3.
    Stoner L, Cornwall J. Did the American Medical Association make the correct decision classifying obesity as a disease? Australas Med J. 2013;7(11):462–4.Google Scholar
  4. 4.
    Padwal RS et al. Using the Edmonton obesity staging system to predict mortality in a population-representative cohort of people with overweight and obesity. CMAJ. 2011;183(14):1059–66.CrossRefGoogle Scholar
  5. 5.
    Hubert HB, Feinleib M, McNamara PM, et al. Obesity as an independet risk facor for cardiovascular disease: a 26-year follow-up of participants in the Framingham heart study. Circulation. 1983;67(5):968–77.CrossRefGoogle Scholar
  6. 6.
    Berrington de Gonzalez A et al. Body-mass index and mortality among 1.46 million white adults. N Engl J Med. 2011;365(9):869.Google Scholar
  7. 7.
    Calle EE, Thun MJ, Petrelli JM, et al. Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med. 1999;341(15):1097–105.CrossRefGoogle Scholar
  8. 8.
    Puhl RM, Brwonell KD. Bias, discrimination, and obesity. Obes Res. 2001;9(12):788–805.CrossRefGoogle Scholar
  9. 9.
    Puhl RM, Heuer CA. Obesity stigma: important considerations for public health. Am J Public Health. 2010;100(6):1019–28.CrossRefGoogle Scholar
  10. 10.
    Bacardía Gascón M, Jiménez-Cruz A, Castillo-Ruiz O, et al. Fat phobia in mexican nutrition students. Nutr Hosp. 2015;32(6):2956–7.Google Scholar
  11. 11.
    Pantenburg B, Sikorski C, Luppa M, et al. Medical students' attitudes towards overweight and obesity. PLoS One. 2012;7(11):e48113.CrossRefGoogle Scholar
  12. 12.
    Caccamese SM, Kolodner K, Wright SM. Comparing patient and physician perception of weight status with body mass index. Am J Med. 2002;112(8):662–8.CrossRefGoogle Scholar
  13. 13.
    Hauner H, Köster I, von Ferber L. Frequency of 'obesity' in medical records and utilization of out-patient health care by 'obese' subjects in Germany. An analysis of health insurance data. Int J Obes Relat Metab Disord. 1996;20(9):820–4.Google Scholar
  14. 14.
    Sjöström L, Peltonen M, Jacobson P, et al. Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA. 2014;311(22):2297–304.CrossRefGoogle Scholar
  15. 15.
    Weiner R, el-Sayes I, Manger T, et al. Antidiabetic efficacy of obesity surgery in Germany: a quality assurance nationwide survey. Surg Obes Relat Dis. 2014;10(2):322–7.CrossRefGoogle Scholar
  16. 16.
    Nickel F et al. Bariatric surgery as an efficient treatment for non-alcoholic fatty liver disease in a prospective study with 1-year follow-up : BariScan study. Obes Surg. 2017;Google Scholar
  17. 17.
    Billeter AT, Senft J, Gotthardt D, et al. Combined non-alcoholic fatty liver disease and type 2 diabetes mellitus: sleeve gastrectomy or gastric bypass?-a controlled matched pair study of 34 patients. Obes Surg. 2016;26(8):1867–74.CrossRefGoogle Scholar
  18. 18.
    Sjöström L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93.CrossRefGoogle Scholar
  19. 19.
    Kalinowski P, Paluszkiewicz R, Ziarkiewicz-Wróblewska B, et al. Liver function in patients with nonalcoholic fatty liver disease randomized to roux-en-Y gastric bypass versus sleeve gastrectomy: a secondary analysis of a randomized clinical trial. Ann Surg. 2017;266(5):738–45.CrossRefGoogle Scholar
  20. 20.
    Müller-Stich BP, Fischer L, Kenngott HG, et al. Gastric bypass leads to improvement of diabetic neuropathy independent of glucose normalization--results of a prospective cohort study (DiaSurg 1 study). Ann Surg. 2013;258(5):760–5.CrossRefGoogle Scholar
  21. 21.
    Nickel F, Schmidt L, Bruckner T, et al. Gastrointestinal quality of life improves significantly after sleeve gastrectomy and roux-en-Y gastric bypass-a prospective cross-sectional study within a 2-year follow-up. Obes Surg. 2017;27(5):1292–7.CrossRefGoogle Scholar
  22. 22.
    Nickel F et al. Influence of bariatric surgery on quality of life,body image, and general self-efficacy within 6 and 24 months-a prospective cohort study. Surg Obes Relat Dis. 2017;12(2):313–9.CrossRefGoogle Scholar
  23. 23.
    Peterli R, Wölnerhanssen BK, Vetter D, et al. Laparoscopic sleeve gastrectomy versus roux-Y-gastric bypass for morbid Obesity-3-year outcomes of the prospective randomized Swiss multicenter bypass or sleeve study (SM-BOSS). Ann Surg. 2017;265(3):466–73.CrossRefGoogle Scholar
  24. 24.
    Nickel F et al. The way from cost approval to bariatric surgery : analysis of resource utilization in a maximum care hospital: Chirurg; 2017.Google Scholar
  25. 25.
    Bacon JG, Scheltema KE, Robinson BE. Fat phobia scale revisited: the short form. Int J Obes. 2001;25(2):252–7.CrossRefGoogle Scholar
  26. 26.
    Robinson BE, Bacon JG, O’Reilly J. Fat phobia: measuring, understanding and changing anti-fat attitudes. Int J Eating Dis. 1993;14(4):467–80.CrossRefGoogle Scholar
  27. 27.
    R Core Team. A language and environment for statistical computing, R.C. Team, Editor. Vienna: R Foundation for Statistical Computing; 2015.Google Scholar
  28. 28.
    Zhang Q, Wang Y. Socioeconomic inequality of obesity in the United States: do gender, age, and ethnicity matter? Soc Sci Med. 2004;58(6):1171–80.CrossRefGoogle Scholar
  29. 29.
    Jacob S, Klimke-Hübner A, Dippel FW, et al. Knowing what matters in diabetes: healthier below 7′: results of the campaign’s first 10 years (part 1): participants with known type 2 diabetes. Cardiovasc Endocrinol. 2016;5(1):14–20.CrossRefGoogle Scholar
  30. 30.
    Nickel F, Schmidt L, Sander J, et al. Patient perspective in obesity surgery: goals for weight loss and improvement of body shape in a prospective cohort study. Obes Facts. 2018;11(6):466–74.CrossRefGoogle Scholar
  31. 31.
    Stein J, Luppa M, Ruzanska U, et al. Measuring negative attitudes towards overweight and obesity in the German population – psychometric properties and reference values for the German short version of the fat phobia scale (FPS). PLoS One. 2014;9(12):e114641.CrossRefGoogle Scholar
  32. 32.
    Soto L et al. Beliefs, attitudes and phobias among Mexican medical and psychology students towards people with obesity. Nurt Hosp. 2014;30(1):37–41.Google Scholar
  33. 33.
    Berryman DE, Dubale GM, Manchester DS, et al. Dietetics students possess negative attitudes toward obesity similar to nondietetics students. J Am Diet Assoc. 2006;106:1678–82.CrossRefGoogle Scholar
  34. 34.
    Carels RA, Young KM, Wott CB, et al. Weight bias and weight loss treatment outcomes in treatment-seeking adults. Ann Behav Med. 2009;37(3):350–5.CrossRefGoogle Scholar
  35. 35.
    Fogelman Y, Vinker S, Lachter J, et al. Managing obesity: a survey of attitudes and practices among Israeli primary care physicians. Int J Obes Relat Metab Disord. 2002;26(10):1393–7.CrossRefGoogle Scholar
  36. 36.
    NCD Risk Factor Collaboration. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet. 2017;Google Scholar
  37. 37.
    Jung FU et al. Referral behavior of general physicians for patients with obesity. Chirurg. 2018;Google Scholar
  38. 38.
    Ebell MH. Bariatric surgery improves quality of life and results in more weight loss than intensive medical therapy. Am Fam Physician. 2017;95(12):805.Google Scholar
  39. 39.
    Kmietowicz Z. Recognise obesity as a disease to reduce prevalence, says RCP. BMJ. 2019;364:145.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of General, Visceral and Transplant SurgeryUniversity of HeidelbergHeidelbergGermany
  2. 2.Institute of Medical Biometry and InformaticsUniversity of HeidelbergHeidelbergGermany
  3. 3.Coordination Centre of Clinical TrialsUniversity Hospital of HeidelbergHeidelbergGermany
  4. 4.Department of General Practice and Health Services ResearchUniversity Hospital of HeidelbergHeidelbergGermany
  5. 5.Hospital MittelbadenBaden-BadenGermany

Personalised recommendations