# Weight Stigma and Orthopedic Surgeons' Treatment Preferences for Patients With Obesity Who Are Candidates for Elective Total Knee Arthroplasty

## TL;DR

This study shows that orthopedic surgeons' biases about obesity affect their treatment choices for knee surgery candidates.

## Contribution

The study reveals how anti-fat attitudes and obesity management views influence surgeons' treatment preferences for knee surgery.

## Key findings

- Stronger anti-fat attitudes correlate with preferring conservative treatments over surgery for obese patients.
- Supportive obesity management attitudes are linked to less preference for conservative treatment.
- Male surgeons show higher anti-fat attitudes and a greater inclination for conservative treatment than female surgeons.

## Abstract

This study aimed to examine how anti‐fat attitudes and attitudes toward obesity management influence orthopedic surgeons' treatment preferences for patients with obesity who are candidates for elective total knee arthroplasty (TKA).

A cross‐sectional survey was conducted among 150 orthopedic surgeons using a web‐based questionnaire. The survey included four sections: socio‐demographic data, the Antifat Attitudes Questionnaire (AFA) assessing biases related to obesity (dislike, fear of fatness, and beliefs about willpower), an adapted questionnaire on attitudes toward obesity management, and a custom section on treatment preferences.

The sample had a mean age of 43.4 years (SD = 9.7) and was predominantly male (70.7%). Participants exhibited moderate anti‐fat attitudes alongside positive views on obesity management. Stronger anti‐fat attitudes correlated with a preference for conservative treatments over surgery (r = 0.45 to r = 0.29, p < 0.001), whereas supportive attitudes toward obesity management were associated with less preference for conservative treatment (r = −0.53, p < 0.001). Male surgeons demonstrated higher anti‐fat attitudes and a greater inclination for conservative treatment than female surgeons. Regression analysis identified attitudes toward obesity management as a significant predictor of treatment preferences (β = −0.54, p < 0.001).

Findings highlight the impact of weight stigma on clinical decision‐making and emphasise the need for increased awareness and education to ensure equitable access to TKA for patients with obesity.