Summary The objective of this study was to critically review the empirical evidence from all relevant disciplines regarding obesity stigma in order to (i) determine the implications of obesity stigma for healthcare providers and their patients with obesity and (ii) identify strategies to improve care for patients with obesity. We conducted a search of Medline and PsychInfo for all peer-reviewed papers presenting original empirical data relevant to stigma, bias, discrimination, prejudice and medical care. We then performed a narrative review of the existing empirical evidence regarding the impact of obesity stigma and weight bias for healthcare quality and outcomes. Many healthcare providers hold strong negative attitudes and stereotypes about people with obesity. There is considerable evidence that such attitudes influence person-perceptions, judgment, interpersonal behaviour and decision-making. These attitudes may impact the care they provide. Experiences of or expectations for poor treatment may cause stress and avoidance of care, mistrust of doctors and poor adherence among patients with obesity. Stigma can reduce the quality of care for patients with obesity despite the best intentions of healthcare providers to provide high-quality care. There are several potential intervention strategies that may reduce the impact of obesity stigma on quality of care.

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Cognitive theories of adherence to difficult courses of action and findings from previous survey research on coping with a major life event-job loss-were used to generate a preventive intervention, tested by a randomized field experiment. The aim was to prevent poor mental health and loss of motivation to seek reemployment among those who continued to be unemployed and to promote high-quality reemployment. Ss were 928 recently unemployed adults from southeastern Michigan, representing a broad range of demographic characteristics; they were randomly assigned to either the experimental or control condition. The experimental intervention included training in job seeking with a problem-solving process emphasizing inoculation against setbacks and positive social reinforcement. A pretest was administered, followed by posttests 1 and 4 months after the experiment. The experimental condition yielded higher quality reemployment in terms of earnings and job satisfaction, and higher motivation among those who continued to be unemployed. Loss of a job is a major life event that affects nearly 10 million persons annually (Riegle, 1982). Studies indicate that job loss places these people at increased risk of poor mental health in terms of increased depression, anxiety, minor psychiatric morbidity, and decreased self-esteem and life satisfaction (e.g.,

There is extensive evidence of racial/ethnic disparities in receipt of health care. The potential contribution of provider behavior to such disparities has remained largely unexplored. Do health and human service providers behave in ways that contribute to systematic inequities in care and outcomes? If so, why does this occur? The authors build on existing evidence to provide an integrated, coherent, and sound approach to research on providers' contributions to racial/ethnic disparities. They review the evidence regarding provider contributions to disparities in outcomes and describe a causal model representing an integrated set of hypothesized mechanisms through which health care providers' behaviors may contribute to these disparities.

IMPORTANCE Burnout among physicians is common and has been associated with medical errors and lapses in professionalism. It is unknown whether rates for symptoms of burnout among resident physicians vary by clinical specialty and if individual factors measured during medical school relate to the risk of burnout and career choice regret during residency. OBJECTIVE To explore factors associated with symptoms of burnout and career choice regret during residency. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study of 4732 US resident physicians. First-year medical students were enrolled between October 2010 and January 2011 and completed the baseline questionnaire. Participants were invited to respond to 2 questionnaires; one during year 4 of medical school (January-March 2014) and the other during the second year of residency (spring of 2016). The last follow-up was on July 31, 2016. EXPOSURES Clinical specialty, demographic characteristics, educational debt, US Medical Licensing Examination Step 1 score, and reported levels of anxiety, empathy, and social support during medical school. MAIN OUTCOMES AND MEASURES Prevalence during second year of residency of reported symptoms of burnout measured by 2 single-item measures (adapted from the Maslach Burnout Inventory) and an additional item that evaluated career choice regret (defined as whether, if able to revisit career choice, the resident would choose to become a physician again). RESULTS Among 4696 resident physicians, 3588 (76.4%) completed the questionnaire during the second year of residency (median age, 29 [interquartile range, 28.0-31.0] years in 2016; 1822 [50.9%] were women). Symptoms of burnout were reported by 1615 of 3574 resident physicians (45.2%; 95% CI, 43.6% to 46.8%). Career choice regret was reported by 502 of 3571 resident physicians (14.1%; 95% CI, 12.9% to 15.2%). In a multivariable analysis, training in urology, neurology, emergency medicine, ophthalmology, and general surgery were associated with higher relative risks (RRs) of reported symptoms of burnout (range of RRs, 1.23 to 1.48) relative to training in internal medicine. Characteristics associated with higher risk of reported symptoms of burnout included female sex (RR, 1.19 [95% CI, 1.09 to 1.29]; risk difference [RD], 7.6% [95% CI, 3.8% to 11.3%]) and higher reported levels of anxiety during medical school (RR, 1.08 per 1-point increase [95% CI, 1.06 to 1.10]; RD, 1.7% per 1-point increase [95% CI, 1.5% to 1.9%]). A higher reported level of empathy during medical school was associated with a lower risk of reported symptoms of burnout during residency (RR, 0.99 per 1-point increase [95% CI, 0.99 to 1.00]; RD, −0.5% per 1-point increase [95% CI, −0.5% to −0.2%]). Reported symptoms of burnout (RR, 3.46 [95% CI, 2.83 to 4.23]; RD, 15.2% [95% CI, 12.8% to 17.5%]) and clinical specialty (range of RRs, 1.60 to 2.96) were both significantly associated with career choice regret. CONCLUSIONS AND RELEVANCE Among US resident physicians, symptoms of burnout and career choice regret were prev...