[Determinants of a Weight-Centered Clinical Approach in Medical Practice: A Vignette-Based Study]

Weight stigma is a social determinant that negatively impacts the quality of medical care, particularly when it manifests in clinical decisions that prioritize body weight as the primary indicator of health. This practice, referred to as weight-centered care, can lead to inappropriate interventions and reinforce health inequities.

To identify the personal and professional variables that predict a weight-centered approach in a simulated clinical case of low back pain, using a standardized vignette.

Cross-sectional and correlational study with 79 medical residents in Chile. A validated clinical vignette was used along with scales assessing attributional beliefs and attitudes toward obesity treatment. A hierarchical multiple linear regression was conducted in four blocks, with bootstrap resampling (5,000 iterations) applied for robust estimations.

The final model explained 52.5% of the variance in clinical weight-centeredness. Beliefs that individually blame patients for their obesity (β= 0.382; p*= 0.021) and negative attitudes toward its treatment (β= 0.276; p*= 0.087) were the most relevant predictors. Sociodemographic variables such as gender or BMI lost significance when these attitudinal factors were considered. No significant effects were found for professional variables.

Findings show that internalized beliefs and attitudes about obesity are key to understanding weight-centered decision-making in clinical settings, even when weight is not relevant to the presenting complaint. This study provides local empirical evidence on an underexplored phenomenon in Chile and underscores the need to incorporate training frameworks that promote critical, non-stigmatizing, and person-centered care. Future research could explore educational interventions and the impact of weight-centered approaches on longitudinal clinical decisions.