Abstract
OBJECTIVE: 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). METHODS: 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. RESULTS: 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). CONCLUSION: 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.