Iran Journal of Nursing

Introduction
Obesity or overweight is a global public health problem. The World Health Organization defines overweight or obesity as an abnormal accumulation of fat in the body. A body mass index ≥30 in considered obese. The World Health Organization estimateed that the number of obese people worldwide in 2021 was approximately 2.1 billion, which makes up about 30% of the total population. This number continues to rise. The worldwide obesity rate has tripled since 1975. Over 3 million people each year die from obesity, which shows the unfavorable conditions in the world. In Iran, obesity has a prevalence of 25.80 %, putting it in the 13th place among the countries with highest obesity in the world. Overweight and obesity can lead to a variety of diseases such as type 2 diabetes, cardiovascular diseases, and cancer. Recent studies have shown an association between obesity and increased mortality caused by coronavirus disease 2019 (COVID-19). In addition to physical consequences, obesity has various social consequences. Obese people suffer from prejudice, discrimination, and negative attitudes of others. Multiple studies have indicated the discriminatory behaviors of medical staff, including physicians and nurses, towards obese people, which can affect the quality of care for these people. Examining the perceptions and cultural beliefs of the society about obesity can help solve the problems related to these patients. Although there is a lot of evidence about these beliefs and perceptions about obese people in other countries, but not many studies have been conducted in Iran on the perceptions about discriminatory behaviors of medical staff towards obese people. Therefore, this study was aims to survey the perceptions of nurses about obese patients and providing care to them.
Materials and methods
In this descriptive-analytical study, 162 nurses working in one of hospitals in Guilan province of Iran participated. The data collection tool was a two-part questionnaire; the first part surveyed demographic information (gender, age, clinical work experience, marital status, educational level, and type of employment) and the second part surveyed nurses’ attitudes using the 36- nurses’ attitudes towards obesity and obese patients scale (NATOOPS) in five areas (response to obese patients, personality traits of obese people, controllable obesity factors, stereotypical characteristics of obese people and supportive roles in caring for obese patients). After obtaining permission from the developer of NATOOPS, it was translated from English into Persian and its validity and reliability were assessed. To evaluate its face validity, the questionnaire was given to 10 nurses. For determining content validity, it was sent to 10 faculty members of the School of Nursing and Midwifery, Hamadan University of Medical Sciences. The content validity index was obtained 0.78, indicating its good content validity. To determine the reliability of the Persian version, internal consistency was assessed in a pilot study and a Cronbach’s alpha of 0.82 was obtained. Data were collected and analyzed using descriptive statistics (frequency, mean and standard deviation) and inferential statistics (independent t-test, one-way analysis of variance) in SPSS software, version 16. Multiple linear regression analysis by Backward method was also used to determine the predictors of nurses’ attitudes towards obesity and obese patients. Significance level was set at 0.05. 
Results 
The mean age of nurses was 34.08 ± 7.9 years. Most of whom were female (97.5%), married (79.6%) and with a bachelor’s degree (94.4%). Their mean work experience was 8.65±7.01 years, and most of them (41.4%) had permanent employment. None of them received any training related to providing care to obese patients. The total score of NATOOPS was 110.18±14.23, indicating that nurses did not have a high attitude towards obesity and obese patients. Regarding nurses’ attitudes score, a significant difference was observed between nurses in terms of working department (P=0.001), educational level (P=0.042), and type of employment (P=0.004). The results of linear regression showed that the factors of age, educational level, and type of employment were the significant predictors of nurses’ attitude towards obesity and obese patients.
Discussion
According to the results of this study, nurses had a low attitude towards obesity and providing care to obese patients and factors such as age, working department, clinical work experience, educational level, and type of employment significantly affect their attitude. Since a favorable attitude towards obese patients in nurses can affect their care to these patients, and given that social support to health, regardless of body mass, is the right of all patients, the need for nursing managers to pay attention to factors such as reducing the workload of nurses, especially those special care units, and providing necessary training to nurses about providing safe care and support for obese patients are necessary. One of the limitations of this study was the possibility of bias in nurses’ responses to the questions. 

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Hamadan University of Medical Sciences (code: IR.UMSHA.REC.1397.128)

Funding
The Vice-Chancellor for Research and Technology of Hamadan University of Medical Sciences has financially supported this research (Research project num-ber: 9703081369).

Authors' contributions
Conceptualization: Marzieh Jahani Sayad Noveiri, Khodayar Ashundi and Zahra Maqsoodi; Research and investigation: Marzieh Jahani Sayad Noveiri and Zahra Maqshoodi; Data analysis: Nasser Kamiari; Editing and final editing: Marzieh Jahani Sayad Noveiri and Zahra Maqsoodi.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
We want to thank the Vice-Chancellor for Research and Technology of Hamadan University of Medical Sciences for their support.

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