Are Medical Students Aware of Their Anti-obesity Bias?

Dr. Miller is associate professor, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina. Dr. Spangler is professor, Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina. Dr. Vitolins is professor, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina. Mr. Davis is assistant professor, Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina. Dr. Ip is professor, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina. Dr. Marion is professor, Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina. Dr. Crandall is professor, Department of Physician Assistant Studies, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Academic medicine: journal of the Association of American Medical Colleges (Impact Factor: 3.47). 05/2013; 88(7). DOI: 10.1097/ACM.0b013e318294f817
Source: PubMed

ABSTRACT PURPOSE: Anti-obesity prejudices affect the quality of care obese individuals receive. The authors sought to determine the prevalence of weight-related biases among medical students and whether they were aware of their biases. METHOD: Between 2008 and 2011, the authors asked all third-year medical students at Wake Forest School of Medicine to complete the Weight Implicit Association Test (IAT), a validated measure of implicit preferences for "fat" or "thin" individuals. Students also answered a semantic differential item assessing their explicit weight-related preferences. The authors determined students' awareness of their biases by examining the correlation between students' explicit preferences and their IAT scores. RESULTS: Of 354 medical students, 310 (88%) completed valid surveys and consented to participate. Overall, 33% (101/310) self-reported a significant ("moderate" or "strong") explicit anti-fat bias. No students self-reported a significant explicit anti-thin bias. According to the IAT scores, over half of students had a significant implicit weight bias: 39% (121/310) had an anti-fat bias and 17% (52/310) an anti-thin bias. Two-thirds of students (67%, 81/121) were unaware of their implicit anti-fat bias. Only male gender predicted an explicit anti-fat bias (odds ratio 3.0, 95% confidence interval 1.8-5.3). No demographic factors were associated with an implicit anti-fat bias. Students' explicit and implicit biases were not correlated (Pearson r = 0.03, P = .58). CONCLUSIONS: Over one-third of medical students had a significant implicit anti-fat bias; few were aware of that bias. Accordingly, medical schools' obesity curricula should address weight-related biases and their potential impact on care.

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    ABSTRACT: Objective This study examined weight bias among students training in health disciplines and its associations with their perceptions about treating patients with obesity, causes of obesity, and observations of weight bias by instructors and peers.Methods Students (N = 107) enrolled in a post-graduate health discipline (Physician Associate, Clinical Psychology, Psychiatric Residency) completed anonymous questionnaires to assess the above variables.ResultsStudents reported that patients with obesity are a common target of negative attitudes and derogatory humor by peers (63%), health-care providers (65%), and instructors (40%). Although 80% of students felt confident to treat obesity, many reported that patients with obesity lack motivation to make changes (33%), lead to feelings of frustration (36%), and are non-compliant with treatment (36%). Students with higher weight bias expressed greater frustration in these areas. The effect of students' weight bias on expectations for treatment compliance of patients with obesity was partially mediated by beliefs that obesity is caused by behavioral factors.Conclusions Weight bias is commonly observed by students in health disciplines, who themselves report frustrations and stereotypes about treating patients with obesity. These findings contribute new knowledge about weight bias among students and provide several targets for medical training and education.
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