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: 2.93). 05/2013; 88(7). DOI: 10.1097/ACM.0b013e318294f817
Source: PubMed


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.

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.

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).

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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    • "Two topics in obesity education that particularly merit increased attention are stigma and communication skills. In a recent study by Miller et al., 354 third year medical students completed the Weight Implicit Association Test (IAT) and a semantic differential item assessing their explicit preferences for fat or thin individuals [7]. Overall, approximately 40% of students had a moderate or strong implicit anti-fat bias, yet few were aware of it. "
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    ABSTRACT: In order to manage the increasing worldwide problem of obesity, medical students will need to acquire the knowledge and skills necessary to assess and counsel patients with obesityFew educational intervention studies have been conducted with medical students addressing stigma and communication skills with patients who are overweight or obese. The purpose of this study was to evaluate changes in students' attitudes and beliefs about obesity, and their confidence in communication skills after a structured educational intervention that included a clinical encounter with an overweight standardized patient (SP). First year medical students (n = 127, 47% female) enrolled in a communications unit were instructed to discuss the SPs' overweight status and probe about their perceptions of being overweight during an 8 minute encounter. Prior to the session, students were asked to read two articles on communication and stigma as background information. Reflections on the readings and their performance with the SP were conducted prior to and after the encounter when students met in small groups. A newly constructed 16 item questionnaire was completed before, immediately after and one year after the session. Scale analysis was performed based on a priori classification of item intent. Three scales emerged from the questionnaire: negative obesity stereotyping (7 items), empathy (3 items), and counseling confidence (3 items). There were small but significant immediate post-intervention improvements in stereotyping (p = .002) and empathy (p < .0001) and a very large mean improvement in confidence (p < .0001). Significant improvement between baseline and immediate follow-up responses were maintained for empathy and counseling at one year after the encounter but stereotyping reverted to the baseline mean. Percent of students with improved scale scores immediately and at one year follow up were as follows: stereotyping 53.1% and 57.8%; empathy 48.4% and 47.7%; and confidence 86.7% and 85.9%. A structured encounter with an overweight SP was associated with a significant short-term decrease in negative stereotyping, and longer-term increase in empathy and raised confidence among first year medical students toward persons who are obese. The encounter was most effective for increasing confidence in counseling skills.
    BMC Medical Education 03/2014; 14(1):53. DOI:10.1186/1472-6920-14-53 · 1.22 Impact Factor
  • Childhood Obesity 01/2014; 10(1). DOI:10.1089/chi.2014.1012 · 1.87 Impact Factor
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    ABSTRACT: Objective To examine the magnitude of explicit and implicit weight biases compared to biases against other groups; and identify student factors predicting bias in a large national sample of medical students. Design and Methods A web-based survey was completed by 4732 1st year medical students from 49 medical schools as part of a longitudinal study of medical education. The survey included a validated measure of implicit weight bias, the implicit association test, and 2 measures of explicit bias: a feeling thermometer and the anti-fat attitudes test. Results A majority of students exhibited implicit (74%) and explicit (67%) weight bias. Implicit weight bias scores were comparable to reported bias against racial minorities. Explicit attitudes were more negative toward obese people than toward racial minorities, gays, lesbians, and poor people. In multivariate regression models, implicit and explicit weight bias was predicted by lower BMI, male sex, and non-Black race. Either implicit or explicit bias was also predicted by age, SES, country of birth, and specialty choice. Conclusions Implicit and explicit weight bias is common among 1st year medical students, and varies across student factors. Future research should assess implications of biases and test interventions to reduce their impact.
    Obesity 04/2014; 22(4). DOI:10.1002/oby.20687 · 3.73 Impact Factor
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