Measuring Medical Student Attitudes and Beliefs Regarding Patients Who Are Obese

Dr. Ip is professor of biostatistical sciences, Department of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina. Ms. Marshall is a fourth-year medical student, University of California, San Francisco School of Medicine, San Francisco, California. Dr. Vitolins is professor of epidemiology and prevention medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina. Dr. Crandall is professor of family and community medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina. Mr. Davis is assistant professor of family and community medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina. Dr. Miller is associate professor of internal medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina. Ms. Kronner is project manager, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina. Ms. Vaden is education coordinator, Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina. Dr. Spangler is professor of family and community medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Academic medicine: journal of the Association of American Medical Colleges (Impact Factor: 2.93). 12/2012; 88(2). DOI: 10.1097/ACM.0b013e31827c028d
Source: PubMed


Research shows obesity bias to undermine the patient-doctor relationship and lead to substandard care. The authors developed and tested an instrument to measure medical students' attitudes and beliefs about obese patients.

The authors conducted a literature search to identify validated measures of obesity bias. Because they identified no appropriate scale, they decided to design a novel survey instrument: the Nutrition, Exercise and Weight Management (NEW) Attitudes Scale. An expert panel generated items which focus groups of third-year medical students then discussed. Next, experienced medical educators judged and weighted the remaining revised items. Then, second- and fourth-year medical students completed the scale alongside two previously validated measures of obesity bias, the Anti-Fat Attitudes Questionnaire (AFA) and Beliefs About Obese Persons Scale (BAOP). Third-year students completed the NEW Attitudes Scale before and after a simulated encounter with an obese standardized patient instructor. The authors tested the validity and reliability.

The final instrument comprised 31 items. A sample of 201 judges rated the items. A sample of 111 second- and fourth-year medical students completed the survey (mean score 24.4, range -37 to 76 out of a possible -118 to 118; higher scores indicate more positive attitudes). Pearson correlations between the NEW Attitudes Scale and AFA and BAOP were, respectively, -0.47 and 0.23. Test-retest reliability was 0.89. Students scored 27% higher after completing the standardized patient-instructor encounter (P < .001).

The NEW Attitudes Scale has good validity and reliability and may be used in future studies.

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    • "Furthermore, it supports the need for additional educational experiences in the medical curriculum. Recently a new 31 item scale to measure medical student attitudes and beliefs regarding obesity was developed that initially appears to have good validity and reliability [29]. However, it was not available at the time of our study. "
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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.
    Full-text · Article · Mar 2014 · BMC Medical Education
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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.
    Full-text · Article · Apr 2014 · Obesity
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    ABSTRACT: Background: A high prevalence of stigmatizing attitude among healthcare personnel towards obese people has been reported. Objective: To evaluate the beliefs, attitudes and phobias that Mexican medical and psychology students have towards obese people. Methods: A cross-sectional study was conducted with 528 students enrolled at the Autonomous University of Baja California in psychology and medical schools. Weight, height and waist circumference were evaluated. Beliefs about obesity were assessed with the BAOP scale, attitudes towards obese people by the ATOP scale and obesity phobias by the F-scale. Results: Participants achieved a mean F-scale score of 3.4. Only seven per cent showed neutral or positive attitudes towards obesity (<= 2.5). Less fat phobia was associated with beliefs that obesity was not a result of the person's self-control (p = 0.0001) and had better attitudes towards obese people (p = 0.0001). Men had higher risk of fat phobia (OR = 1.5). Conclusions: High prevalence of phobias and negative attitudes towards obesity was observed. Men had higher stigma.
    Full-text · Article · Aug 2014 · Nutricion hospitalaria: organo oficial de la Sociedad Espanola de Nutricion Parenteral y Enteral
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