Anti-Obesity Bias

Many Medical Students Are Unaware of Their Anti-Obesity Bias

One-third of medical students at Wake Forest School of Medicine surveyed between 2008 and 2011 showed a significant anti-obesity bias, researchers reported in the July issue of Academic Medicine. Most students were not aware of their bias. Carrying this bias into practice may prevent physicians from properly addressing the health risks of obesity, including the risk of developing diabetes.

“Any prejudice can affect care in a number of ways,” explained lead author David P. Miller, Jr, MD, MS, Associate Professor, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina. “Other studies have shown that bias influences doctors’ diagnoses and treatment decisions. Bias also damages trust in the patient-physician relationship. Patients are less likely to confide in a doctor who comes across as cold or judgmental,” he said.

In this study of 354 third-year medical students, scores on a validated measure of implicit preferences for obese or thin people known as the Weight Implicit Association Test showed that 39% had an anti-fat bias and 17% had an anti-thin bias. Most students—two-thirds—were unaware of their implicit anti-obesity bias. In addition, 33% of students self-reported an explicit anti-obesity bias that was moderate or strong in intensity.

Are We Inherently Biased?

“Having biases is in our human nature—it is a fact of consciousness,” commented Carol A. Aschenbrener, MD, Chief Medical Education Officer, Association of American Medical Colleges (AAMC). “The key is to be aware of one’s biases so they do not limit action. We hope that this study will raise awareness of faculty and medical students to examine their own biases so that they do not interfere with compassionate care,” she said.

To uncover unconscious biases, she suggested that, when in an unfamiliar place, people might monitor their reactions to others walking toward them. “If you are uncomfortable, try to determine what labels you are adding,” Dr. Aschenbrener said. Mindfulness mediation is another good practice. “As you observe your thoughts, you might see things bubble up that you may not consciously own, which could be influencing your behavior on a deeper level,” she explained.

Steps to Reduce Anti-Obesity Bias

“Reducing bias has proven very difficult,” Dr. Miller said, adding that “a simple lecture won’t fix the problem. Rather, reducing the effects of bias likely takes a multilayered approach.

“As a first step, students and doctors need to be made aware that bias exists and understand how it can harm patient care,” she added. “Teachers and senior physicians should model professional behavior and empathy in their interactions with obese patients. A physician on rounds who gently brings an end to joking about obese patients will affect students’ views of respectful behavior. Students also need to have many opportunities to focus on practicing popularly endorsed values, such as treating all patients equally. Lastly, giving students the chance to learn about the daily challenges obese patients face can help increase understanding,” he explained.

“At Wake Forest, we have created a video documentary of obese patients discussing their challenges and experiences with the medical community. We show this video to all of our third-year medical students followed by a debriefing discussion,” Dr. Miller said.

Medical schools should be alert to attitudes or behaviors in the learning environment that could contribute to bias, Dr. Aschenbrener said. In fact, in an Association of American Medical Colleges’ (AAMC’s) expert panel report on prevention and treatment of overweight and obesity, a guiding principle is that “medical education should not contribute to the stigmatization of overweight and obese patients: To provide compassionate and effective care, future physicians must be trained to be sensitive to the ostracism experienced by many overweight and obese patients.”

Another expert panel convened by the AAMC suggests the importance of understanding the determinants of health and the interaction of biological factors and social processes. “That kind of interaction is very important both in the development of obesity and in one’s ability to get to a healthier weight,” she said.

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