Medical Students: Unconscious Bias Against Obesity Common

Larry Hand

May 28, 2013

Many medical students may have an antiobesity bias and may not know it, according to an article published online May 22 in Academic Medicine.

David P. Miller, MD, associate professor of internal medicine at Wake Forest School of Medicine, Winston-Salem, North Carolina, and colleagues conducted an annual survey over the course of 3 years of third-year medical students at Wake Forest to determine the extent to which these future physicians might be biased against obese patients.

Of 354 medical students, 310 (88%) completed the survey for school years 2008-2009 through 2010-2011. The students, who were 56% men and 73% white, came from 25 different US states and 12 countries outside the United States. The students completed questionnaires and a weight Implicit Association Test (IAT) that asked them to pair images of "thin" or "fat" people with negative or positive words, using a computer keyboard in a timed exercise.

The researchers used IAT D scores to stratify students' implicit preferences from neutral to strong. Students also completed a semantic test to assess their explicit preferences for fat or thin.

Most students (72%) self-reported that they preferred thin people over fat people, with 101 of 310 students (33%) characterizing the preference as moderate or strong. Only 4 students (1%) reported a preference for fat people. Men were twice as likely as women to report a significant bias against fat people (P < .001).

According to the IATs, however, 56% of students had a moderate or strong implicit weight bias, with 39% being antifat biased and 17% being antithin biased, with no variations among sex, race, and age. Yet two thirds (67%, 81/121) of the antifat students actually thought they were neutral, and all antithin students thought they were neutral.

The researchers write that minimizing the effects of an implicit bias requires a multilevel approach, with students recognizing they have a bias, accepting their bias could affect their actions, and reducing or mitigating their bias. In addition, the authors write, medical schools should develop curricula to address weight-related biases.

"Because anti-fat stigma is so prevalent and a significant barrier to the treatment of obesity, teaching medical students to recognize and mitigate this bias is crucial to improving the care for the two-thirds of American adults who are now overweight or obese," Dr. Miller said in a Wake Forest news release. "Medical schools should address weight bias as part of a comprehensive obesity curriculum."

This research was supported through an obesity-management educational grant from the National Cancer Institute. The authors have disclosed no relevant financial relationships.

Acad Med. Published online May 22, 2013. Abstract

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