An Unmet Need in Medical Training: Addressing Weight Bias

Rebecca M. Puhl, PhD


February 03, 2014

In This Article

"Weight Bias" Already Harbored by Medical Students

Rising obesity rates in recent decades have been coupled with widespread societal stigma and bias toward individuals who are affected by obesity.[1] This form of bias, also known as "weight bias," has been consistently documented in multiple daily life settings, including the workplace, educational institutions, the media, and unfortunately the healthcare setting.[2] Healthcare providers across a range of specialty areas have been shown to harbor negative stereotypes toward patients with obesity, including biases that these patients are lazy, lacking in self-control, noncompliant with treatment, unsuccessful, and dishonest.[2,3,4,5]

Research in this area has also examined weight bias among medical students and trainees in professional health disciplines. Unfortunately, the same negative stereotypes are present in students, who additionally believe that patients with obesity are at fault for their condition, deserve to be targets of derogatory humor, and are not motivated to improve their health.[6,7,8] These kinds of biases also influence students' provision of obesity treatment and lead them to feel uncomfortable discussing weight with patients.

Two recently published studies[9,10] illustrate the pervasiveness of this problem. First, a study published by Phelan and colleagues[9] in the journal Obesity examined the extent of both explicit (outwardly expressed) and implicit (automatic, unconscious) weight biases compared with other types of bias among 4732 first-year medical students, from 49 medical schools. Students completed a range of different surveys assessing their biases. The researchers found that 74% of students held implicit weight bias (similar to reported bias against racial minorities), and 67% exhibited explicit weight bias. Student attitudes toward persons with obesity were more negative than attitudes toward racial minorities, gays, lesbians, and poor people.

In a second recent study[10] (also published in Obesity), my colleagues and I examined weight bias and perceptions of obesity treatment among students training in professional health disciplines. We found that many students expressed frustration about treating patients with obesity, and viewed them to be difficult to deal with and noncompliant with treatment recommendations. Students with higher levels of weight bias expressed more frustration and pessimism in providing obesity treatment.

Furthermore, weight bias was reported to be a common problem observed in the clinical care setting: 63% of students had witnessed other students making jokes about patients with obesity, 40% had observed professors or instructors making negative comments or fat jokes about obese patients, and 65% had witnessed healthcare providers making negative comments or jokes about patients with obesity. Furthermore, 43% of students indicated that patients with obesity are a common target of derogatory humor in the medical setting by students, residents, and attendings.


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