COMMENTARY

An Unmet Need in Medical Training: Addressing Weight Bias

Rebecca M. Puhl, PhD

Disclosures

February 03, 2014

In This Article

Effects of Weight Bias on Patients

When patients perceive bias from medical providers, they report feeling ashamed, embarrassed, and upset, and many avoid future healthcare encounters. One study, for example, found that obese women delayed and avoided preventive healthcare services because of perceived weight bias in the healthcare setting.[11] The percentage of women who attributed healthcare avoidance to weight bias increased with body mass index, with the heaviest women reporting the most bias-related barriers to care.

More recent research by our group at the Rudd Center has found that even the language that providers use about weight can have similar consequences for their patients; 21% of adults indicated that they would avoid future medical appointments if they felt that their doctor referred to their weight in a stigmatizing or blaming manner.[12] When we replicated this research with parents, we found that 25% of parents would avoid future medical appointments for their children if they felt that their children's weight had been stigmatized by a doctor.[13]

Beyond these direct consequences for healthcare, there is considerable evidence that being a target of weight bias also increases risk for other adverse outcomes affecting health, including binge-eating; increased calorie consumption; maladaptive weight-control practices; cortisol reactivity; reduced motivation for exercise; and increased risk for obesity, depression, anxiety, and psychological distress.[2,14]

These studies give us reason for pause. With two thirds of Americans now overweight or obese, weight bias is a clinical concern that cannot be ignored. The evidence clearly and consistently indicates a growing need to address this form of bias in medical training.

If students may be entering medical school with these societal biases already firmly established, how should stigma reduction best be implemented in training? Given the competing demands for content in medical school curricula, the limited (or absent) training on obesity and nutrition in medical school, and the apparent social acceptability of weight bias in the clinical care environment, there are legitimate challenges to identifying and implementing training efforts that are feasible, broad-reaching, and effective to reduce weight bias.

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