Addressing Unconscious Obesity Bias in Physicians

biasWeight bias is prevalent in our society and can be observed everywhere–from on the beach to in the workplace.  Previous research has shown that on average, doctors have a strong  “anti-fat” bias similar to that of the general population. Now, a new study has found that these biases exist in many doctors before they’ve even finished medical school. Researchers at Wake Forest Baptist Medical Center found that two out of five medical students have an unconscious bias against obese people.

The goal of the new study was to measure the prevalence of  weight-related biases among medical students and further, to assess whether the students were aware of those biases. The study included more than 300 third-year medical students in the southeastern United States from 2008–2011. The group represented at least 25 different states and an additional 12 countries outside the U.S. To assess their unconscious weight biases, the students completed surveys using a computer program called the Weight Implicit Association Test (IAT).

The results indicated that about 40% of medical students had a moderate to strong unconscious anti-fat bias. In comparison, 17% had a moderate to strong anti-thin bias. Less than 25% of students were aware of their biases. Lead author of the study, David Miller, M.D, associate professor of internal medicine at Wake Forest Baptist, said: “Bias can affect clinical care and the doctor-patient relationship, and even a patient’s willingness or desire to go see their physician, so it is crucial that we try to deal with any bias during medical school.” He added that with the prevalence of obesity in the U.S., medical schools should address weight bias as part of a comprehensive obesity curriculum.

“Weight bias in our society is ubiquitous and represents a real challenge to all of us, whether in the medical profession or not,” said Dr. Layton Alldredge, expert bariatric surgeon in Utah. “It has been correctly called the last bastion of discrimination. One of the most poignant stories I have heard from a patient recalled her being ignored at ticket counters, department stores and other places where she was making a purchase. Then she said: “The bigger I got, the more invisible I became.”

As a medical professional, I was “nurtured” in this bias during my training years. Imagine my surprise when, as a beginning bariatric surgeon, I found that my bariatric patients were my best patients. They were more motivated, more compliant and happier. My interactions with them were more pleasant, generally, than with my non-bariatric patients. Societal bias changes slowly. Studies like this, at least, heighten our awareness of where we need to go,” Dr. Alldredge concluded.

Another recent study from Johns Hopkins examined how obesity affects the patient-physician relationship and found that primary care doctors build less of an emotional rapport with their overweight and obese patients, compared with their patients of normal weight. The researchers found that while the patient’s size did not affect the quantity of physicians’ medical questions, medical advice, counseling, or treatment regimen discussions, it did have an effect in areas such as showing empathy, concern and understanding.  Physicians were significantly more likely to express those important behaviors in interactions with patients of normal weight than with overweight and obese patients.

Empathy and bonding are essential to the patient-physician relationship. Research has shown that when doctors express more empathy, patients tend to adhere more closely to medical recommendations and respond to behavior-change counseling. The study authors advise that physicians be mindful of their interactions with overweight and obese patients, and make an effort to bond with them. “In doing so, physicians may find their obese patients more responsive to weight-loss counseling”, concluded senior author Kimberly A. Gudzune, M.D., M.P.H., an assistant professor at the Johns Hopkins University School of Medicine.

Related Reading: Are Doctors Addressing Weight with Patients?

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