Implicit and explicit weight bias in a national sample of 4,732 medical students: The medical student CHANGES study

Abstract

Objective To examine the magnitude of explicit and implicit weight biases compared to biases against other groups; and identify student factors predicting bias in a large national sample of medical students. Design and Methods A web-based survey was completed by 4732 1st year medical students from 49 medical schools as part of a longitudinal study of medical education. The survey included a validated measure of implicit weight bias, the implicit association test, and 2 measures of explicit bias: a feeling thermometer and the anti-fat attitudes test. Results A majority of students exhibited implicit (74%) and explicit (67%) weight bias. Implicit weight bias scores were comparable to reported bias against racial minorities. Explicit attitudes were more negative toward obese people than toward racial minorities, gays, lesbians, and poor people. In multivariate regression models, implicit and explicit weight bias was predicted by lower BMI, male sex, and non-Black race. Either implicit or explicit bias was also predicted by age, SES, country of birth, and specialty choice. Conclusions Implicit and explicit weight bias is common among 1st year medical students, and varies across student factors. Future research should assess implications of biases and test interventions to reduce their impact.

Stimulating Weight Stigma in Future Experimental Designs on Physical Activity - Development and Pilot Validation of a Video Instrument

“…Another solution would be to test implicit attitudes. For instance, the Implicit Association Test [51] has already been successfully used in the context of weight stigma [52,53] and should be taken into consideration for future validations. Third, the QDAC was a self-developed and non-validated instrument.…”

Stigma In Persons with Obesity

“…Preclinical medical students are thus good examples of the effects of both implicit (unconscious) and explicit ( conscious) weight bias. Surveys show more than 40 % of medical students have signifi cant implicit weight bias [ 82 ], yet few are aware of their bias [ 83 ]. Unfortunately, the degree of weight stigma does not decrease with accumulating medical education or clinical experience.…”

Assumed or Assessed? The Affective Domain in Health Care Education

“…Many studies have reported on the prevalence of racial bias and stereotyping among health care practitioners [6,7]. A startling prevalence of bias toward obese patients exists among medical students [8], medical providers, [9][10][11] and even dietitians and nutritionists [12]. Harboring bias, and implicitly or explicitly demonstrating such negative attitudes, can have highly detrimental effects on patient outcomes including reinforcing obesogenic behaviors [7,13].…”