Reducing obesity prejudice in medical education

Abstract

Background: Healthcare worker attitudes toward obese individuals facilitate discrimination and contribute to poor health outcomes. Previous studies have demonstrated medical student bias toward obese individuals, but few have examined effects of the educational environment on these prejudicial beliefs. We sought to determine whether an innovative educational intervention (reading a play about obesity) could diminish obesity prejudice relative to a standard medical lecture. Methods: We conducted a randomized, controlled trial enrolling medical students (n = 129) from three universities. Students were assigned to play-reading or a standard lecture. Explicit attitudes and implicit bias toward obese individuals were assessed prior to intervention and after four months. Results: At baseline, students demonstrated moderate explicit and implicit bias toward obese people despite high scores on empathy. Students randomized to the play-reading group had significantly decreased explicit fat bias (P = 0.01) at follow-up, while students in the lecture group showed increased endorsement of a prescriptive model of care at the expense of a patient-centered approach (P = 0.03). There was a significant increase in empathy for those in both the theater (P = 0.007) and lecture group (P = 0.02). The intervention had no significant effect on implicit bias or regard for obesity as a civil rights issue. Discussion: Dramatic reading may be superior to traditional medical lectures for showcasing patient rights and preferences. The present study demonstrates for the first time that play-reading diminishes conscious obesity bias. Further research should determine whether nontraditional methods of instruction promote improved understanding of and care for obese patients.

The Impact of Applicants’ Weight and Education About Obesity on Applicant Ratings

“…These findings suggest that a very brief educational intervention about the controllable causes of obesity may actually increase explicit beliefs about the controllability of obesity, and individuals who believe obesity is controllable have more negative attitudes toward obese individuals (Allison et al, 1991). However, previous studies have shown that education and educational interventions have decreased antifat biases in participants (Diedrichs & Barlow, 2011;Matharu et al, 2014;O'Brien et al, 2010).…”

“…The lecture provided insight on how obese persons are discriminated against by society and health professionals in regard to treatment plans, as well as stressed the importance of patient involvement during treat ment. The researchers found that explicit bias was significantly reduced in the roleplaying condition, and in both conditions, sympathy increased toward obese individuals (Matharu et al, 2014). Diedrichs and Barlow (2011) also found that explicit bias was reduced when participants partook in a 2hour course discussing weight bias and controllable and uncontrollable factors that influence body weight.…”

Addressing Medical Students’ Negative Bias Toward Patients With Obesity Through Ethics Education

“…12 Our findings also add to the growing body of literature on educational interventions aimed at mitigating negative weight bias. [17][18][19][20][21][22][23][24][25][26] The session in which we explore students' negative attitudes toward patients with obesity is innovative in a few ways. First, it explicitly links negative weight bias to ethics.…”

“…16 Several interventions to address and mitigate negative weight bias among physicians and medical students have been developed and evaluated but with mixed results. [17][18][19][20][21][22][23][24][25][26] With few exceptions, 25,27 educational research designed to combat negative weight bias uses standard curricular interventions such as didactic presentations, role playing, and standardized patients. [18][19][20][21][22][23][24]26 To our knowledge, none of these interventions has explicitly highlighted negative weight bias as an ethical challenge in caring for patients who struggle with obesity.…”

Stigma In Persons with Obesity

“…Although there was an immediate and medium-term postintervention improvement in empathy for patients and self-effi cacy around providing obesity-related counseling, 1-year follow-up data showed a return of students' attitudes back to baseline [ 107 ]. Another study demonstrated that the use of theatrical readings, in place of a lecture, on obesity could diminish explicit obesity bias; however, it did not change levels of implicit bias or empathy [ 108 ]. Educational strategies emphasizing the complex etiology and physiological regulation of body weight have resulted in positive attitudes about patients with obesity among medical students [ 104 ].…”