A deeper look at implicit weight bias in medical students

Abstract

The Implicit Relational Assessment Procedure (IRAP, Barnes-Holmes et al. in Psychol Rec 60:527-542, 2010) was utilized as a relatively new tool to measure implicit weight bias in first- and third-year medical students. To date, only two studies (Miller et al. in Acad Med 88:978-982, 2013; Phelan et al. in Med Educ 49:983-992, 2015) have investigated implicit weight bias with medical students and both have found pro-thin/anti-fat implicit attitudes, on average, using the Implicit Association Test (IAT, Greenwald and Banaji in Psychol Rev 102:4-27, 1995) as the assessment tool. The IRAP, however, allows for a deeper analysis of implicit attitudes with respect to both thin and fat in isolation, and it was found that medical students are, on average, actually both pro-thin and pro-fat, and on average are more pro-thin than pro-fat, as opposed to anti-fat. Additionally, it was found that medical students' implicit weight bias against fat/obese individuals improved over the first 2 years of medical training, and this improvement was specifically driven by improved implicit attitudes toward overweight and obese, while implicit attitudes toward thin remained constant over that time. The implications of more sensitive implicit bias assessment and specific changes in bias over time are discussed within the context of medical education curriculum development.

Unconscious Weight Bias Among Nursing Students: A Descriptive Study

“…This may reduce student acceptance of the IAT results and may also cause considerable distress. Implications for educators, therefore, include the caveat to avoid forcing students into such categories [22]. Authors should discuss the results and how they can be interpreted in perspective of previous studies and of the working hypotheses.…”

The Implicit Association Test in health professions education: A meta-narrative review

“…In general, the IAT was used to measure implicit bias or as a prompt for discussion and reflection. While 24 out of 38 articles used the IAT as a metric of bias [7, 36–58], another 15 articles used the IAT as a stimulus to encourage discussion and reflection [8, 21, 59–71] (one used the IAT for both) [7]. When used as a metric of implicit bias, the IAT was used to calculate the degree of implicit bias, and measure implicit attitudes in relation to an educational intervention.…”

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

“…Therefore, we cannot replicate the associations other studies of medical students have found between personal experiences with obesity, beliefs about the causes of obesity, and negative weight bias. [13][14][15][16] Finally, our study was not specifically designed to evaluate the "ethics and professionalism" session and its impact on students' attitudes toward obesity. If we had set out to do such a study, we would have collected postsession data from all cohorts immediately following the session and would have used more objective attitudinal measures than self-report.…”

“…Several studies indicate that personal experiences with weight also contribute to medical students' negative attitudes and beliefs. [13][14][15] Perhaps counterintuitively, evidence suggests that medical students who themselves have successively struggled with overweight or obesity are more likely to hold negative attitudes toward patients with obesity than their counterparts who have regained lost weight. 13 Of particular concern is that medical students do not seem aware of their negative biases.…”