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

Abstract

Background: Negative bias toward patients with obesity is an ethical challenge in patient care. Several interventions to mitigate medical students' negative weight bias have been tried but none with an explicit focus on ethics. Here we describe first-year medical students' attitudes toward obesity and our effort to improve their attitudes through an innovative ethics session embedded within the required course, "Obesity, Nutrition, and Behavior Change," at Johns Hopkins University School of Medicine.Methods: Precourse survey data were collected from 6 first-year cohorts (2012)(2013)(2014)(2015)(2016)(2017). Before the ethics session, students take the Implicit Association Test (IAT) to measure implicit weight bias. During the session, students discuss their classmates' personal struggles with weight, beliefs about causes of obesity, and the IAT results. They also watch and discuss video clips from the TV show House depicting negative weight bias. In addition, the 2017 cohort was surveyed 4 months later to evaluate the impact of different components of the session on students' self-reported attitudes.Results: All students responded to the precourse survey. Across cohorts, IAT results revealed that 70% of students held a thin preference, 18% were neutral and 12% held a fat preference. Forty-seven percent had personally struggled with weight loss. While most students thought obesity is a disease (89%) or behavioral (88%), 74% thought it results from ignorance, and 28% thought people with obesity are lazy. Among the 59 respondents to the follow-up survey, 30% reported improvement in their attitudes after the session. Over 40% thought it was useful to discuss students' personal struggles with weight and the IAT and survey results, and over 70% thought the House video clips were useful.

Explicit and implicit weight bias among health care students: a cross-sectional study of 39 Australian universities

“… 85 Existing weight bias reduction interventions aimed at health care students have sought to challenge and reduce beliefs that obesity is within a person's control, evoke empathy, raise awareness, promote weight acceptance and improve communication skills; however, the majority of interventions have only succeeded partially and have been unable to sustain long-term reductions in weight bias. 9 , 48 , 71 , 86 , 87 , 88 Current findings indicate that gender and empathy are significant factors that were associated with weight bias. While weight bias reduction interventions targeting individual genders are impractical, novel, multifaceted interventions to evoke distinct aspects of empathy may produce desirable outcomes, as research has demonstrated the association of low empathic concern with a greater level of generalised prejudice.…”

A systematic review of implicit attitudes and their neural correlates in eating behaviour

“…Similarly, weight bias persisted after a media-based conditioning intervention, which relied upon the presentation of videos portraying obese people struggling with their weight status and discrimination ( Gapinski et al , 2006 ). An ethics educational training partially improved attitudes towards obesity ( Geller and Watkins, 2018 ), whereas Russell-Mayhew et al (2015) showed a reduction of both implicit and explicit weight bias after performing an interactive professional workshop and O’Brien et al (2010) demonstrated that it was possible to reduce or exacerbate both anti-fat explicit and implicit attitudes, depending on the information provided about causes of obesity. In contrast, Scrivano et al (2017) found that informing about the causes of obesity had an impact only on the explicit beliefs about the controllability of obesity.…”

“…Moreover, since weight bias has been found even among medical students ( Miller et al , 2013 ; Phelan et al , 2014 , 2015b ; Baker et al , 2017 ) and within the healthcare setting ( Teachman and brownell, 2001 ; Schwartz et al , 2003 ; Vallis et al , 2007 ; Sabin et al , 2012 ; Tomiyama et al , 2015 ; Aweidah et al , 2016 ; Halvorson et al , 2019 ), the possibility that the quality of patient’s care can be negatively affected, leading people with overweight and obesity to avoid preventive healthcare, should be taken into account. Due to the potential negative implications of weight bias, some researches tried to verify the effects of different manipulations aimed to improve weight stigma ( Geier et al , 2003 ; Teachman et al , 2003 ; Gapinski et al , 2006 ; O’Brien et al , 2010 ; Rukavina et al , 2010 ; Domoff et al , 2012 ; Flint et al , 2013 ; Swift et al , 2013 ; Russell-Mayhew et al , 2015 ; Hilbert and Meyre, 2016 ; Karsay and Schmuck, 2017; Rudolph and Hilbert, 2017 ; Scrivano et al, 2017 ; Geller and Watkins, 2018 ; Wijayatunga et al , 2019 ), providing mixed results, but leading hopes about the possibility that negative attitudes towards fatness can be minimized ( Teachman et al , 2003 ; O’Brien et al , 2010 ; Russell-Mayhew et al , 2015 ; Hilbert and Meyre, 2016 ). A prospective research focusing on medical students ( Phelan et al , 2015b ) found evidence for changes in weight bias, fostered by school training and interactions with patients with obesity, suggesting that curricula and lecturers should be shaped, taking into consideration such mediating variables, in order to improve weight-related attitudes of future professionals.…”

“Don’t Drink, Don’t Smoke, What Do You Do?”

“…15 Even if I don't believe these lifestyle choices make a difference in my research, I should still disclose them because of the danger of unconscious bias. 16…”