Discovering the Roots: A Qualitative Analysis of Medical Students Exploring Their Unconscious Obesity Bias

Abstract

Phenomenon: Bias against individuals with obesity in medical settings has negative implications for patients, including stigmatization, poor health outcomes, and reduced healthcare utilization. This study explored reflections of medical students when confronted with their own implicit obesity bias.

Approach: A group of 188 pre-clinical second-year medical students from George Washington University School of Medicine and Health Sciences completed the Weight Implicit Association Test (IAT) in 2020 and were instructed to write a reflective response based on their results. Participants reflected upon their preferences (“fat” vs. “thin”) and described the factors that influenced their perceptions of obesity. Inductive coding techniques were used to generate themes from medical students’ responses using Dedoose Version 8.3.35 (SocioCultural Research Consultants LLC, Los Angeles, California).

Findings: Regarding IAT results, 7% of medical students preferred “fat over thin,” 14% had no preference, and 78% preferred “thin over fat.” Reflection themes highlighted medical students’ difficulty accepting IAT results, perspectives on the origins of obesity in individuals, personal and family challenges with obesity and body image, medical training’s perceived influence on bias, reservations about discussing obesity with patients, and desires to change current and future practices.

Insights: Many medical students expressed a desire to provide optimal care for patients of all weight classes despite demonstrating a strong unconscious bias against individuals with obesity on the IAT. Medical school should provide targeted opportunities to acknowledge and mitigate obesity bias by expanding on medical students’ pre-established and often harmful understandings of obesity and highlighting the complexities of this disease. Such training would better equip medical students to facilitate successful interactions with patients as future physicians.

Key Words:

• implicit bias
• obesity bias
• implicit association test
• obesity curriculum
• reflective writing

Acknowledgments

The authors would like to thank Dr. Thomas Sherman for his generous support, guidance, and sharing of his innovative curriculum. They also would like to thank Dr. William Dietz, Dr. Christina Chauvenet, and Dr. Matthew Haemer for their assistance with reviewing and providing substantial feedback on the manuscript.

Disclosure statement

The authors alone are responsible for the content and writing of the paper. No potential conflict of interest to report.

Funding

The author(s) reported there is no funding associated with the work featured in this article.