fitness · weight stigma

Reducing anti-fat bias among doctors: will a little more knowledge help?

Here’s some good news: medical schools are (finally) paying attention to the fact that their students have a bunch of false beliefs about their fatter patients, which contributes to bad medical care. Johns Hopkins and NYU medical schools created some special 3-4 day courses devoted to better understanding obesity (a term I hate, but they use it, so I will use it here when I have to). Their goal is to help future doctors care better for their fatter patients.

For those who love references: you can read a news article about the NYU study here, and the actual NYU here. For the Hopkins study, there’s a JAMA article about it here, and the Hopkins study in more detail is found here.

Okay, now that the bibliography is done, here’s what the studies discovered about medical students’ beliefs and attitudes toward fat patients.

tl:dr version: lots of future doctors falsely believe that body weight is largely controllable. They also have negative feelings and attitudes toward fat people– a significant percentage think fat people are lazy or don’t make good decisions. Possibly as a result, they are less empathetic to their fat patients. This translates into bad medical care.

Here’s my deeper dive: from studies we know that a large percentage of 4th year medical students believe that lack of willower is an important contributor to obesity. The Hopkins study looked at 6 medical student cohorts who had taken a 4-day course on obesity. Before the course, here is what the students believed:

Across cohorts, 89% of students agreed or strongly agreed that obesity is a disease (range, 85% to 92%), and 89% of students believed it was behavioral (range, 82% to 92%). At the same time, over 90% of students agreed or strongly agreed that obesity results from poverty (range, 90% to 97%), and 57% believed that obesity is primarily genetic (range, 51% to 62%). Finally, 74% of students agreed or strongly agreed that ignorance contributes to obesity (range, 70% to 79%), and 28% had the opinion that people with obesity were lazy (range, 21% to 38%). 

This is appalling but not surprising. The NYU study found similar negative attitudes and false beliefs:

More than half of medical students rated unhealthy diet (62.0%), physical inactivity (56.3%), and overeating (52.1%) as very important contributors to obesity. Only 26.8% of students rated genetics or biological factors as very important. Lack of willpower was rated as less important than genetics or biological factors, but over 40% of students considered it [lack of willpower] to be at least a moderately important cause of obesity.

These disheartening results hold for practicing doctors as well. The NYU study cites this information:

In a survey of US primary care physicians, genetic factors ranked below physical inactivity, overeating, and high fat diet as important causes of obesity. More than 30% viewed patients with obesity as weak-willed, sloppy, or lazy, over 50% viewed them as awkward, unattractive, ugly, and noncompliant, and only 50% of physicians rated genetic factors as a very important cause of obesity.

So, we have a situation in which physicians and future physicians have false beliefs about human metabolism and controllability of body weight. Medical schools (and hospitals and medical associations and patient groups) are aware of this fact, and are trying to educate these populations to give them correct information and a solid knowledge base from which to view their patients more equitably and justly.

But the problem is: knowledge doesn’t seem like it’s going to make things better. In a followup survey, the Hopkins researchers asked the medical student cohorts how (if at all) the course changed their views about obesity. More than 50% of the respondents reported no change at all. 30% reported positive changes in their views. The rest reported either no change or more negative views over time.

As the NYU study authors put it in the last line of their article, “Research about the most effective methods for teaching the basis of obesity and reducing bias is sparse, however and more studies are needed to identify best practices.”

Yeah, I would say that’s right. So, what’s missing here? Some researchers say this: we don’t know how to teach people to be empathetic with others, especially about fatness. You might think that doctors or medical students who have struggled with body image and dieting yo-yo weight changes would be more empathetic toward their fat patients. But no– the data show otherwise.

So how do you teach people empathy? There are actually programs to teach physicians empathy for their patients. Knowing that how a primary care provider responds to us emotionally is a strong influence on how well they treat us (medically and personally) gives us a little more power in an area of life where people are relegated to the status of passive, silent patient. And if we’re up to the task, advocating for ourselves and others by calling out lack of empathy and calling for more empathy training might make going to the doctor less daunting and unpleasant. Here’s hoping…

Doctors walking down a hallway, rearview. Photo by Unsplash.

2 thoughts on “Reducing anti-fat bias among doctors: will a little more knowledge help?

  1. It is important that the patient not take offence if the doctor requests for a range tests –ie. cardio, etc. and then, after some analsyis speaks with the patient by listening also to the patient the type of lifestyle activities they engage in. Part of the problem is listening and asking open questions of the patient.

    We have to find a happy medium between patient and doctor in this area. My doctor – sister herself lost 50 lbs. through diet changes and running. Then she regained some when she was pregnant with 2 children.. So most likely some life experiences can help if doctor is mindful.. She also has my mother who had 6 children and probably 40 lbs. more than she was in her 20’s before kids. Would she go at my mother….she hasn’t, because ironically mother has cooked very healthy for all her children. It took my mother’s doctor to tell her that she was bordering on diabetes 2 to cut back on certain foods. This is after…..3 decades.

    My mother doesn’t exercise and my sister-doc hasn’t bothered/said anything. What is the point for a woman over 80 who has given so much to 6 children? We’re just happy that we know mother prepares her own meals and others healthy.

    Sorry to get off rails.

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  2. This connects to one of my biggest beefs as a (currently) former fat person–When I was bigger, EVERY doctor visit included a conversation about my weight. Back pain? Let’s talk about weight. Chronic diarrhea? Have you tried to lose weight? Broken hand? Maybe if you lost some weight. . . Ok, I’m being a bit facetious, but just barely. Now, I’m about 5 pounds into the “normal” range, my previous weight history is NEVER taken into consideration. I’m at higher risk of some stuff because I was big and inactive from a young age. If we discuss my size or fitness at all, it’s a warning that my BMI is just barely acceptable, and have I, perhaps, considered trying to lose some weight? Arrgh!

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