PictureDr. David Miller, Wake Forest
Less than a month ago, Academic Medicine published a new study of medical students and obesity bias. As Patient Promise signers will recall, one of the major tenets of the oath is to guard oneself from potential biases against their patients. The paper concludes:

"Over one-third of medical students had a significant implicit anti-fat bias; few were aware of that bias. Accordingly, medical schools' obesity curricula should address weight-related biases and their potential impact on care."

We had the opportunity to interview lead author and professor at Wake Forest School of Medicine, Dr. David Miller. This is what he had to say about the study and what it means for the practice of healthcare. 

How did you become interested in the issue of weight stigma in healthcare?

We received a grant from the National Cancer Institute to develop a comprehensive obesity prevention and management curriculum for medical schools.  As part of our efforts, we asked all 3rd year medical students at our institution to take the Weight Implicit Association Test prior to a small group discussion of bias and its impact on the medical encounter.  We noticed many reports of anti-obesity bias in society, so we were very curious to see if medical students shared this bias and if they were aware of it.  If we found that many medical students had an unconscious weight bias, then we would need to address that as part of our curriculum. 

Can you describe the various forms of weight bias (patient to provider, provider to patient, etc), and how much a problem they've posed (statistics)?

In our study, we found that approximately 40% of medical students had a moderate or strong anti-obesity bias, and most were unaware of their bias.  We didn’t specifically examine how this bias affected their clinical encounters, but other researchers have examined that question.  From other published studies, we know that bias affects treatment decisions, differential diagnoses, and patients’ willingness to seek care.

Are there other forms of stigma that we can draw lessons from, e.g. smoking?

It’s hard for me to comment on this question since our study only looked at weight bias.  But you will find several published studies describing the impact of racial bias on medical care.

What are specific steps that healthcare providers can implement to reduce weight stigma in healthcare?

The first step to reducing the effect of bias is to acknowledge its existence and its potential to influence the care we give.  If we (meaning us health professionals) think we are unbiased, then we won’t take any steps to counteract it.  Once we accept the possibility that we could harbor some bias, we can begin to think of ways to minimize its impact.  Unfortunately, actually reducing the impact of bias has proven difficult, and most experts in this area think it takes repeated opportunities for practice.  When we notice we are developing a negative reaction to a patient, that is a good cue to pause and ask ourselves why we are having that reaction and how we can use the situation as a chance to practice our ideals (such as treating all patients equally and with respect).  It may also help to try to understand how obesity has impacted our patients’ daily lives.  Glimpsing their life experience can facilitate empathy. 

What do you think of The Patient Promise as a way to raise awareness/change behavior among clinicians? 

Behavior change is very hard.  Sometimes as physicians we forget that . . . until we try to change something in our own lives.  The demands of medicine can also make it difficult to find time to take care of ourselves.  I’m glad to see the Patient Promise is encouraging physicians to engage in healthy behaviors which will benefit not only us, but our patients as well.


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