The latest study suggests that the one-third of Americans who are obese they may not be getting the proper health care they need — because their doctors are biased against treating them.
The study, published in the Journal of Academic Medicine, shows that two out of five medical students have a subconscious bias against obese people. The bias may not be overt, but it can have serious implications for the patient’s health once they leave the doctor’s office.
Previous research found that doctors, like the general population, may assume that heavy-set patients won’t follow advice for healthy living as stringently as patients of normal weight. That means they may not be as likely to advise their patients to treat their obesity, or guide them toward the most effective weight management strategies.
To determine when this bias sets in, the researchers focused on a group of medical students and found that this way of thinking can appear before doctors even start to treat patients.
Over three years, the scientists from Wake Forest Baptist Medical Center in North Carolina studied 300 third-year medical students at a southeastern medical school starting in 2008. Using a computer program called the Weight Implicit Association Test (IAT), they measured the students’ subconscious preferences for thin or fat patients by recording how love it took the students to associate positive words such as ‘laughter’ or ‘happiness’ with drawings of thin or overweight people. The participants also filled out questionnaires that explicitly asked about their weight preferences. The difference between the two measures, the researchers said, reflected the amount of unintentional bias the medical students had.
Based on the results, 39% of the students had a moderate to strong subconscious bias against the overweight, and less than 25% of the students were aware of their bias.
Acknowledging such bias could be critical for helping doctors to better treat obesity among their patients; in another study published in February in the journal Preventive Medicine, researchers documented the close relationship between how doctors think about obesity and how they treat it. That study found that the majority of doctors believed obesity is caused by factors that can be controlled by the obese individual, and therefore preventable. Of the 500 primary care doctors surveyed, 88% said overeating was a significant driver of obesity, 62% reported restaurant food and fast food were important contributors to obesity, and 60% said sugar-sweetened beverages were a major factor contributing to obesity. Very few doctors — only 19% — blamed genetics as a cause for obesity.
This perspective invariably influenced how the physicians advised their patients, such as recommending that they eat smaller portions or avoid drinking soda. Doctors who believed overeating was a primary cause for obesity were three times more likely to advise patients to patients to eat smaller portions and were twice as likely to tell them to cook with lower-calorie ingredients. Doctors who thought eating at restaurants and fast food spots were to blame were 93% more likely to tell their patient they should avoid ordering high-calorie menu items.
Other work also showed that doctors who were overweight themselves were less likely to discuss weight with their patients, and therefore not as successful in helping their patients to shed pounds.
According to the Wake Forest scientists, making medical students aware of their subconscious bias is important for improving the way obesity is treated. At the university, all third-year students must take the IAT and participate in a class to discuss the sources of unintentional bias and how it can affect the care they will go on to provide to patients.