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Medicine Education Science

Med Students Unaware of Their Bias Against Obese Patients 446

An anonymous reader sends news of a study which found that "two out of five medical students have an unconscious bias against obese people." The study, published in the Journal of Academic Medicine (abstract) examined med students from many different cultural and geographical backgrounds. "The researchers used a computer program called the Weight Implicit Association Test (IAT) to measures students’ unconscious preferences for 'fat' or 'thin' individuals. Students also answered a survey assessing their conscious weight-related preferences. The authors determined if the students were aware of their bias by seeing if their IAT results matched their stated preferences. Overall, 39 percent of medical students had a moderate to strong unconscious anti-fat bias as compared to 17 percent who had a moderate to strong anti-thin bias. Less than 25 percent of students were aware of their biases. 'Because anti-fat stigma is so prevalent and a significant barrier to the treatment of obesity, teaching medical students to recognize and mitigate this bias is crucial to improving the care for the two-thirds of American adults who are now overweight or obese,' Miller said. 'Medical schools should address weight bias as part of a comprehensive obesity curriculum.'"
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Med Students Unaware of Their Bias Against Obese Patients

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  • by Anonymous Coward on Saturday May 25, 2013 @05:11PM (#43823601)

    I'm not unaware. I know exactly what I think about fat people and It's not good.

  • Compassion (Score:5, Informative)

    by Dunbal ( 464142 ) * on Saturday May 25, 2013 @05:16PM (#43823639)
    Compassion is supposed to be a hallmark trait of the medical profession. Any doctor who lets his personal beliefs get in the way of his practicing medicine in the best possible way to ANY patient - be s/he fat, thin, muslim, atheist, black, green, prisoner, retarded, or just an average joe - is a bad doctor. If a patient is obese then yes, it poses a serious health risk and a problem. My job as a doctor is not to lecture that patient or make fun of them, but to try to help them as much as I can with the tools I have at my disposal. The same for alcoholics, drug addicts, and anyone else. Because at the end of the day said behavior is usually just a symptom of a different, underlying problem.
  • Implicit Association (Score:5, Informative)

    by CanadianRealist ( 1258974 ) on Saturday May 25, 2013 @05:18PM (#43823651)

    For those not familiar with implicit association tests, they are based on measuring your reaction times when matching certain types of data according to different specified criteria. For example a gender association test might measure time for matching gender with staying at home raising children versus working outside the home.

    Harvard has plenty of sample tests. [harvard.edu]

    Having taken some of the tests I can say that the results can be quite surprising and point out biases that you are unaware of. I definitely found that some associations were much easier for me than others. (Happy to say that the gender example above was not a problem for me.)

  • Re:Med students (Score:4, Informative)

    by tysonedwards ( 969693 ) on Saturday May 25, 2013 @05:46PM (#43823799)
    Are you unaware that "Less than 25 percent of students were aware of their biases" means that 75% were unaware of their biases?

    Sounds as though that is a pretty apt title.
    Sure, it is biases against "various weights" not just "overweight & obese", but the point still stands.
  • Re:Med students (Score:5, Informative)

    by ebno-10db ( 1459097 ) on Saturday May 25, 2013 @06:06PM (#43823897)

    A health care professional can be expected to have a bias regarding healthy vs unhealthy life choices.

    No shit. That is not what they mean by bias in this study. RTFA:

    “Bias can affect clinical care and the doctor-patient relationship, and even a patient’s willingness or desire to go see their physician, so it is crucial that we try to deal with any bias during medical school,” said David Miller, M.D., associate professor of internal medicine at Wake Forest Baptist and lead author of the study.

    “Previous research has shown that on average, physicians have a strong anti-fat bias similar to that of the general population. Doctors are more likely to assume that obese individuals won’t follow treatment plans, and they are less likely to respect obese patients than average weight patients,” Miller said.

  • Re:Fat Hatred (Score:2, Informative)

    by Anonymous Coward on Saturday May 25, 2013 @06:14PM (#43823927)

    Some have argued (sorry I don't have the citation handy) that the OPPOSITE is true: people who live unhealthy lifestyles are far cheaper to maintain for one simple reason: they die before they get old (that time in your life where your maintenance becomes FAR more expensive).

    The article I read had some interesting numbers that stated health care in the developed world would be substantially cheaper if everyone smoked and ate badly.

  • Re:Fat Hatred (Score:2, Informative)

    by Anonymous Coward on Saturday May 25, 2013 @06:23PM (#43823961)

    Citation: http://daveatherton.wordpress.com/2012/03/17/the-true-costs-of-treating-smokers-the-obese-and-the-healthy/

    It is just a summary but they link to their more official sources. The core values, as quoted from the blog:
    The lifetime costs were in Euros:
    Healthy: 281,000
    Obese: 250,000
    Smokers: 220,000

    So, obesity saves more than 10% of lifetime healthcare cost.

  • Re:Med students (Score:2, Informative)

    by beelsebob ( 529313 ) on Saturday May 25, 2013 @06:38PM (#43824071)

    Let me ponder this for a minute.

    A health care professional can be expected to have a bias regarding healthy vs unhealthy life choices. Being fat indicates that a person has made one HELL of a lot of unhealthy choices. Like - every single day, he eats to much.

    Actually, not necessarily, for two reasons:
    1) There are plenty of medical causes of being fat, e.g. polycystic ovarian syndrome, type 1 diabetes (which causes fatness rather than the reverse), etc. Not just eating too much every single day.
    2) Studies have repeatedly shown that overweight and moderately obese (grade 1 obese) people actually live longer, healthier lives than people of "normal" weight. Only at grade 2 and 3 obesity do these people start to live shorter less healthy lives due to type 2 diabetes and kidney disease. Underweight as a category leads to shorter lifespan than all of overweight, normal and grade 1 obesity.

  • Re:Fat Hatred (Score:4, Informative)

    by AmiMoJo ( 196126 ) * <mojoNO@SPAMworld3.net> on Saturday May 25, 2013 @06:48PM (#43824141) Homepage Journal

    I'm not quite obese but I am overweight, and it's because I suffer from two conditions (CFS and arthritis) that making losing weight extremely difficult. It isn't a lifestyle choice, and before these two things got bad I was able to stay fairly trim.

    I feel bad. I don't like the way I look. Thing is though, it really isn't my fault. I wish it was because then I could do something about it.

    Don't make assumptions about people you don't know.

  • Re:Med students (Score:5, Informative)

    by tlambert ( 566799 ) on Saturday May 25, 2013 @07:22PM (#43824347)

    Let me ponder this for a minute.

    A health care professional can be expected to have a bias regarding healthy vs unhealthy life choices. Being fat indicates that a person has made one HELL of a lot of unhealthy choices. Like - every single day, he eats to much.

    Alternately they have hypothyroidism, for example, as a result of Hashimotos. It could also be Prader-Willi syndrome, or Bardet-Biedl syndrome. There are other genetic factors and diseases which can also result in obesity. Candida Albicans infections of the gut have also been implicated. There are also medications which can result in obesity. Prednisone, which is often used to treat very severe allergies, and also as an anti-rejection drug following organ transplantation, or to treat autoimmune disorders, is one. Others include antidepressants, seizure medications, and certain high blood pressure drugs, such as atenolol and metoprolol (both beta blockers).

  • Re:Med students (Score:4, Informative)

    by mellyra ( 2676159 ) on Sunday May 26, 2013 @04:51AM (#43826141)

    Doctors should diagnose based on full spectrum data collection. Not simply based on what they see and think at first glance.

    I had this discussion a dozen times with my brother who is a medical student and the tl;dr is "nobody has the time or money for that".

    A doctor will always assume the most likely cause for any given combination of symptoms (even if they don't match 100%) and only start thinking about less likely alternatives if his treatment doesn't lead to improvements. Yes, sucks to be someone with a rare disease (that will only be diagnosed correctly very late if at all) but symptoms are often so unspecific and a thorough examination would be so expensive (let's do a blood screen every time you catch a cold because you might have some ultra-rare disease?) that this is the only practicable way.

    Hormonal causes for obesity are possible but pretty rare - a much larger share of obese patients claims to suffer from e.g. thyroid issues than statistically possible. "Just eat less" is the right answer for the vast majority of obese patients and as they will lie to you about their food intake and exercise (admittedly often unconsciously, but then they don't tend to cooperate well when you ask them to keep a diary of every single thing they eat to make the more self-conscious) you never know if your original attempt at treatment did work or not. The share of patients who will lie into your face about having tried everything is probably still much larger than the share of patients who have actually followed your advice and it didn't help because they have some underlying physical issue.

    The standard medical procedure of most likely diagnosis -> treatment -> in-depth examination if treatment doesn't show results just breaks down as the doctor has no way of knowing whether the treatment ever took place or not.

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