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Medical weight bias involves negative attitudes, beliefs, and discriminatory behaviors against larger-bodied people, and environmental- and systemic-level factors that foster inaccessible, non-inclusive, or detrimental care. Systemically, many patients are excluded from evidence-based interventions due to body size, appropriately sized equipment is often unavailable, and insurance- and provider-level policies disproportionately impact larger-bodied patients. When physicians interact with larger-bodied patients, they perpetuate weight bias by being less empathetic, having less communication, practicing less patient-centered care, and performing fewer preventative health screenings compared to thin patients. This weight bias contributes to delays in medical care, healthcare avoidance, and poorer quality of care. Medical students demonstrate similar weight biases, believing that larger-bodied patients are unhappy, noncompliant, and lack self-control.
Interventions to reduce weight bias in medical students have primarily focused on uncontrollable causes of high weight, myths/stereotypes about fatness, and increasing empathy, but results are mixed and improvements transient.
Our study involved a collaboration between social workers, physicians, and medical students to develop a novel weight bias intervention for medical students centering critical consciousness development and weight-inclusivity, alongside causal information, empathy evoking, and interprofessional consultation. We aimed to test the effect of this intervention on weight bias outcomes for medical students.
Methods:
This single-arm pilot study evaluated a two-hour online intervention focused on decreasing weight bias and increasing weight inclusivity, which was offered to all medical students at University of Michigan. Externalized weight bias was measured using the Fat Attitudes Assessment Toolkit (FAAT); internalized weight bias was measured using the Modified Weight Bias Internalization Scale (WBIS-M). Participants (N=22) completed measures at baseline, post-intervention, and 3-months. Open-ended questions addressed students’ interest in the intervention and efficacy in identifying and/or interrupting weight bias.
Paired sample t-tests (comparing pre- and post-intervention scores and pre- and 3-month scores) assessed whether the intervention was associated with changes in weight bias. Thematic analysis was utilized to analyze open-ended responses.
Results:
Post-intervention, significant positive improvements were found on the FAAT subscales of Responsibility (x̅=0.79, d=0.78, p<0.001), Body Acceptance (x̅=0.37, d=0.31, p=0.003), Empathy (x̅=0.22, d=0.48, p=0.008), Critical Health (x̅=0.34, d=0.49, p=0.009), Socioeconomic Complexity (x̅=0.23, d=0.63, p=0.005), Activism (x̅=0.37, d=0.43, p=0.002). Changes in Body Acceptance (x̅=0.43, d=0.33, p=0.011) and Responsibility (x̅=0.42, d=0.37, p=0.008) were maintained at 3-months follow-up. Weight bias internalization showed no change post-intervention but had improved significantly (x̅=0.40, d=0.28, p=0.02) at 3-months, suggesting that internalized bias may take longer to shift than explicit attitudes.
Qualitative data themes included: (1) Critiques of the weight-centric paradigm (endorsed by 58%); (2) Curiosity with weight-inclusive paradigms, 81%; (3) Personal aspirational motivations, 65%; (4) Weighing the evidence, 55%; (5) Identifying weight stigma, 42%; (6) Personal reckoning, 45%; (7) Questioning weight-centric knowledge, 52%; (8) Disempowerment, 48%; (9) Activated and ready, 35%.
Conclusions and Implications:
Findings suggest that incorporating critical consciousness raising and weight-inclusivity into weight bias interventions for medical students may improve trainings, prolong effects, and impact internalized stigma and explicit attitudes. As some effects decreased over time, refresher courses or more comprehensive integration into medical school curriculum may be needed to maximize impact.