Do future healthcare providers show weight bias?

Research shows Australian healthcare students hold both explicit and implicit weight-biased attitudes and beliefs, leading to possible negative outcomes to patients.
 
Published in eClinicalMedicine, researchers surveyed 900 healthcare students and found ‘alarming’ rates of dislike towards people living with overweight or obesity, and beliefs that obesity was within a person’s control and that obese and overweight people lacked willpower.
 
They also found some participants were fearful of gaining weight, while others lacked confidence in clinical settings when helping overweight or obese patients.
 
Students answered assessments such as the Implicit Association Test (IAT), Beliefs About Obese Persons Scale (BAOP) and Antifat Attitudes Questionnaire (AFA).
 
Lead researcher and PhD student Ravisha Jayawickrama said individuals on the receiving end of weight bias or discrimination around the world have a 60% greater risk of mortality and are 2.5 times more likely to experience mental health disorders, such as anxiety.
 
‘Our study found the level of weight bias exhibited by Australian healthcare students was alarming and has the potential to negatively impact the care that people living with obesity receive, contributing to poor health outcomes and quality of life,’ she said.
 
‘These impacts could include spending less time in consultations, raising unwarranted concerns about a patient’s weight, and being unwilling to perform certain examinations.’
 
Approximately 25% of children and adolescents are overweight or obese and 67% of adults are overweight or obese, according to the Australian Institute of Health and Welfare.
 
Students participating in the study were from 39 universities across Australia, and a range of disciplines including medicine, paramedicine, dentistry, nursing, social work and optometry.
 
The findings show that male students are more likely to explicitly state their bias toward overweight or obese people compared to females, who expressed greater empathy.
 
‘They held a greater fear of “gaining weight” themselves,’ Miss Jayawickrama said.
 
‘A smaller number of students did express empathy for people living with obesity and were more likely to view them with compassion, understand their emotions, and the ongoing challenges they face when trying to lose weight and maintain weight loss.’
 
Dr Terri-Lynne South, Chair of RACGP Specific Interests Obesity Management, told newsGP she was not surprised by the findings.
 
‘I was at a conference in Melbourne recently with doctors and allied health professionals run by a psychologist,’ she said.
 
‘We did an IAT in weight bias, and even us as health professionals had unconscious internal weight associations. We discussed this as a group; we are still part of that larger community that has weight bias and a lot of it was unconscious.
 
‘The psychologist who ran the course showed our curve [of results] wasn’t that different to the general population. We are also humans, and we still have the same influences that the rest of the world has.’
 
Dr South, who is a GP and dietitian, now works exclusively in metabolic and weight management. She says the best way to improve weight biases among future healthcare professionals is to address them openly.
 
‘We have to say, “this is normal”. We don’t want healthcare students to be shamed for being human,’ Dr South said.
 
‘We all work in this area and are trying to reduce our weight biases, but our own upbringing affects us.
 
‘We can’t help or reverse something if we don’t know it’s there. That’s why I like the IAT, which brings up unconscious thoughts.’
 
Dr South has personally seen the secondary health consequences for patients ‘in bigger bodies’.
 
‘They aren’t getting the standard treatment,’ she said.
 
‘In my previous role, for my female weight population, we didn’t have the adequate equipment for things like internal examinations and pap smears.
 
‘Also, not having the appropriate beds and having to take them to the treatment room where the beds could take the greater weight.
 
‘I could only close the curtains, so this meant less privacy, extra time, and here I am thinking I’m a sensitive, caring health professional, but I didn’t see it as a potential problem for all my patients living in a bigger body.’
 
This type of experience, Dr South says, could lead to patients avoiding such examinations or investigations in the future.
 
The Queensland-based GP and dietitian now runs a service incorporating both her dietetics and medical backgrounds to tackle the whole range of obesity management, from diet, medications and prevention to surgical aftercare.
 
‘Most GPs have a reasonable understanding of what healthy eating is,’ Dr South said.
 
‘They also have it from an exercise prescription point of view. It’s also the mode of “yes we can” as GPs to also provide focused psychological strategies and behaviour change for habits.
 
‘We need to help patients understand from a metabolic and mental health point of view how to improve their health.’
 
The RACGP released a policy statement regarding obesity in 2019, advocating that the focus be on ‘gaining health’ rather than simply ‘losing weight’.
 
The college called for more education of registrars and GPs in the prevention, detection and management of obesity, particularly since an estimated <1% of general practice consultations centre around obesity.
 
Last year, an Australian algorithm for the management of obesity was released, which provides a practical clinical tool to guide the implementation of existing worldwide guidelines.
 
The RACGP’s Red Book provides guidelines for overweight and obesity preventive measures.
 
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