Medical Science Educator

, Volume 28, Issue 2, pp 327–333 | Cite as

Medical Student Weight Bias: the Relationship of Attitudinal Constructs Related to Weight Management Counseling

  • Cassie A. Eno
  • Thomas P. Guck
  • Taraneh Soleymani
  • Karen M. Ashe
  • Linda C. Churchill
  • Sybil L. Crawford
  • Christine F. Frisard
  • Rashelle B. Hayes
  • Leslee Martin
  • Katherine L. Margo
  • Lori Pbert
  • Jyothi A. Pendharkar
  • Monica Ann Shaw
  • Judith K. Ockene
Original Research


Obesity is a prevalent disease that is often a source of stigmatization. Weight bias has been documented in healthcare settings and associated with less physician time spent with patients, less patient-centered communication, and more patient delay or withdrawal from care. Weight bias is widespread in society and the healthcare field, including among medical students. This study examined the hypothesis that weight bias in medical students is related to negative attitudes toward weight management counseling (WMC), perceived WMC skills, and self-efficacy for WMC. A sample of 762 medical students during their core clerkship rotation (graduating class of 2017) from eight US medical schools completed questions related to weight bias, attitudes toward WMC, perceived WMC skills, and self-efficacy for WMC. Results indicated that medical students with more weight bias held more negative attitudes toward WMC, even after adjustment for age, gender, and intended medical specialty. Weight bias was not significantly related to perceived WMC skills or self-efficacy for WMC. Females had a more positive attitude toward WMC, but lower perceived WMC skills and self-efficacy for WMC than males. Males had significantly more weight bias and were less likely to choose primary care than females. Implications for medical education are discussed.


Weight bias Weight management counseling Medical students Medical education 



The MSWeight program is supported by a grant from NCI. The authors thank the MSWeight investigators and staff, the participating medical schools and students, and the weight bias consultant for their dedication and making this study possible. We acknowledge all school site PIs, research coordinators, evaluators, research assistants, support staff, and the participating medical students and course directors who have implemented and participated in the study thus far.


Research reported in this publication was supported by the National Cancer Institutes of Health under Award 5R01CA194787. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011–2014. NCHS Data Brief. 2015;219:1–8.Google Scholar
  2. 2.
    Ogden CL, Carroll MD, Lawman HG, Fryar CD, Kruszon-Moran D, Kit BK, et al. Trends in obesity prevalence among children and adolescents in the United States, 1988–1994 through 2013–2014. JAMA. 2016;315(21):2292–9. Scholar
  3. 3.
    Puhl RM, Heuer CA. Obesity stigma: important considerations for public health. Am J Public Health. 2010;100(6):1019–28. Scholar
  4. 4.
    Puhl RM, Heuer CA. The stigma of obesity: a review and update. Obesity (Silver Spring). 2009;17(5):941–64. Scholar
  5. 5.
    Washington RL. Childhood obesity: issues of weight bias. Prev Chronic Dis. 2011;8(5):A94.Google Scholar
  6. 6.
    Crandall CS. Prejudice against fat people: ideology and self-interest. J Pers Soc Psychol. 1994;66(5):882–94. Scholar
  7. 7.
    Lieberman DL, Tybur JM, Latner JD. Disgust sensitivity, obesity stigma, and gender: contamination psychology predicts weight bias for women, not men. Obesity (Silver Spring). 2012;20(9):1803–14. Scholar
  8. 8.
    Sabin JA, Marini M, Nosek BA. Implicit and explicit anti-fat bias among a large sample of medical doctors by BMI, race/ethnicity and gender. PLoS One. 2012;7(11):e48448. Scholar
  9. 9.
    Schwartz MB, O’Neal Chambliss H, Brownells KD, Blair SN, Billngton C. Weight bias among health professionals specializing in obesity. Obes Res. 2003;11(9):1033–9. Scholar
  10. 10.
    Teachman BA, Brownell KD. Implicit anti-fat bias among health professionals: is anyone immune? Int J Obes Relat Metab Disord. 2001;25(10):1525–31. Scholar
  11. 11.
    Hebl MR, Xu J. Weighing the care: physicians’ reactions to the size of a patient. Int J Obes Relat Metab Disord. 2001;25(8):1246–52. Scholar
  12. 12.
    Khandalavala BN, Rojanala A, Geske JA, Koran-Scholl JB, Guck TP. Obesity bias in primary care providers. Fam Med. 2014;46(7):532–5.Google Scholar
  13. 13.
    Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griffin JM, van Ryn M. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev. 2015;16(4):319–26. Scholar
  14. 14.
    Pantenburg B, Sikorski C, Luppa M, Schomerus G, König HH, Werner P, et al. Medical students’ attitudes toward overweight and obesity. PLoS One. 2012;7(11):e48113. Scholar
  15. 15.
    Miller DP, Spangler JG, Vitolins MZ, Davis SW, Ip EH, Marion G, et al. Are medical students aware of their anti-obesity bias? Acad Med. 2013;88(7):978–82. Scholar
  16. 16.
    Phelan SM, Dovidio JF, Puhl RM, Burgess DJ, Nelson DB, Yeazel MW, et al. Implicit and explicit weight bias in a national sample of 4732 medical students: the medical student CHANGES study. Obesity (Silver Spring). 2014;22(4):1201–8. Scholar
  17. 17.
    Phelan S, Puhl RM, Burke SE, Hardeman R, Dovidio JF, Nelson DB, et al. The mixed impact of medical students’ implicit and explicit weight bias. Med Ed. 2015;49(10):983–92. Scholar
  18. 18.
    Persky S, Eccleston CP. Medical student bias and care recommendations for an obese versus non-obese virtual patient. Int J Obes. 2011;35(5):728–35. Scholar
  19. 19.
    Andrade AD, Ruiz JG, Mintzer MJ, Cifuentes P, Anam R, Diem J, et al. Medical students’ attitudes toward obese patient avatars of different skin color. Stud Health Technol Inform. 2012;173:23–9.Google Scholar
  20. 20.
    Puhl RM, Luedicke J, Grilo CM. Obesity bias in training: attitudes, beliefs, and observations among advanced trainees in professional health disciplines. Obesity (Silver Spring). 2014;22(4):1008–15. Scholar
  21. 21.
    Association of American Medical Colleges. The prevention and treatment of overweight and obesity. In Report VIII, Contemporary Issues in Medicine, Medical School Objectives Project. USA: Association of American Medical Colleges; 2007.Google Scholar
  22. 22.
    Alberga AS, Pickering BJ, Hayden KA, Ball GDC, Edwards A, Jelinski S, et al. Weight bias reduction in health professionals: a systematic review. Clin Obes. 2016;6(3):175–88. Scholar
  23. 23.
    Wiese HJ, Wilson JF, Jones RA, Neises M. Obesity stigma reduction in medical students. Int J Obes Relat Metab Disord. 1992;16(11):859–68.Google Scholar
  24. 24.
    Poustchi Y, Saks NS, Piasecki AK, Hahn KA, Ferrante JM. Brief intervention effective in reducing weight bias in medical students. Fam Med. 2013;45(5):345–8.Google Scholar
  25. 25.
    Persky S, Eccleston CP. Impact of genetic causal information on medical students’ clinical encounters with an obese virtual patient: health promotion and social stigma. Ann Behav Med. 2011;41(3):363–72. Scholar
  26. 26.
    Kushner RF, Zeiss DM, Feinglass JM, Yelen M. An obesity educational intervention for medical students addressing weight bias and communication skills using standardized patients. BMC Med Educ. 2014;14(1):53. Scholar
  27. 27.
    Roberts DH, Kane EM, Jones DB, Almeida JM, Bell SK, Weinstein AR, et al. Teaching medical students about obesity: a pilot program to address an unmet need through longitudinal relationships with bariatric surgery patients. Surg Innov. 2011;18(2):176–83. Scholar
  28. 28.
    Matharu K, Shapiro JF, Hammer RR, Kravitz RL, Wilson MD, Fitzgerald FT. Reducing obesity prejudice in medical education. Ed Health. 2014;27(3):231–7. Scholar
  29. 29.
    Ockene JK, Ashe KM, Hayes RB, Churchill LC, Crawford SL, Geller AC, et al. Design and rationale of the medical students learning weight management counseling skills (MSWeight) group randomized control trial. Contemp Clin Trials. 2018;64:58–66. Scholar
  30. 30.
    Ip EH, Marshall S, Vitolins M, Crandall SJ, Davis S, Miller D, et al. Measuring medical student attitudes and beliefs regarding patients who are obese. Acad Med. 2013;88(2):282–9. Scholar
  31. 31.
    Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Obesity Society. J Am Coll Cardiol. 2014;63(25 Pt B):2985–3023.CrossRefGoogle Scholar
  32. 32.
    Fitzmaurice GM, Laird NM, Ware JH. Applied longitudinal analysis. New York: Wiley; 2004.Google Scholar
  33. 33.
    Xu R. Measuring explained variation in linear mixed effects models. Stat Med. 2003;22(22):3527–41. Scholar
  34. 34.
    Molenberghs G, Verbeke G. Models for discrete longitudinal data. New York: Springer Science and Business Media, Inc; 2005.Google Scholar
  35. 35.
    Smith S, Seeholzer EL, Gullett H, Jackson B, Antognoli E, Krejci SA, et al. Primary care residents’ knowledge, attitudes, self-efficacy, and perceived professional norms regarding obesity, nutrition, and physical activity. J Grad Med Educ. 2015;7(3):388–94. Scholar
  36. 36.
    Vitolins MZ, Crandall S, Miller D, Ip E, Marion G, Spangler JG. Obesity education interventions in U.S. medical schools: a systematic review and identified gaps. Teach Learn Med. 2012;24(3):267–72. Scholar
  37. 37.
    Latner JD, O’Brien KS, Durso LE, Brinkman LA, MacDonald T. Weighing obesity stigma: the relative strength of different forms of bias. Int J Obes. 2008;32(7):1145–52. Scholar

Copyright information

© International Association of Medical Science Educators 2018

Authors and Affiliations

  • Cassie A. Eno
    • 1
  • Thomas P. Guck
    • 1
  • Taraneh Soleymani
    • 2
  • Karen M. Ashe
    • 3
  • Linda C. Churchill
    • 3
  • Sybil L. Crawford
    • 3
  • Christine F. Frisard
    • 3
  • Rashelle B. Hayes
    • 4
  • Leslee Martin
    • 5
  • Katherine L. Margo
    • 6
  • Lori Pbert
    • 3
  • Jyothi A. Pendharkar
    • 3
  • Monica Ann Shaw
    • 5
  • Judith K. Ockene
    • 3
  1. 1.Creighton University School of MedicineOmahaUSA
  2. 2.University of Alabama at BirminghamBirminghamUSA
  3. 3.University of Massachusetts Medical SchoolWorcesterUSA
  4. 4.Virginia Commonwealth University School of MedicineRichmondUSA
  5. 5.University of Louisville School of MedicineLouisvilleUSA
  6. 6.Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA

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