Skip to main content
Log in

Addressing Bias Toward Overweight Patients: a Training Program for First-Year Medical Students

  • Original research
  • Published:
Medical Science Educator Aims and scope Submit manuscript



Physicians may have biases toward overweight patients which likely influences clinical judgments and can lead to disparities in patient care. An increasing number of adults are considered overweight/obese, so it is important to address these biases in training future physicians.


Forty-five first-year medical students participated in art museum programs and physician presentations, or were part of the control group. Four validated measures Beliefs About Obese Persons Scale, Attitudes Toward Obese Persons Scale, Fat Phobia Scale, and the Harvard Implicit Association Test (IAT) and researcher-generated questions, measured levels of bias before and after study activities.


All participants demonstrated decreased bias. ANCOVA analysis did not reveal significant differences between the experimental and control groups. However, prior to the study 75% of participants had “preference for thin individuals.” Forty percent of those participating in study activities indicated a positive change by associating more positive traits with obese body shapes, compared to 29% of the control group. Study activities were rated positively.


The art museum was an engaging/relaxing place for reflection on body types and biases. Physicians provided important instruction for normalization/de-stigmatization of patient care. Although there were no significant findings, the study has raised questions for continuing this work. What are most effective ways/times to address weight bias within the medical school curriculum? Could this work extend to other marginalized patient groups? The diversity in art and humanities creates a rich resource for discussing viewpoints and experiences. The small number of participants and the timing/lack of focus in museum sessions are noted as limitations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


  1. The World Health Organization has defined “overweight” as a body mass index (BMI) between 25 and < 30 and “obese” as a BMI over 30. For this study, the two terms are used interchangeably.

  2. Examples of art museum and medical school partnerships can be found at


  1. CDC. Adult obesity facts. 2020. Accessed January 6 2021.

  2. WHO. Obesity and overweight. 2020. Accessed January 6 2021.

  3. AAMC. Contemporary issues in medicine: the prevention and treatment of overweight and obesity. 2007.

  4. George TP, DeCristofaro C, Murphy PF, editors. Unconscious weight bias among nursing students: a descriptive study. Healthcare. Multidisciplinary Digital Publishing Institute. 2019.

  5. Chapman EN, Kaatz A, Carnes M. Physicians and implicit bias: how doctors may unwittingly perpetuate health care disparities. J Gen Int Med. 2013;28(11):1504–10.

    Article  Google Scholar 

  6. Wolf C. Physician assistants’ attitudes about obesity and obese individuals. J Allied Health. 2012;41(2):45E-8E.

    Google Scholar 

  7. 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.

    Article  Google Scholar 

  8. Hatzenbuehler ML, Keyes KM, Hasin DS. Associations between perceived weight discrimination and the prevalence of psychiatric disorders in the general population. Obesity. 2009;17(11):2033–9.

    Article  Google Scholar 

  9. McGuigan RD, Wilkinson JM. Obesity and healthcare avoidance: a systematic review. AIMS Public Health. 2015;2(1):56–63.

    Article  Google Scholar 

  10. Fontaine KR, Faith MS, Allison DB, Cheskin LJ. Body weight and health care among women in the general population. Arch Fam Med. 1998;7(4):381.

    Article  Google Scholar 

  11. 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. 2014;22(4):1201–8.

    Article  Google Scholar 

  12. Phelan SM, Puhl RM, Burke SE, Hardeman R, Dovidio JF, Nelson DB, et al. The mixed impact of medical school on medical students’ implicit and explicit weight bias. Med Educ. 2015;49(10):983–92.

    Article  Google Scholar 

  13. Miller DP, Spangler JG, Vitolins MZ, Davis SW, Ip EH, Marion GS, et al. Are medical students aware of their anti-obesity bias? Acad Med J Assoc Am Med Coll. 2013;88(7):978–82.

    Article  Google Scholar 

  14. 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 

  15. Health Care Providers. In: Weight bias & stigma. UConn Rudd Center for Food Policy & Obesity. Accessed January 6, 2021.

  16. Understanding Obesity Stigma. Obesity Action Coalition. Accessed January 6, 2021.

  17. O’Brien Kerry S, Puhl Rebecca M, Latner Janet D, Mir Azeem S, Hunter John A. Reducing anti-fat prejudice in preservice health students: a randomized trial. Obesity. 2012;18(11):2138–44.

    Article  Google Scholar 

  18. Puhl RM, Schwartz MB, Brownell KD. Impact of perceived consensus on stereotypes about obese people: a new approach for reducing bias. Health Psychol. 2005;24(5):517–25.

    Article  Google Scholar 

  19. Essel KD, Hysom EK, Goldman EF, Lichtenstein C. The resident experience of an obesity-focused home visiting curriculum. Med Sci Educ. 2019;29(1):113–9.

    Article  Google Scholar 

  20. Howley L, Gaufberg E, King B. The fundamental role of arts and humanities in medical education. Washington, DC: AAMC; 2020.

    Google Scholar 

  21. Art Museum-Based Health Professions Education Fellowship. Harvard Macy Institute. Accessed January 23 2021.

  22. Jasani SK, Saks NS. Utilizing visual art to enhance the clinical observation skills of medical students. Med Teach. 2013;35(7):e1327–31.

    Article  Google Scholar 

  23. Schaff PB, Isken S, Tager RM. From contemporary art to core clinical skills: observation, interpretation, and meaning-making in a complex environment. Acad Med. 2011;86(10):1272–6.

    Article  Google Scholar 

  24. Naghshineh S, Hafler J, Miller A, Blanco M, Lipsitz S, Dubroff R, et al. Formal art observation training improves medical students’ visual diagnostic skills. J Gen Int Med. 2008;23(7):991–7.

    Article  Google Scholar 

  25. Boudreau JD, Cassell EJ, Fuks A. Preparing medical students to become skilled at clinical observation. Med Teach. 2008;30(9–10):857–62.

    Article  Google Scholar 

  26. Karanfilian BV, Saks NS. Measuring the effects of an observation training program for first-year medical students. Med Sci Educ. 2018;28(4):649–53.

    Article  Google Scholar 

  27. Mangione S, Chakraborti C, Staltari G, Harrison R, Tunkel AR, Liou KT et al. Medical students’ exposure to the humanities correlates with positive personal qualities and reduced burnout: a multi-institutional U.S. survey. J Gen Int Med. 2018;33(5):628–34.

  28. Matharu K, Shapiro J, Hammer R, Kravitz R, Wilson M, Fitzgerald F. Reducing obesity prejudice in medical education. Educ Health. 2014;27(3):231–7.

    Article  Google Scholar 

  29. Allison DB, Basile VC, Yuker HE. The measurement of attitudes toward and beliefs about obese persons. Int J Eating Disord. 1991;10(5):599–607.

    Google Scholar 

  30. Bacon JG, Scheltema KE, Robinson BE. Fat phobia scale revisited: the short form. Int J Obesity. 2001;25(2):252.

    Article  Google Scholar 

  31. Greenwald AG, Poehlman TA, Uhlmann EL, Banaji MR. Understanding and using the Implicit Association Test: III. Meta-analysis of predictive validity. J Pers Soc Psychol. 2009;97(1):17–41.

  32. An Artful Approach to Medicine. The Perelman School of Medicine at the University of Pennsylvania, AAMC. Accessed January 6, 2021.

  33. Bombak AE, Meadows A, Billette J. Fat acceptance 101: Midwestern American women’s perspective on cultural body acceptance. Health Sociol Rev. 2019;28(2):194–208.

    Article  Google Scholar 

  34. Kelly L, Daneshjoo S. Instagram & body positivity among female adolescents & young adults. J Adolesc Health. 2019;64(2):S134–5.

    Article  Google Scholar 

  35. Savoy S, Boxer P. The impact of weight-biased media on weight attitudes, self-attitudes, and weight-biased behavior. Psychol Pop Media. 2020;9(1):31–44.

    Article  Google Scholar 

  36. Sayej N. Race, resistance and revolution: what to expect from US art in 2020. The Guardian. January 6, 2020.

Download references


The authors would like to thank Donna Gustafson, PhD, and the Rutgers University Zimmerli Art Museum, and Liesel Copeland PhD for assistance in completing this project.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Norma Saks.

Ethics declarations

Ethics Approval

This study was reviewed and approved as exempt research by the Rutgers University New Brunswick Health Sciences Review Board.

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nestorowicz, S., Saks, N. Addressing Bias Toward Overweight Patients: a Training Program for First-Year Medical Students. Med.Sci.Educ. 31, 1115–1123 (2021).

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: