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Med Students Unaware of Their Bias Against Obese Patients
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.'"
I'm not unaware. I know exactly what I think about fat people and It's not good.
"Doctors are more likely to assume that obese individuals won’t follow treatment plans"
The primary goal of our treatment plan is often to get them to lose weight to cure their hypertension and type 2 diabetes. It's not a bias if you see the same patient in clinic every few months for years and they continue to gain weight and ignore your recommendations.
**** ********* M.D. , PGY-4 Resident
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.
Well, you completely missed the point. Doctors who don't recognize their biases are more likely to misdiagnose patients that they're biased against.
Take me, for example. My kidneys failed due to IGA nephropathy, which has absolutely nothing to do with weight. I'm overweight, however, so for the first year of me feeling run down, getting sick often and having other health isuses my doctor insisted that I just needed to lose weight. He never bothered looking for other potential causes because, in his mind, the problem had to be that I was too fat and therefore didn't deserve any further attention.
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).
I must be one of the lucky few people in the U.S. then. I have two doctors who actually cared enough to get to know me as a person and realize why I have the problems that I have. One of those doctors is my E.N.T. He spent a lot of time and energy clearing up a chronic ear infection and has helped me with some other issues related to my health. The other "doctor" is a nurse practitioner who performed a yearly physical and found that I had a HORRIBLY under-active thyroid that lead to me gaining 30 pounds in just over 4 months. I have spent most of the past year on medication, adjusting the dosage to be correct for my needs. I figure between that and my joining a crossfit gym (if you need to know what it is use some Google fu) I will be loosing most of the weight I have gained. I had a coworker state that I am "unhealthy" because of my weight, yet this same person eats Chinese take out crap 6 days a week, and the other day he eats McDonald/taco bell/fast food and sees nothing wrong with this. He also thinks because he is thin he is in good shape. I have also seen some people who are rail thin, but have an astonishing high problem with diabetes, arthritis, high body fat percentage, and other issues. Yet the doctors tend to take one look at them and say oh you are perfect because you fit the model of health we are taught by the school/government. I have a friend who is overweight, and she knows it. She realizes she has a problem and is working on fixing it with medication, diet, exercise, and a support group. She has a medical condition that was found by a doctor, AFTER she demanded the appropriate tests. Her nutritionist and doctor spent a lot of time going round and round with the results from the test, the doctor did not believe it and thought that diet/exercise was the only reason for the problem. The nutritionist realized that it was a metabolism issue and that it would take some medication in addition to the normal move more, eat less regimen. She physically could not get appropriate nutrition from food, and that lead to eating more to get the required nutrition. This cycle lead to a bunch of other issues, the least of which being weight gain. The medical industry in the U.S. is BROKEN and requires a complete reboot. I have a friend who went to college and graduated with two undergrad degrees and had NO debt. This friend then went to medical school and racked up over three hundred thousand dollars in debt due to tuition, fees and expenses. This is after fighting to get a slot in med. school due to the AMA setting up a limit to how many slots can be made in a given year. He will now be spending the REST OF HIS LIFE paying off student loans from medical school. This same "education" taught outdated skills and minimized critical thinking outside of the industry standards. Thankfully he had an amazing bit of training from his grandparents who were doctors in another country, and knows how to fix things without resorting to over-used, over-priced medications. And he knows what it means to be unconsciously biased against as he is an openly gay man.
*Are* they less likely to follow treatment plans? It stands to reason that someone who won't do what's necessary for his health in one area might be less likely to do so in another area as well.
Studies have shown that the most common assumption is that fat people are lazy, undisciplined, unwilling to work hard, etc. -- not just in terms of health choices. Your comment is playing directly into that bias.
I think this bias, like most, actually does have some relationship to reality -- i.e., a greater percentage of fat people are likely to have these traits than others.
HOWEVER -- pre-judging an individual on the basis of a single characteristic is the very definition of "bias."
Even if 90% of obese people are lazy bastards who won't even try to listen to their doctor's advice (and I don't think the number is that high), that does not excuse a doctor who provides inferior treatment to the other 10% because of assumptions.
If the doctors' assumption is accurate, it's not bias in the sense implied.
That's like saying -- If a black person is driving around a rich neighborhood, he must be looking to steal something -- because "black people are more likely to commit crimes" is an "accurate" statistic.
Even if X is often correlated with Y, it doesn't justify the assumption that X always implies Y. When dealing with healthcare, these sorts of assumptions can literally be deadly, such as when a physician fails to search for secondary contributory causes of obesity in a particular patient because the assumption is just that the patient must be a lazy bastard who can't follow directions.