first-year medical students from 49 medical schools were examined to measure explicit and implicit weight biases. 11% 15% 15% 27% 32% 5% 29% 9% 19% 39% Pro-fat Bias No Bias Slight Anti-fat Bias Moderate Anti-fat Bias Strong Anti-fat Bias Explicit Implicit Majority of students express explicit and implicit weight bias *Stronger weight bias among students who were male, white or Hispanic, and with lower BMI 14 INCREASES IN: Empathy Confidence in interacting with patients of higher weight Understanding of the role of genetics and environment in obesity etiology DECREASES IN: Negative stereotyping about personal characteristics of patients with obesity Anti-fat biases Part 4: Physicians of the 21st Century: Training in Medical School Efforts to address weight bias need to begin early in medical training, so that students are provided with appropriate education and opportunities to practice skills that promote sensitive and effective patient care. In fact, recent studies with medical students evaluating education about weight stigma63-68 indicate that changes can begin early, including: In a 2013 study,69 60 medical students completed an optional weight management experience that included an evaluation of their BMI, weight loss and health behavior goal setting, and selfmonitoring (of calories, exercise, or weight loss). Common themes that arose from this experience included, - Better understanding of how to help patients and provide resources - Increased empathy for patients - Better able to educate and encourage patients - Realization that dieting and exercise is difficult to sustain Research Highlight 15 Practice Interpersonal & Communication Skills • Promote empathy and compassion for building rapport with patients and family • Provide experiental learning opportunities with standardized patients • Foster skills to effectively collaborate within an inter-disciplinary team (e.g., nutritions, therapists, psychologists) Training for Patient-Centered Care • Instill competency in counseling patients about lifestyle changes • Develop motivational interviewing skills for discussing weight management efforts with patients Strategies to teach students about weight bias: Educate about the Complexity of Obesity • Explain the multi-faceted etiology of obesity • Identify the environmental, biological, and genetic conributors of obesity, which have little to do with personal willpower or control Part 4: Physicians of the 21st Century: Training in Medical School In 2011, a pilot program was launched to improve medical students’ attitudes towards and care for patients with obesity.68 The pilot program included: - Establishment of a longitudinal relationship with patient undergoing bariatric surgery - Faculty mentorship - Self-reflection journal Upon completion, common reflection themes included, - awareness of physicians’ attitudes about obesity - recognition of obesity stereotypes - improved estimation of body mass index Research Highlight 16 Lead by Example • Model sensitive and non-stigmatizing practices in your care • Provide experiential opportunities such as discussing weight and health, and recording weight and height • Facilitate discussions about patients with obesity in response to assigned readings or videos, or about first-hand experiences Encourage Personal Development • Increase student awareness of personal weight biases • Guide practices in selfreflection and perspectivetaking • Help identify personal and professional improvement goals Checklist: Are my students able to… ü Understand how diet and exercise are among many different factors causing obesity? ü Identify plans and resources for health behavior changes? ü Make appropriate referrals? ü Use patient-centered communication skills to discuss weight-related health with patients? ü Acknowledge personal biases toward patients with overweight? ü Understand how weight affects patients’ social and emotional experiences? ü Set goals for selfimprovement? Part 4: Physicians of the 21st Century: Training in Medical School 17 After looking over her chart, her doctor says: Consider these questions: Part 4: Case Example: Sherry Everything here looks pretty good, except that your glucose is a little high. If you lose some weight, it probably won’t develop into anything serious. Sherry replies: Please read the case example and consider the questions below: Sherry is meeting with her doctor for a routine primary care visit. She is 28 years old, weighs 236 pounds and has a BMI of 39. She hasn’t seen her doctor in 3 years. The last time she visited her doctor, he recommended that she lose weight. Sherry has made some healthy changes in her life, but she has been unable to maintain significant weight loss. She has stopped drinking sugary beverages, walks to work every day, and tries to make healthy food choices. “I’ve tried to lose weight and it never works. I’ve lost over 30 pounds, but I just keep regaining it back.” Her doctor replies: “You just need to try harder. Losing weight is a simple matter of eating less and exercising more. Why don’t you try skipping desserts and doing some exercise? Maybe join a gym?” What assumptions is the doctor making about Sherry based on her weight? Is the doctor underestimating how difficult it is for some people to lose weight? Why or why not? How might Sherry react to her doctor’s words? Will she be motivated to “try harder?” What could her doctor have said instead that might motivate Sherry to continue to make healthier lifestyle changes?