Reprinted from the Fall 2021 Issue of The Ohio Family Physician
By: Sami Nandyal, OMS-IV; Alanna Meadows, OMS-IV; Alicia Rodgers, OMS-IV; Gisselle Pichardo, OMS-II; and Sharon Casapulla, EdD, MPH; Ohio University Heritage College of Osteopathic Medicine
Weight bias in health care is an often overlooked topic in medical education that can lead to adverse health outcomes for large-bodied patients. Health professionals have been found to be less willing to /treat, spend less time with, and inappropriately— and sometimes neglectfully—fixate on patient weight as the cause of their health complaints. Patients who experience discriminatory comments or actions by their physician or other health care provider based on their weight tend to avoid care, delaying the discovery and treatment of health issues.1 This bias has roots before entering the field, as a study conducted by the University of Pennsylvania found that 70% of students reflected negative attitudes towards larger-bodied cadavers.2 Instances of weight bias do not occur in a vacuum; they intersect with and heighten the detrimental effects of racism, sexism, and homophobia that are perhaps more openly being addressed within the medical community.3
We were catalyzed to find a solution to this problem after hearing the story of a friend’s encounter with weight bias. She shared that physician after physician dismissed her complaints of abdominal pain for years, telling her with good intention that weight reduction may reduce her pain. Only years later, when a physician decided to do imaging, was a softball sized ovarian cyst discovered and removed. The patient shared that this was only one of many instances of discrimination by health care providers she had experienced based on her size.
Empathy impacts a physician’s ability to provide compassionate, unbiased, and patient-centered care.4,5,6 In order to increase empathy and reduce weight bias, we developed and tested an educational intervention with medical students, physicians, and students in other health professions. The intervention utilized real stories from patients who have experienced weight bias in medicine. Following a narrative medical approach, participants were asked to listen fully and then answer a series of empathy-based questions (e.g. How do you think the patient felt when this happened? How did you feel listening to their story?).7 Then, they engaged in small and large group discussions led by faculty and student facilitators.
Over 80 healthcare students and professionals (primarily DOs and DO students, but also MDs, nurses, physician assistants, and physical therapists) attended the workshop and participated in listening, empathy exercises, and group discussions surrounding the stories of size discrimination. In order to observe any effect on weight bias that the workshop had on participants, we asked participants to take a pre- and post-survey that included the weight bias tool, Attitudes Towards Obese Persons (ATOP).8 Weight bias decreased significantly post-intervention. Additionally, participants rated the stories from the workshop as “moving” (8.6/10 mean) and facilitators provided comments such as “[participants] expressed various emotional reactions: angry, frustrated, aware, listening, inspired by the storyteller’s perseverance” on their surveys.
We attribute the significant decrease in bias to the practice of empathy and listening that is integral to medical education and family medicine. Our results suggest that this humanistic approach may help reduce weight bias, thus reducing barriers to care and improving patient outcomes. We believe that empathetic, reflective practices in the form of this workshop should be used both in foundational medical education, as well as continuing medical education, to open the hearts and eyes of future and current health care providers to their role in addressing weight bias in medicine.
References available on the Ohio Academy of Family Physicians website.