Bias can affect the care of certain groups, including obese patients.
There are no studies evaluating the presence of bias exclusively in pediatricians or in pediatric residents. Moreover, there are no studies evaluating how to change anti-obesity bias in pediatric residents. The purpose of this paper is to describe how we found answers to these queries, first, by confirming the presence of anti-obesity bias in pediatric residents and, second, by evaluating the efficacy of an obesity curriculum to modify any initial bias.
The Implicit Association Test (IAT), a tool designed to demonstrate implicit bias, has been used to demonstrate implicit weight bias among health care students and practitioners,
A small group of pediatric residents were evaluated for their explicit and implicit anti-obesity bias. The initial IAT average indicated strong to moderate automatic preference for thin people. In addition, there was evidence of explicit bias based on questionnaire responses. This was more evident in the senior resident class.
An important aspect of changing bias is to recognize its presence. A study revealed that over one third of medical students at one university had implicit anti-fat bias, but most were not aware of the bias.
There is evidence that bias may be even greater long after medical school and residency training have been completed. A study reviewing bias in primary care providers found that those with more years of practice had greater feelings of dislike towards the obese. The authors proposed that ongoing continuing education on obesity and bias should be provided particularly to those who have been in practice the longest.
Early interventions could modify bias, in favor of better health care for the obese. To date, there is no study demonstrating that education can modify implicit bias in pediatric residents.
An obesity curriculum was designed and implemented to understand the impact of education. The curriculum was provided as a lecture series, reading material and video. The lecture series was divided into four 30-minute lectures on obesity diagnosis, management, and bias. A second IAT was administered 6 weeks after completion of the curriculum, demonstrating that there was significant improvement from pre to post IAT scores. The participants were also invited to take part in a group discussion once the second IAT and the lecture series were completed. The residents stated that awareness of their bias made them more likely to be mindful of their own attitude during a clinical encounter. Those who reported anti-obesity bias stated that this bias was likely due to their own history of obesity or due to frustration with patients on their lack of success with weight loss.
Anti-obesity bias is undeniably present among pediatric residents. Acknowledging the existence of anti-obesity bias in healthcare is the first step towards change.
Educational interventions can decrease anti-obesity bias. This confirms the value of obesity education, and provides an argument to pediatric residency training programs towards dedicating time and resources to this endeavor.
The ultimate goal of understanding anti-obesity bias should be to provide state of the art, timely, and compassionate care to all patients with obesity. Future studies may need to link changes in pediatric residents’ bias with patient satisfaction and health care cost and outcomes.
I wish to thank Kimberly Reid, Ellen Tessmann, Lisa A. Holstrom, and Robert Harper for their review and suggestions in the preparation of this manuscript.
The author declares that they have no conflict of interest.