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Addressing biases early on
Are medical students aware of their anti-obesity bias? Miller DP et al. Academic Medicine 2013;88(7):978-982.
Reviewed by Caroline Paul

What was the study question?
Are medical students biased against obese people? If so, are they aware of such a bias?

How was the study done?
Three consecutive classes (2008-2011) of third-year medical students at Wake Forest School of Medicine in Winston-Salem, North Carolina were asked to complete the Weight Implicit Association Test (IAT), a validated and well-described instrument designed to determine one's preference for "fat" or "thin" people. Students also completed a semantic differential to assess explicit preferences. Developed logistic regression models determined if co-variants predicted an anti-obesity bias.

What were the results?
Response rate for the study was 92% (324/354). With regards to explicit or conscious bias, the majority of students ( 72%) reported they preferred "thin" people over "fat" people. Males were twice as likely as females to report an anti-obesity bias. Regarding implicit or unconscious bias, 56% had a moderate or strong weight-related bias. 23% of those students with a significant weight-related bias were aware of such bias. Multivariate logistic regression showed that gender (male) only predicted explicit anti-obesity bias.

What are the implications of these findings?

The majority of students reported an anti-obesity bias. T he authors describe interventions they have implemented at their institution to address this bias including in-class discussions and online educational modules (available freely at This study highlights the clinical topic of obesity in the context of provider/learner bias.

Editor's note: The authors have developed a multi-faceted educational approach to address the students' anti-obesity bias (which is shared by both the general population and physicians). They recognize that both explicit (conscious) and implicit (unconscious) biases have the potential to negatively affect patient care and patient outcomes and are trying to address these early in the medical students' careers (SLB).

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