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Weight bias among Australian healthcare students could impact future care

Australian healthcare students often hold negative attitudes and beliefs towards people living with obesity, which could lead to poor clinical care outcomes, according to the findings of a study led by researchers from Curtin University. The study surveyed 900 health care students across 39 Australian universities and found students held explicit and implicit weight-biased attitudes and beliefs, were fearful of "gaining weight" and lacked confidence in clinical settings when helping patients living with overweight.

"Our study found the level of weight bias exhibited by Australian health care students was alarming and has the potential to negatively impact the care that people living with obesity receive, contributing to poor health outcomes and quality of life. These impacts could include spending less time in consultations, raising unwarranted concerns about a patient's weight, and being unwilling to perform certain examinations," explained lead researcher and PhD student, Ravisha Jayawickrama, from the Curtin School of Population Health. "Students surveyed believed that obesity was within a person's control and that they lacked willpower, while some expressed dislike towards people living with overweight or obesity. We also found male students were more likely to explicitly state their bias toward these groups, and while females expressed greater empathy for these patients, they held a greater fear of 'gaining weight' themselves. A smaller number of students did express empathy for people living with obesity and were more likely to view them with compassion, understand their emotions, and the ongoing challenges they face when trying to lose weight and maintain weight loss."


In their cross-sectional study, Australian university students enrolled in health care courses were invited via social media advertisements, snowball and convenience sampling, and by making direct contact with universities to complete an online survey. The students provided demographic information including discipline of study, perceived weight status and state of residence. Students then completed several measures which assessed their explicit and implicit weight bias, and empathy. Descriptive statistics established the presence of explicit and implicit weight bias, and ANCOVAs, ANOVA, and multiple regression analyses were conducted to examine the potential factors associated with students’ exhibited weight bias.

In total, 900 eligible health care students attending 39 Australian universities participated in the study. Students reported varying levels of explicit and implicit weight bias, with minimal differences between disciplines on most outcome measures. Students who identified as men (vs. women) exhibited higher of both explicit and implicit bias (Beliefs About Obese Persons (BAOP): p=0.0002, Antifat Attitudes Questionnaire (AFA)—Dislike: p = 0.019, AFA Willpower p<0.0001, Empathy for Obese Patients: p=0.0011, Implicit Association Test: p=0.022), and students who displayed greater (vs. less) empathic concern exhibited lower levels of explicit bias (BAOP, AFA Dislike and Willpower, and Empathy for Obese Patients: p<0.0001).


Having witnessed the enactment of weight stigma sporadically (vs. regularly) by role models was associated with greater attribution of the causes of obesity to willpower (a few times a month vs. daily: p=0.020, a few times a year vs. daily: p=0.022), and less time spent with people living with overweight or obesity outside of study was associated with more dislike (a few times a month vs. daily: p=0.0048, once a month vs. daily: p=0.0002) and less fear of fat (once a month vs. daily: p=0.036, and once a month vs. a few times a week: p=0.0028).


"Australian health care students are going to be future health practitioners, doctors and nurses, so it is critical that educators and universities play a key role in reducing this stigma and weight bias exhibited by these students,” added senior co-author, Dr Blake Lawrence, also from the Curtin School of Population Health. “Given the predicted rise in obesity, we need to better educate our students, health care trainees and practicing professionals on the negative impact of weight bias to enhance the Australian healthcare system. No individual, no matter their weight, color, gender or ethnicity, should experience discrimination when seeking medical attention. We need to support students to develop the skills and abilities that will enable overweight and obese people to be treated with equity and dignity in health care settings."


The findings were reported in the paper,’Explicit and implicit weight bias among health care students: a cross-sectional study of 39 Australian universities’, published in eClinicalMedicine, To access this paper, please click here

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