Casting a too-critical eye on obese patients

Even health professionals who specialize in treating and studying obesity aren’t immune to anti-fat bias. Like many Americans, they too tend to view excess pounds as a character failing -- even if only unconsciously, researchers have reported.

Doctors, nurses, pharmacologists, dietitians and lab scientists have all been taught that obesity is rooted not just in personal habits but in a mix of genetics and environmental influences.

And yet a survey of nearly 400 health professionals found “how difficult it is to fight these automatic beliefs and messages in our culture that fat people are lazy and stupid,” said Marlene B. Schwartz, lead author of a study appearing in the current issue of the journal Obesity Research. “I think what we were surprised by was that all of us are vulnerable.”

The bias could affect health professionals’ ability to empathize and support overweight patients, although the study couldn’t determine if patient care was compromised, said Schwartz, a Yale University psychology researcher. The health community needs to be more aware of its vulnerability to anti-fat messages, she said. “Unlike your unconscious associations, your behavior is something you control, so physicians and the health professionals can get training to learn to monitor their own behavior.”

The findings were based on responses of 389 clinicians and researchers -- 198 women and 191 men -- to an Implicit Association Test administered at the opening session of the 2001 annual meeting of the North American Assn. for the Study of Obesity in Quebec City. It was designed to pick up overt and unconscious biases by measuring reaction times to various word associations.

Bias was greater among younger professionals and among women, which Schwartz attributed to the greater pressure on women to be thin. Bias was mitigated by the subjects either having obese friends or being obese themselves. And those survey subjects who worked most closely with obese people were less biased than those removed from patient contact.

The study was funded by the Rudd Institute, a nonprofit organization that funds academic research into bias, stigma and discrimination against obesity, and goes by the motto: “See the person, not the pounds.”