Many med students biased against obese or thin patients

More than one-third of 310 medical students surveyed had a moderate to strong bias against obese people, according to a recent study.1 Researchers gave third-year medical students Harvard’s Implicit Association Test on weight, which measures how long it takes for people to associate a positive word with an image of a person who is either thin or obese. Overall, 39% of medical students had a moderate to strong unconscious anti-fat bias. Less than 25% of students were aware of their biases.

In addition, 17% had a moderate to strong anti-thin bias. “We were surprised that none of these students recognized their preference for obese individuals,” says David P. Miller, MD, MS, the study’s lead author and an associate professor of internal medicine at Wake Forest School of Medicine in Winston-Salem, NC.

“Just like the students with an anti-obesity bias, they thought they, too, were either neutral or preferred thin people,” says Miller. “It made us wonder if anti-obesity bias has become so common in our society, that even students who prefer obese people to thin people have a hard time believing it.”

Physicians strive to treat all patients equally, deliver the best care possible, and treat everyone with respect, and bias or prejudice interferes with the ability to accomplish those goals, says Miller. “This is why it is critical for medical schools to teach their students about bias and strategies for minimizing its impact on patient care,” he urges.

The study’s findings are consistent with other studies that have examined physicians’ weight-related attitudes and preferences. Other studies have found that many physicians assume obese patients are unlikely to follow healthy lifestyle recommendations or adhere to medical treatments.2-4

“Another study using the same bias test we used found a high rate of anti-obesity bias among practicing physicians. In that study, even obese physicians showed a bias against obese individuals,” says Miller.5

Research has shown that bias affects the diagnoses doctors make and the treatments they recommend.6 “Bias can also harm trust,” says Miller. “People tend to notice if someone has an initial negative reaction to them. Patients who sense this bias will be less likely to trust their doctors or confide in them.”

Addressing bias in medical care has proven difficult, however. “One strategy that some experts recommend is reframing the medical encounter as a chance to practice egalitarian goals,” says Miller. “Bioethicists could help teach students these principles and strategies for putting them into practice.”


1. Miller D, Spangler, J, Vitolins M. Are medical students aware of their anti-obesity bias? Acad Med 2013 May 22. [Epub ahead of print]

2. Ferrante JM, Piasecki AK, Ohman-Strickland PA, et al. Family physicians’ practices and attitudes regarding care of extremely obese patients. Obesity 2009;17:1710-1716.

3. Foster GD, Wadden TA, Makris AP, et al. Primary care physicians’ attitudes about obesity and its treatment. Obesity Research 2003;11:1168-1177.

4. Jochemsen-van der Leeuw HG, van Dijk N, Wieringa-de Waard M, et al. Attitudes towards obesity treatment in GP training practices: A focus group study. Family Practice 2011;28:422-429.

5. Sabin JA, Marini M, Nosek BA. Implicit and explicit anti-fat bias among a large sample of medical doctors by BMI, race/ethnicity and gender. PLOS ONE 2012:e48448.

6. Sheifer SE, Escarce JJ, Schulman KA. Race and sex differences in the management of coronary artery disease. Am Heart J 2000; 139:848–857.


• David P. Miller, MD, MS, FACP, Associate Professor of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC. Phone: (336) 713-9800. E-mail: