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Med Students Unaware of Their Bias Against Obese Patients

Soulskill posted about a year ago | from the still-angry-that-santa-isn't-real dept.

Medicine 446

An anonymous reader sends news of a study which found that "two out of five medical students have an unconscious bias against obese people." The study, published in the Journal of Academic Medicine (abstract) examined med students from many different cultural and geographical backgrounds. "The researchers used a computer program called the Weight Implicit Association Test (IAT) to measures students’ unconscious preferences for 'fat' or 'thin' individuals. Students also answered a survey assessing their conscious weight-related preferences. The authors determined if the students were aware of their bias by seeing if their IAT results matched their stated preferences. Overall, 39 percent of medical students had a moderate to strong unconscious anti-fat bias as compared to 17 percent who had a moderate to strong anti-thin bias. Less than 25 percent of students were aware of their biases. 'Because anti-fat stigma is so prevalent and a significant barrier to the treatment of obesity, teaching medical students to recognize and mitigate this bias is crucial to improving the care for the two-thirds of American adults who are now overweight or obese,' Miller said. 'Medical schools should address weight bias as part of a comprehensive obesity curriculum.'"

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Med students (0, Interesting)

Anonymous Coward | about a year ago | (#43823533)

And you are unaware of your bias against med students, 2 out of 5 makes 40% I don't see how that justifies your title.

Re:Med students (3, Informative)

tysonedwards (969693) | about a year ago | (#43823799)

Are you unaware that "Less than 25 percent of students were aware of their biases" means that 75% were unaware of their biases?

Sounds as though that is a pretty apt title.
Sure, it is biases against "various weights" not just "overweight & obese", but the point still stands.

Re:Med students (0)

WillKemp (1338605) | about a year ago | (#43823817)

Are you unaware that "Less than 25 percent of students were aware of their biases" means that 75% were unaware of their biases?

Or it means that less than 25% were honest about their biases.

Re:Med students (0, Troll)

Runaway1956 (1322357) | about a year ago | (#43823861)

Let me ponder this for a minute.

A health care professional can be expected to have a bias regarding healthy vs unhealthy life choices. Being fat indicates that a person has made one HELL of a lot of unhealthy choices. Like - every single day, he eats to much.

Bias. Healthy, vs unhealthy. I'm weighing this in my mind.

Question: What would happen if physicians just decided that it's alright to be obese? When a fat bastard comes to visit the doctor, Doc says "You look FAAHHHBULOUS, you fat bastard! Are you getting enough to eat?"

IMO, there is something wrong with that 25% who are NOT biased against fat and obesity!

Re:Med students (5, Informative)

ebno-10db (1459097) | about a year ago | (#43823897)

A health care professional can be expected to have a bias regarding healthy vs unhealthy life choices.

No shit. That is not what they mean by bias in this study. RTFA:

“Bias can affect clinical care and the doctor-patient relationship, and even a patient’s willingness or desire to go see their physician, so it is crucial that we try to deal with any bias during medical school,” said David Miller, M.D., associate professor of internal medicine at Wake Forest Baptist and lead author of the study.

“Previous research has shown that on average, physicians have a strong anti-fat bias similar to that of the general population. Doctors are more likely to assume that obese individuals won’t follow treatment plans, and they are less likely to respect obese patients than average weight patients,” Miller said.

Re:Med students (1, Interesting)

Jiro (131519) | about a year ago | (#43824011)

*Are* they less likely to follow treatment plans? It stands to reason that someone who won't do what's necessary for his health in one area might be less likely to do so in another area as well. If the doctors' assumption is accurate, it's not bias in the sense implied.

Re:Med students (5, Interesting)

GrumpySteen (1250194) | about a year ago | (#43823903)

Well, you completely missed the point. Doctors who don't recognize their biases are more likely to misdiagnose patients that they're biased against.

Take me, for example. My kidneys failed due to IGA nephropathy, which has absolutely nothing to do with weight. I'm overweight, however, so for the first year of me feeling run down, getting sick often and having other health isuses my doctor insisted that I just needed to lose weight. He never bothered looking for other potential causes because, in his mind, the problem had to be that I was too fat and therefore didn't deserve any further attention.

Re:Med students (-1, Troll)

some old guy (674482) | about a year ago | (#43823947)

How do you misdiagnose a clear presentation of chronic gluttony? TFA refers to a specific condition, not general diagnostics.

Re:Med students (3, Insightful)

GrumpySteen (1250194) | about a year ago | (#43823963)

I explained it in simple terms and offered a real life example and you still can't figure out why a doctor that doesn't recognize his biases is a bad thing?

Re: Med students (0)

Anonymous Coward | about a year ago | (#43824015)

I wonder if they used a weighted averaged......

Re:Med students (2)

Dahamma (304068) | about a year ago | (#43823859)

Actually, it's even worse - 25% of students were aware of the bias, and 39% were biased against obese people, so it's really only 30%.

Other reasons this study is stupid:

* half as many students instead have an anti-thin bias
* about 40% of med students never even graduate and become doctors anyway
* it was done at a single "Southeastern university"
* one of the assumptions they were worried about was that they "are more likely to assume that obese individuals won’t follow treatment plans." Given the number one thing an obese person can do to improve their health is exercise, eat less, and subsequently lose weight (all achievable goals for the majority of obese people, who honestly already knew those things anyway) they probably have a reason to worry about that, and it's therefore medically significant to their treatment recommendations!

Re:Med students (2)

ebno-10db (1459097) | about a year ago | (#43824005)

* about 40% of med students never even graduate and become doctors anyway

Cite?

* it was done at a single "Southeastern university"

Which means a follow on study should cover a broader group, not that the study is invalid. Starting with a small sample and expanding it as time and money allows is common practice.

* one of the assumptions they were worried about was that they "are more likely to assume that obese individuals won’t follow treatment plans." Given the number one thing an obese person can do to improve their health is exercise, eat less, and subsequently lose weight ... they probably have a reason to worry about that, and it's therefore medically significant to their treatment recommendations!

They said "treatment plans", not "treatment plans related to obesity". Treatment plans specifically related to obesity are, as you observed, not necessary except in extreme cases. Dealing with a broken finger or taking the entire course of antibiotics even though you're feeling better also involve treatment plans. Being fat usually means a lack of self-control or excessive self-indulgence in one particular area. The same is true about people who do any number of things, like have unprotected sex with multiple partners. It does not mean they won't follow recommendations in other areas. Your prejudice demonstrates exactly what the study is concerned about.

one thing an obese person can do to improve their health is exercise, eat less

Putting aside that that's two things, there is growing evidence that getting insufficient exercise is worse than being moderately overweight (not fat though). There are plenty of thin people who get little exercise, and exercise is not the biggest factor in loosing weight. However the amount of exercise you get is something that's easy to lie to the doctor about. Additionally a lack of aerobic/cardio exercise is not something that's immediately obvious to people you meet, hence less prejudice.

Rightly So (-1)

Anonymous Coward | about a year ago | (#43823537)

There is nothing more disgusting than a fat fuck. I'm not talking a little chub as most of us have(I myself am an active builtfat who likes good beer and Mexican food), I'm talking about the disgusting 400-pound blobs driving those motorized carts all over the place.

What needs to be done to those fuckers is to leash their necks to the rear bumper of a truck, which then drives all over town at 5 miles per hour for all to see. It would be not only legal, but encouraged for bystanders to laugh and throw things at them. Those punished who lack the will to keep up with the truck simply die, their fat flobby corpses flapping and greasing the roads up until the stray dogs tear their carcasses to pieces.

  What do you think, guys? I think that's a fucking awesome idea.

-- Ethanol-fueled

Re:Rightly So (0)

Anonymous Coward | about a year ago | (#43823585)

Hear, hear!

Re:Rightly So (0)

Anonymous Coward | about a year ago | (#43823749)

I think you're probably a very lonely and unhappy person.

Re:Rightly So (-1, Troll)

some old guy (674482) | about a year ago | (#43823959)

Mod up for insightfully pointing out that a large percentage of the general population despises pigs in human skin, not just med students.

Those patients aren't fat! (0)

Anonymous Coward | about a year ago | (#43823541)

They're just big-boned.

Who needs fat chicks? (-1)

Anonymous Coward | about a year ago | (#43823543)

Who needs those grotesque parodies of human perfection?

Worse on Slashdot (1)

Rob the Bold (788862) | about a year ago | (#43823575)

As of this posting, the vast majority of ACs took the opportunity to make disparaging comments about the overweight. Classy.

Re:Worse on Slashdot (1)

Anonymous Coward | about a year ago | (#43823629)

How dare you say that to my face!

Well, I'd say it behind your back but my car's only got half a tank of gas.

Bias sounds reasonable. (-1, Flamebait)

Anonymous Coward | about a year ago | (#43823581)

Oh C'mon. This is like bias against smokers, and I see nothing wrong with it. Obese people need different sort of medical care, and clearly have issues with respect to motivation to lead a healthy lifestyle.

Why should people who act differently be treated the same? Obesity is a mental disorder and has much to do with lifestyle factors. As far as I'm concerned, it speaks volumes about a person.

Don't give me the "it's not their fault" bullshit. When's the last time you've seen an obese person doing regular physical activity? They don't, and that's part of why they're fat.

I'm for treating it as mental illness like drug addition. Doctors are surely biased against heroin addicts, so why not obese people?

Re:Bias sounds reasonable. (0)

Stumbles (602007) | about a year ago | (#43823607)

With dumb asses like you everything is a mental illness.

There is a mental illness aspect to obesity. (1, Insightful)

Anonymous Coward | about a year ago | (#43823757)

If I repeatedly hit my penis with a hammer three, four, or even five times per day, every day for years on end, it'd be clear that I have a mental illness.

If I soaked my scrotum in sulfuric acid three, four or even five times per day, every day for years on end, it'd be clear that I have a mental illness.

If I burned my glans with a cigarette lighter three, four or even five times per day, every day for years on end, it'd be clear that I have a mental illness.

Yet if I eat greasy fast food, snacks that are mostly sugar, sodas laden with chemicals and artificial sweeteners, and other food that don't promote good health three, four or even five times per day, every day for years on end, I don't have a mental illness? BULLSHIT!

Yet if I refuse to even attempt exercise of any sort, even something as simple as walking around, all day, every day, for years on end, I don't have a mental illness? BULLSHIT!

Aside from a small number of very isolated cases, obese people are obese solely because they show an utter contempt and disrespect for their own bodies and health. It is indeed a mental illness, even if it affects 60% or more of the American population today.

Don't pretend that obesity isn't a mental illness, because in almost all cases it is exactly that.

Re:There is a mental illness aspect to obesity. (1)

Anonymous Coward | about a year ago | (#43823847)

Ah well there are a few important differences in your examples. Your first three all cause pain and instant, obvious injury, which normal people (and even animals) won't do when given the opportunity.

Eating sugary foods, on the other hand, brings instant pleasure with no instant, obvious injury. Normal people (and even animals) often do this when given the opportunity.

Over doing it, of course, makes one unhealthy over the long haul. However, our instincts and desires make us a bit more fit to survive in an environment where overdoing it is a lot harder than our modern environment, making most obesity just a matter of failing to exercise conscious self-restraint. Maybe that still qualifies as a mental illness, but it is nothing like the sorts of mental illnesses you describe. It also doesn't require the sort of contempt that you seem to think it does...it just requires laziness and a difficulty saying "no."

Some people fall into this state upon realizing that they are going to die no matter how healthy they keep their bodies. They decide that sacrificing a few years of being old and miserable at the tail end of their life is worth greater enjoyment throughout their lives. From this perspective, the behavior is a normal enough emotional response to an objective take on reality.

And, just in case you are unaware, there are other categories of mental illness that involve a need to feel unnaturally superior to everyone else, driving one to exaggerate any excuse they can find to disparage those around them. Such people usually wind up a lot more frustrated than they think they should be..

Re:There is a mental illness aspect to obesity. (2)

negRo_slim (636783) | about a year ago | (#43823893)

It's not mental illness, it's addiction. Yet, I really don't like that word as it implies a removal of personal responsibility. No, like so many other things, overeating has to do with abuse of our pleasure systems. If we taught people to be self aware enough to recognize when they are engaging in actions that will subvert physiological systems into a habit then they would (hopefully) be able to self limit early on.

Re:There is a mental illness aspect to obesity. (0)

Anonymous Coward | about a year ago | (#43823909)

I contend that it is more usefully thought of as an addiction, rather than a mental illness. Of course, some may think addiction == mental illness; I do not.

Re:There is a mental illness aspect to obesity. (1)

FuzzNugget (2840687) | about a year ago | (#43823989)

That's a nice sentiment, but analogies don't automatically make a point valid.

Please be so kind as to point us to the scientifically founded data to support your claims that obesity is largely due to mental illness and not laziness.

Re:Bias sounds reasonable. (1, Troll)

Cinder6 (894572) | about a year ago | (#43823803)

My brother-in-law is a nurse. He says that the overwhelming majority of his patients are in the hospital due to poor lifestyle choices, with obesity being the most common cause of the illness. Naturally, some people are obese due to something outside of their control, but not most. I can see it being frustrating helping a patient who wouldn't be there if they'd just done a better job taking care of themselves.

Furthermore, it's my understanding that providing care to a skinny person is easier than giving it to an obese person for a number of reasons. Combine that with the fact that we're essentially programmed to prefer skinny people, and it's obvious that there would be a bias.

Does that mean that I think obese people should receive subpar treatment? Hell no. You signed up for the job, now go and do it. I just get tired of studies that confirm something everyone already knows.

Fat Hatred (2, Insightful)

WOOFYGOOFY (1334993) | about a year ago | (#43823591)

Fat hatred and blaming people for being fat is so universal and so conscious that it's hard to take any methodolgy seriously that finds that people are "unconscious" of their hatred of obese people.

Want to get at the real socially redeeming value of this journal entry? Study the methodolgy, understand where it went wrong, and above all never, ever use it.

Re:Fat Hatred (2, Insightful)

Pinky's Brain (1158667) | about a year ago | (#43823725)

I "blame" fat people for being fat for the same reason I blame criminals for being criminals ... not because I don't recognize hereditary and environmental aspects, but because the concept of personal responsibility is rather important to a functioning society.

PS. if they don't feel self pithy, aren't fat enough to suffer health problems and don't care that I find it ugly then I don't really blame them ... it's just a lifestyle choice which doesn't really impact me.

Re:Fat Hatred (1)

davester666 (731373) | about a year ago | (#43823831)

That's just it. In 20,30,40 years it will impact you.

The rising proportion of the population that is obese or worse is going to cost everyone a crazy amount of money to 'save' them [as in, keep them alive, with a variety of illnesses like heart disease, diabetes and a variety of other maladies which become much more likely as you gain weight].

And at that point in time, it's too late to do anything about the problem. Even if they lose weight then, they still have one or more 'rest-of-their-life' illnesses which won't be cheap to maintain. And most of them won't have the money to pay for it, so it's like all kinds of other problems we have, it's down the road and not happening to us right now, so we'll worry about it then.

Re:Fat Hatred (1)

Pinky's Brain (1158667) | about a year ago | (#43823925)

Being obese will generally impact your health quite immediately, but I was more talking about people who are simply overweight ... which still has some impact, but in the bigger picture it's just not that big a deal.

Re:Fat Hatred (2, Informative)

Anonymous Coward | about a year ago | (#43823927)

Some have argued (sorry I don't have the citation handy) that the OPPOSITE is true: people who live unhealthy lifestyles are far cheaper to maintain for one simple reason: they die before they get old (that time in your life where your maintenance becomes FAR more expensive).

The article I read had some interesting numbers that stated health care in the developed world would be substantially cheaper if everyone smoked and ate badly.

Re:Fat Hatred (2, Informative)

Anonymous Coward | about a year ago | (#43823961)

Citation: http://daveatherton.wordpress.com/2012/03/17/the-true-costs-of-treating-smokers-the-obese-and-the-healthy/

It is just a summary but they link to their more official sources. The core values, as quoted from the blog:
The lifetime costs were in Euros:
Healthy: 281,000
Obese: 250,000
Smokers: 220,000

So, obesity saves more than 10% of lifetime healthcare cost.

obese people don't follow diet.. (1)

gl4ss (559668) | about a year ago | (#43823599)

..and having a bias for thinking so is a bias in this study.
can't blame them though. because people who stay obese can't follow a diet, obviously. too thin people might have some "respectable" reason for being unable to digest or eat enough, it's much harder to eat on purpose more to gain weight than it is to lose it - the other just needs you not to buy food and put it in your mouth and chew it while the other needs you to have appetite to be able to put it in your stomach and the stomach to be able to digest it(personal bias experience, had both).

also it's hard to have respect for some obese guy - at least when it comes to respecting them with knowing about them only that they're fat and have a medical problem from being obese.

next up: medical students keep sexy patients in higher regard.

4th year med student here (5, Informative)

Anonymous Coward | about a year ago | (#43823601)

I'm not unaware. I know exactly what I think about fat people and It's not good.

Re:4th year med student here (0, Troll)

ebno-10db (1459097) | about a year ago | (#43823707)

I know exactly what I think about fat people and It's not good.

I feel the same way about sanctimonious people. Sounds like you'll make a shitty doctor.

Re:4th year med student here (-1, Flamebait)

ebno-10db (1459097) | about a year ago | (#43823723)

P.S. See Dunbal below (@5:16) for what a real doctor is supposed to be like. Either tame your juvenile prejudices or find another line of work.

Re:4th year med student here (1)

Rob the Bold (788862) | about a year ago | (#43823769)

I know exactly what I think about fat people and It's not good.

I feel the same way about sanctimonious people. Sounds like you'll make a shitty doctor.

I don't think the OP's trying to be sanctimonious, but admitting to a bias. As they say, that's the first step.

There are, of course, too many docs who don't concern themselves with any aspect of a patient's health till they lose weight. Or quit smoking, or drinking, or doing drugs, or whatever. Sure, all those changes can dramatically affect overall health, but the "magic bullet" approach isn't the right one. Unless one's physician takes a comprehensive interest in your health rather than just tell you to "eat less, fatty", then it's gonna be hard to get the patient to comply with any advice. After all, if the doc just thinks of you as a fat guy (or smoker, etc.) then you'll just think of the doc as the "person who nags me about my weight." Hard to work as a team with that kind of rapport.

I don't mind fat people (3, Funny)

ozduo (2043408) | about a year ago | (#43823603)

but I couldn't eat a whole one

Fat and Fit (1)

Aerynvala (1109505) | about a year ago | (#43823605)

is a real thing. Despite how well my mother's bloodwork was all through chemo her doctor kept telling her to lose weight. She was doing amazingly well for someone on chemo and over and over all they could talk about was her weight. It's ridiculous.

Re:Fat and Fit (0)

Anonymous Coward | about a year ago | (#43823687)

Healthcare is a limited supply, get over it. How you want to divide it up is a matter of debate, but it's still fucking limited. Maybe the doctors don't want to save her from cancer just to have her die from diabetes or heart disease in 5 years. If she is not going to take a better care of herself, then maybe those health resources would be better spent elsewhere. Don't make apologies for her.

And before you throw something personal into the mix, yes my father has died of heart disease brought on by his obesity when I was young, and my mother is currently fighting cancer most likely related to her chain smoking for 30 years. I consider both selfish assholes. Oh and my stepfather drank himself to death (his liver died basically), good residence.

Re:Fat and Fit (0)

Anonymous Coward | about a year ago | (#43823733)

Yeah and the people running their mouth the most about fat people are just the lucky faggots who genetically simply don't store fat and can't comprehend in their fucking retard ape brains how anyone else could, despite the thin person having just as shitty a diet as the fat person.

Re:Fat and Fit (0)

Anonymous Coward | about a year ago | (#43823843)

There are people that are *genetically* unable to store fat? You say that right before admitting your diet is shitty too.

Why don't you listen to yourself whine for once in your fat life.

Re:Fat and Fit (0)

Anonymous Coward | about a year ago | (#43823741)

And before you throw something personal into the mix, yes my father has died of heart disease brought on by his obesity when I was young, and my mother is currently fighting cancer most likely related to her chain smoking for 30 years. I consider both selfish assholes.

Looks like it is hereditary.

Re:Fat and Fit (0)

Anonymous Coward | about a year ago | (#43823765)

Source: your ass. "Good residence" indeed.

Re:Fat and Fit (1)

Anonymous Coward | about a year ago | (#43823917)

No, it's really not. You can pretend and there of course are always people who don't show overt effects, but you are wrong. And we are talking obese people here, not someone who needs to lose a few.

It's a proven fact that it puts a much higher strain on your joints (knees, hips, etc), your heart (BP, apnea, etc), your arteries (higher blood pressure), your brain (again, sleep apnea/or other metabolic issues), and a significant increased risk of many cancers (as it sounds like you may have found out).

Show me an obese person who performed better/the same physically (since "fit" here really means "physically fit") before they lost significant weight and *maybe* you would have a shred of proof. But probably not.

Somewhere in the U.S. (0)

smitty_one_each (243267) | about a year ago | (#43823623)

Is a homosexual, minority, disabled vet with PTSD person, with massive food allergies, who is an unemployed whole lotta Rosie.
This benighted person is on the receiving end of more bias, bigotry, and prejudice than anyone else.
I must publicly scourge myself, as penance for my direct and indirect contributions to her hypothetical plight.
Because I am bad, and she is a victim.
[weeps]

They should be discriminated against (-1)

Anonymous Coward | about a year ago | (#43823625)

Obesity is a choice. Those fat fucks put a strain on our hospitals and take the places that could be given to other more deserving people. Fat bastards should not be allowed hospital treatment. period.

Re:They should be discriminated against (1)

Anonymous Coward | about a year ago | (#43823699)

Obesity is a choice. Those fat fucks put a strain on our hospitals and take the places that could be given to other more deserving people. Fat bastards should not be allowed hospital treatment. period.

Driving an automobile is a choice. Those reckless fucks put strain on our hospitals and take place that could be given to more deserving pedestrian. Driver bastards should not be allowed hospital treatment. They knew the risk when they entered their motorized vehicle. [wikipedia.org]

Re:They should be discriminated against (0)

Anonymous Coward | about a year ago | (#43823837)

As a person in 30s who does not drive, I sincerely agree. If now you are puzzled, and on the defensive then you are a dumbass. I can of course choose not to drive since I live in NY metro area, but I sure as fuck don't have a choice when it comes to traveling.

Whether you travel or not for work, school, and life in general is not really a choice in most places in the US. Whether you drive within speed limit while paying attention and obeying all traffic laws or speed while on a cell phone is a choice. Whether you eat or not is not a choice. But whether you eat 2000 calories or 5000 a day is.

or... (-1)

Anonymous Coward | about a year ago | (#43823627)

people could stop stuffing their faces.

Yes but is this different (2, Insightful)

Anonymous Coward | about a year ago | (#43823633)

than doctors having a bias against smokers, recreational drug abusers, sex addicts with lots of partners, etc? Each of these groups are doing things that is typically detrimental to one's health, so there seems to be an issue of self control there.

Re:Yes but is this different (1)

Intrepid imaginaut (1970940) | about a year ago | (#43823943)

sex addicts with lots of partners, etc?

I never got that, in what way is having lots of sex detrimental to the health or well being of a person? Seems like puritanism masquerading as medicine, a bit like circumcision which is meant to stop young men masturbating.

I don't care if you don't like it, that's how it is.

Why not solve the actual problem? (0, Interesting)

Anonymous Coward | about a year ago | (#43823635)

"Medical schools should address weight bias as part of a comprehensive obesity curriculum."

Uh, or Americans should stop eating so much and get some exercise once in a while?

Re:Why not solve the actual problem? (0)

Anonymous Coward | about a year ago | (#43823727)

Uh, or Americans should stop eating so much and get some exercise once in a while?

No. I like their ideas. Also I can't wait to see their comprehensive smoking curriculum and comprehensive unsafe sex curriculum. Hatred and discrimination against unhealthy behaviour need to be rectified. The politically correctness of the society is at stake!

Compassion (4, Informative)

Dunbal (464142) | about a year ago | (#43823639)

Compassion is supposed to be a hallmark trait of the medical profession. Any doctor who lets his personal beliefs get in the way of his practicing medicine in the best possible way to ANY patient - be s/he fat, thin, muslim, atheist, black, green, prisoner, retarded, or just an average joe - is a bad doctor. If a patient is obese then yes, it poses a serious health risk and a problem. My job as a doctor is not to lecture that patient or make fun of them, but to try to help them as much as I can with the tools I have at my disposal. The same for alcoholics, drug addicts, and anyone else. Because at the end of the day said behavior is usually just a symptom of a different, underlying problem.

Re:Compassion (0)

Anonymous Coward | about a year ago | (#43823759)

Learn to read: "unconscious bias", hence everyone has their own thoughts and preferences.You may not even know they exist and it's research like this which helps drive the medical profession forward. Not your snooty "but, but we doctors are so special we would never succumb to any external factors which interfere with our thought process".

Re:Compassion (3, Insightful)

Dunbal (464142) | about a year ago | (#43823783)

You misunderstand me. It's not about being "snooty", it's about professionalism. And I only speak for myself. Whether I am biased or not stays outside the exam room but first I have to realize that such bias is possible. If I was "snooty" and "special" then I could do no wrong in my own eyes anyway. That's not true. I know I am very human, so I make a special effort NOT to be biased in any way. All patients deserve the best medical care no matter what shape or size. I fail to see what is "snooty" about that attitude.

Re:Compassion (1)

CanadianRealist (1258974) | about a year ago | (#43823911)

With all due respect, you may still be missing the point about unconscious bias. You sound completely sincere and your attitude about professionalism is commendable and I completely agree with what you say about how a doctor should behave.

But what if you have a bias that you are not aware of? Have you ever taken an implicit association test? Are you sure that you could counter a bias that you are not even aware of?

As mentioned in another post, I have taken such tests and was surprised by some of the results. I found out that I had biases that I was not aware of. Even after learning about them I was not able to alter my results.

Consider the issue of using double blind studies when testing new drugs or therapies. Do you believe that double blind studies are necessary or are single blind studies ok as long as the person conducting the study is aware that they may be biased? Does that awareness allow them to be objective? How about "no blind" studies if the test subjects are properly informed about the placebo effect?

Re:Compassion (0)

Anonymous Coward | about a year ago | (#43823835)

Whatever "your job" is, biases will creep in. Moreover, the bias against obese people is a *well founded* one for medical concern. It correlates with low self esteem, diabetes, depression, self-destructive behavior, and non-compliance with treatment plans. *All* of these related factors complicate a patient's health, as much as being female or being old complicates a software engineer's life. So while it may be illegal or deemed immoral to discriminate, *of course* it's still going to occur.

Re:Compassion (1)

Frosty Piss (770223) | about a year ago | (#43823881)

Compassion is supposed to be a hallmark trait of the medical profession.

Compassion and bias are not mutually exclusive. And, "bias" is not always unfounded.

Re:Compassion (1)

ceoyoyo (59147) | about a year ago | (#43823905)

Absolutely. This study isn't about that. They used a sensitive test for bias. If you don't like fat people (like the majority of the population) then you'll likely test positive. That has nothing to do with how you treat fat people. What they're saying is that med students should be taught about anti-fat bias to make sure that, despite their quite natural biases, they're treating fat people well. They're already taught to manage their biases against assholes, mass murderers and other difficult patients.

Re:Compassion (1)

Mr. Slippery (47854) | about a year ago | (#43823969)

My job as a doctor is not to lecture that patient or make fun of them, but to try to help them as much as I can with the tools I have at my disposal.

One of the tools a doctor has at their disposal is the lecture -- often dubbed "patient education". It has far fewer side effects than drugs or surgery.

OTOH, to give a good lecture, one must understand the subject. Most doctors know fsck-all about nutrition, or healthy lifestyles in general. An astounding 44 percent of male physicians are overweight [ama-assn.org] . Maybe this bias is frustration at their own failures.

...reader sends news of a study... (0)

Anonymous Coward | about a year ago | (#43823647)

Another submission about an article about a study. Why doesn't the submitter read the actual study and post their own conclusions as the submission? These regurgitated press-releases do noting to advance knowledge or invite insightful discussion. The last several times I read a publication that was widely-reported it became clear not a single 'journalist' actually read the paper itself, let alone challenge any of it's conclusions. Now I'm always skeptical of research results released this way.

Implicit Association (4, Informative)

CanadianRealist (1258974) | about a year ago | (#43823651)

For those not familiar with implicit association tests, they are based on measuring your reaction times when matching certain types of data according to different specified criteria. For example a gender association test might measure time for matching gender with staying at home raising children versus working outside the home.

Harvard has plenty of sample tests. [harvard.edu]

Having taken some of the tests I can say that the results can be quite surprising and point out biases that you are unaware of. I definitely found that some associations were much easier for me than others. (Happy to say that the gender example above was not a problem for me.)

Re:Implicit Association (1)

WillKemp (1338605) | about a year ago | (#43823827)

Having taken some of the tests I can say that the results can be quite surprising and point out biases that you are unaware of.

But in this case were they unaware of their biases or just not prepared to admit to them?

Re:Implicit Association (1)

CanadianRealist (1258974) | about a year ago | (#43823941)

I can really only answer for myself, which is what that statement was about. I found out that I had biases that I was not aware of. At least some associations gave me much more trouble than other ones did, and I don't have any other explanation for that. For some I didn't even need to see the reported times, I was aware of the difference while doing the test.

Maybe everyone else is aware of their biases and is simply not willing to admit them, but I doubt that. I suspect that for these biases:

reality > what people will admit > what people are aware of

Re:Implicit Association (2)

devwild (2314146) | about a year ago | (#43823883)

Thanks for this info, it would be nicer if the article was clearer on what it meant by bias. It's not what they think about obesity, it's what they associate with it, and that's an important difference.

I like to think of myself as a fair person, but I'd probably have at least a mild bias as well. I've had a lot of friends and family who have had and struggle with obesity in different ways, and had associated health problems (my father died of a heart attacked and spent his life dealing with health complications mostly stemming from obesity and smoking). Then I watch people who work at my hospital, but are grossly overweight, go to the cafeteria and get three donuts for breakfast. Also, while not universal by any means, there are frequently apparent physical differences between those who stuggle with weight, are trying to manage it, or have health problems which contribute to weigh gain, and those who simply don't care what it does to them and choose to be that way despite what it does to themselves, their family, and worst of all their children when they pass those habits on.

So yes, sometimes when I look at very obese individuals I can't help but feel little respect for them. Travelling to other countries where people are more active and obesity is less of a problem just reinforces that feeling when you come back to the US and see "Walmart specials" all around you. Similar thoughts go through my mind about smokers, especially heavy smokers - not only did both my parents have health problems from smoking, but two of my grandparents died of lung cancer. At least my parents taught me not to make the same mistakes, but it makes it really hard not to have some preconception about what others are doing to their own bodies.

Unconscious? (1)

WillKemp (1338605) | about a year ago | (#43823653)

The fact that people don't admit to their preference doesn't make that preference unconscious. From the journal article:

[......] possible answers on a seven-point
Likert scale ranging from “I (strongly)
(moderately) (slightly) prefer fat people
to thin people” to “I like thin people
and fat people equally” to “I (slightly)
(moderately) (strongly) prefer thin
people to fat people.”

That doesn't seem like a very sophisticated way of assessing someone's unconscious feelings.

Re:Unconscious? (2)

CanadianRealist (1258974) | about a year ago | (#43823747)

You're ignoring the part about the implicit association test. See my post above. [slashdot.org]

I agree that what someone admits to doesn't say anything about unconscious feelings. But an IAT can demonstrate feelings that you're not even aware of.

Re:Unconscious? (1)

WillKemp (1338605) | about a year ago | (#43823807)

Yeah, of course. But (and i admit i didn't read the whole paper), the point seems to be comparing the results of the IAT with the answers to the preference questions. If the answers to the preference questions are lies, it means nothing.

Re:Unconscious? (1)

CanadianRealist (1258974) | about a year ago | (#43823975)

You raise a valid point. My reply was about assessing their unconscious feelings. Maybe it would be better to say that they are unaware of their bias, or even worse are willing to lie about it.

Re:Unconscious? (1)

WillKemp (1338605) | about a year ago | (#43824009)

Yeah, i probably didn't phrase my original post as clearly as i could have done!

Fatties (0)

Anonymous Coward | about a year ago | (#43823655)

Ooorrrr people could just get in shape.....

anti-fat stigma (4, Insightful)

Pinky's Brain (1158667) | about a year ago | (#43823677)

"anti-fat stigma is so prevalent and a significant barrier to the treatment of obesity"

Being fat-positive would help with the treatment of obesity?

Re:anti-fat stigma (1)

Rob the Bold (788862) | about a year ago | (#43823791)

"anti-fat stigma is so prevalent and a significant barrier to the treatment of obesity"

Being fat-positive would help with the treatment of obesity?

You can't treat a patient you never see. If you know the doctor is just gonna nag you to lose weight again, why would you go back?

Re:anti-fat stigma (0)

Pinky's Brain (1158667) | about a year ago | (#43823867)

But I was talking about the "treatment of obesity" ... to treat your obesity he needs to tell you (how) to lose weight, there is no alternative.

It might be more humane to accept the patient is a fat fuck who is never going to help himself in that regard until things get a whole lot worse and treat symptoms in the mean time and simply not talk about the real problem, but that will not help with the treatment of the actual obesity itself.

Re:anti-fat stigma (0)

Anonymous Coward | about a year ago | (#43823869)

If you know the doctor is just gonna nag you to lose weight again, why would you go back?

To stay alive longer.

Re:anti-fat stigma (1)

ceoyoyo (59147) | about a year ago | (#43823929)

Because you want to be healthier?

It's not a bias if it's true (5, Insightful)

Anonymous Coward | about a year ago | (#43823681)

"Doctors are more likely to assume that obese individuals won’t follow treatment plans"

The primary goal of our treatment plan is often to get them to lose weight to cure their hypertension and type 2 diabetes. It's not a bias if you see the same patient in clinic every few months for years and they continue to gain weight and ignore your recommendations.

**** ********* M.D. , PGY-4 Resident

Re:It's not a bias if it's true (0)

Anonymous Coward | about a year ago | (#43823879)

Whoa, if you type M.D. after something, it hides it? Let me try.

hunter2 M.D.

Re:It's not a bias if it's true (1)

Anonymous Coward | about a year ago | (#43824017)

No, he did it cause he wanted us to know he is an M.D. and has experience.

But of course he doesn't want any repercussions for posting on an intertubes forum, for reasons that might escape the mentally challenged amongst us.

ignore obesity? (1)

aahpandasrun (948239) | about a year ago | (#43823683)

Because medical professionals should just ignore obvious health problems such as obesity?

Being biased against the obese is bad? (0)

Anonymous Coward | about a year ago | (#43823691)

I couldn't find the context in which this bias exists (to they give them worse care, consider them less attractive, estimate their health to be worse, estimate their wright to be higher?). The lack of this context makes it a bit hard to make fun of the article, but I'll try anyway.

Remember folks, bias is a mathematical thing: people are biased toward thinking obese people are obese. Duh. Bias is not a any more universally evil than addition. Sure, bias has some other connotations, but in a article about a statistically study results, I'm gonna use the statistical definition since they provided no context at all for what they intended. (Pro tip: if you have real interesting results, explain what the heck they are, since anyone can get sensationalize context free statistics)

I suspect obesity is correlated with a lot of things I dislike in others: lack of care for one's heath, lack of fitness, lack of intelligence (doing stupid things can make you fat, and bad nutrition early in life can lower your IQ). I am obviously biased against the obese. All other factors the same, I'd prefer someone more healthy on my team in sports, as a mate in life, as a friend etc.

Would I admit this on a study of bias at a school? Maybe: it depends on the context. Its so easy to say no bias, everyone is equal on studies. Its faster and easier to respond that way, so people tend to. No surprise there. Thus, this bias is categorized as unconscious. Not only that, but this bias isn't really prejudice, obesity really is a negative characteristic.

Re:Being biased against the obese is bad? (1)

Ambassador Kosh (18352) | about a year ago | (#43823845)

The issue I see is that movies and tv have taught people a value of normal healthy that is actually too thin to be healthy. Too many people are chasing an idea of unrealistically thin and they do a lot of damage to themselves in the process.

I do think it is not very healthy to be overweight or fat however depending on how far overweight you are the health problems actually tend to be pretty minor. Doctors believe a lot of things that medical studies don't actually back up. Many of them still believe there is a connection between eating fat and being fat while research mostly shows that eating more things like breads, pasta etc is much more likely to make you fat.

You do need to exercise, eat well etc but the advice that doctors give is often not very helpful for that.

Mostly though we need to have real guidelines for what is a healthy weight with actual medical evidence behind it, not what someone thinks looks unhealthy.

Re:Being biased against the obese is bad? (0)

Anonymous Coward | about a year ago | (#43823875)

Pretty simple: If you're a woman and your stomach sticks out past your breasts, fat. If you're a man and you bounce in front of a mirror, if anything is still jiggling after you stop bouncing, fat.

Re:Being biased against the obese is bad? (1)

Anonymous Coward | about a year ago | (#43823993)

The issue I see is that movies and tv have taught people a value of normal healthy that is actually too thin to be healthy.

And yet we have an obesity epidemic and not a too thin epidemic.

Why shouldn't they? (0)

Anonymous Coward | about a year ago | (#43823773)

These people obviously don't care about their own health, why should the doctor have to deal with the problems that arise from it? It's just like smokers...

nd how many of those medical students (4, Insightful)

mark_reh (2015546) | about a year ago | (#43823779)

were obese? When my wife was in med school about half the class was obese, a few morbidly so.

Re:nd how many of those medical students (2)

ceoyoyo (59147) | about a year ago | (#43823995)

Obese people don't like to look at obese people either. We're evolutionarily programmed to prefer to look at and be around healthy, fit people.

Doctors are biased towards sick people! (1)

scotts13 (1371443) | about a year ago | (#43823795)

They get all the care and attention, and healthy people are left out in the cold. Equal treatment for all!

No, seriously, I don't see a bias against obese patients as a problem. And I say that as someone who's pretty heavy, and by my own hand - the hand putting pizza in my mouth. Despite the laughable number of people who say "they have a glandular condition" or some such, 99.9% of the time obesity is a self inflicted injury. The doctors with this bias are, in fact, ahead of the curve. At the end of our slow march towards socialized medicine, there's a world where, if you smoked, ate too much, or didn't wear a motorcycle helmet, you government medical card isn't going to work.

Everybody does (0)

Anonymous Coward | about a year ago | (#43823805)

I have been working out like mad for over two years now 4 times a week, but people's comments oftens make me wonder why bother and not just give up.

This bias is good for patients (0)

Anonymous Coward | about a year ago | (#43823813)

When you hold the knowledge that you need to EAT PROPERLY and EXERCISE A NOMINAL AMOUNT OF TIME PER DAY... and then you go ahead and don't do it, and you get fat -- then why should doctors have to put up with you, if you're not willing to put in the effort and discipline to get into shape? You have only yourself to blame for your illness, fatties.

is this news? (0)

Anonymous Coward | about a year ago | (#43823821)

so people prefer good things, why is anyone surprised doctors don't like people who waste their time and ruin their own bodies

I hate sanctimonious people (1)

ebno-10db (1459097) | about a year ago | (#43823865)

I hate sanctimonious people, and that holier-than-thou nonsense is what the prejudice against fat people is about. By prejudice I mean being biased against people with regard to things that have nothing to do with their weight. It does not mean not wanting a fat girlfriend (or in the case of Slashdotters, not fantasizing about having a fat girlfriend), or suspecting that they wouldn't be good on the track team, or even about charging them more for life insurance. It means being biased about the guy two desks down who is fat as a pig but is a great programmer, or simply that fat people aren't as good as you. Do you feel like you're so much better than the next person simply because they're heavier than you? Congratulations, everybody needs somebody to look down on. BTW, what sense of inferiority are you trying to compensate for?

It's socially unacceptable these days to be prejudiced against people because of the color of their skin or their sex, so "those people" become fat people. There are lots of other possibilities, but fat is good because you can tell just by looking at people. I'm not interested in the argument that race and sex are something that you're born with, whereas fat is something that a person has much more control over. That's an intellectual argument, and prejudice is not something that rises to an intellectual level. It comes simply from the crude desire to have a clearly defined group of "those people" that you can complain about and feel superior to.

Re:I hate sanctimonious people (0)

Anonymous Coward | about a year ago | (#43823953)

Oh put down the fork, tons'o'fun.

What a dick. (0)

Anonymous Coward | about a year ago | (#43823915)

I have a friend who moved recently. When she saw her new doctor, he told her flat out: "You're fat. You need to exercise more" What the doctor didn't realize was that she had already lost 100 lbs over the past 8 months by diet and exercise. I couldn't believe a doctor could be so insensitive and inept in human relations .

Reasonable Bias (0)

Anonymous Coward | about a year ago | (#43823967)

While not politically correct there is a reasonable basis in a bias against people who willfully undermine their own health as is the case with the vast majority of obese people. Same goes for drug addicts, alcoholics and smokers. Doctors are in the business, so we assume, of attempting to help people be healthy. People who choose to be sick are thwarting the doctors's goals and thus a reasonable subject for animosity.

anti-thin bias (0)

Anonymous Coward | about a year ago | (#43823973)

And, what are they going to do about those with an anti-thin bias?

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