Physician bias

JAOA study finds promise in tactic to curb obesity by addressing doctor bias

Osteopathic educators at TUCOM find shifting students’ perspective on obesity has an impact.


Health care professionals may have an inherent bias toward patients with obesity, but educational initiatives to reduce medical students’ bias may help, according to research published in The Journal of the American Osteopathic Association.

An educational initiative at Touro University College of Osteopathic Medicine in California (TUCOM) is reducing medical students’ negative attitudes toward people with obesity, a finding researchers hope will translate into better outcomes for patients struggling with weight, according to the research, which appeared in the JAOA’s August issue.

The study suggests that shifting physicians’ perspective from individual responsibility to a treatable condition may impact and finally slow decades of rising obesity rates.

“We know there are economic, cultural, political and environmental elements causing this problem, yet our approach to treatment puts sole responsibility on the patient’s behavior,” says Michael Clearfield, DO, dean of TUCOM. “It’s not unlike the way we treated depression 40 years ago. Only, instead of telling people to ‘get over it’, we say, ‘just eat right and exercise.’”

The curriculum at TUCOM, which launched in 2012, gauges medical students’ attitudes on the Fat Phobia Scale, which measures biased beliefs in stereotypes.

The students then receive instruction on the causes and treatments of obesity, with follow-up testing on their knowledge and attitudes toward obesity for every year of medical school. Researchers found that students who completed the program significantly reduced their bias by an average of 7 percent.

Changing hearts and minds

Dr. Clearfield noted that confronting physicians’ conscious and unconscious biases may change the dynamic for their patients.

“Sometimes physicians don’t believe that obese people will take care of themselves, so they spend less time with them and, as a result, they miss things in their examinations,” says Dr. Clearfield.

He adds that patients pick up on physicians’ attitudes and feel embarrassed and unwelcome, and so they often stop following medical advice and maybe stop going in for checkups altogether.

TUCOM’s obesity education curriculum focuses on the complexities of obesity, with diet being only one contributing factor. The curriculum also emphasizes a focus on attaining health instead of weight loss, as well as the recognition of incremental improvements.

“With an improved diet, we can get measurably healthier in just 7 to 10 days. From an osteopathic perspective, we need to acknowledge the importance of those small steps so physicians don’t give up on patients and patients don’t give up on themselves.”

Based on the results from the four year study, TUCOM plans to expand its curriculum to an online platform, making it available to other medical schools and residency programs. Ultimately, they intend to study its impact on patient outcomes.


  1. Dr Stan

    I personally find these statements to be offensive. I personally treat everyone as if they were an individual, not obese, Black, Hispanic, or any other characteristic. When I enter a room, I don’t know their insurance, so not to have a bias. When a clinical decision is made, I present it to the patient, and get their approval, and sometimes need to get insurance approval. To state such a broad stroke as to treat obese people different is wrong. The only thing that I state to them is their weight does create health and self esteem issues. And while you cannot do anything to change your race or gender, and not that you need or should, changing your weight – that is under your control through multiple methods. This includes diet, exercise, and possibly even surgery. I am offended by this article, and hope that my colleagues are too.

  2. Michael

    There is so much talk about health care as a right, but very little addressing self responsibility. Patients need to take responsibility for their condition (obesity IS a condition, NOT a disease as the system wants us to believe). Diet and exercise are the cornerstones of a healthy lifestyle, and these need to be the focus of the discussion. The best approach that I ever saw was a gentleman black physician who would ask his obese patient “How did you ever let yourself get like this?”

  3. Anne

    Funny story. My doctor just retired and I’m looking for a new one. I’m overdue for a mammogram and a lipid panel because I’m still mad about her overreaction to the previous results. If it weren’t for needing to get my hypothyroidism and my asthma medication prescriptions renewed I would be content to have my only interactions with the medical establishment be visits to urgent care. I’d hoped that by checking out an DO I’d find someone who could hear that between cutting sugar out of my diet, walking for an hour a day, and treating my hypothyroidism my weight’s been stable for the last 5 years. But the previous comments on this article suggest that even in D.O. I’m going to face the hurdle of convincing a new doctor that I’m worthy of health care.

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