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Anti-obesity attitudes

Reducing medical students' negative attitudes toward the obese

Confronting physicians' conscious and unconscious biases may change the dynamic for their patients

An educational initiative at Touro University College of Osteopathic Medicine is reducing medical students' negative attitudes toward people with obesity, a finding researchers hope will translate into better outcomes for patients struggling with weight.

Drawing a parallel to the medical community's approach to common mental illnesses, researchers suggest that shifting physicians' perspective from individual responsibility to a treatable condition may finally slow decades of rising obesity rates. The paper, ‘The Effects of Education on Osteopathic Medical Students' Attitudes Regarding Obesity’, The Journal of the American Osteopathic Association.

"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 behaviour," said Dr Michael Clearfield, Dean of Touro University's College of Osteopathic Medicine. "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, which launched in 2012, measures medical students' attitudes on the Fat Phobia Scale, which identifies biased beliefs in stereotypes, such as obese people are "lazy" and have "poor self-control". The students then received 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. Those who completed the programme significantly reduced their bias by an average of 7 percent.

Clearfield and colleagues surveyed first-year students to assess thier attitudes toward obesity before the curriculum, directly after completion, and each year after until graduation (graduating classes of 2015 through 2018). Second- and third-year medical students in 2011 (graduating classes of 2014 and 2013), who did not complete the curriculum, were given an examination to establish baseline values and served as the control group.

The obesity curriculum consisted of lectures delivered during the first and second year of medical school and case study simulations during the third year. Knowledge gained from the curriculum was assessed with a multiple-choice examination, and bias was assessed using the Fat Phobia Scale.

Outcomes

A total of 718 first- through fourth-year students were included in the study. Students who completed the first year of the obesity curriculum (n=528) showed significantly greater medical knowledge regarding obesity-related epidemiology, pathogenesis, biochemistry, pathophysiology, and metabolic factors; nutrition, diet, physical activity, self-control, and behaviour modification; pharmacologic and nonpharmacologic interventions; and associated chronic disorders, based on their multiple-choice examination scores compared with the control group.

The examination scores indicated significant increases in medical knowledge compared with the pre-curriculum cohort after the curriculum (OMS I students: 130 [72.4%]; 133 [92.6%]; 133 [91.1%]; 132 [89.0%]; vs control: 105 [47.2%]; 134 [52.6%], respectively [p<0.01]).

In all four years observed, there was a significant reduction in bias among first-year medical students after obesity curriculum (before: 3.65, 3.76, 3.57, 3.61, and after: 3.47, 3.38, 3.34, 3.37, respectively) (p<0.05). The reduction in bias was also significantly sustained throughout the fourth year.

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," he explained.

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 check-ups all-together.

Touro University'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 seven to ten 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, Touro plans to expand its curriculum to an online platform, making it available to other medical schools and residency programmes. Ultimately, they intend to study its impact on patient outcomes.

An alarming historyBack in 2000, the obesity rate in the U.S. went from 15 percent, where it had been for decades, to nearly 23 percent. Despite two decade-long government programs focused on encouraging weight loss, the rate has steadily risen to between 37 and 38 percent.

Clearfield sees this as evidence for physicians to reconsider their approach, "I think it's pretty obvious that what we've been doing isn't working."

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