Geller Gail, Watkins Paul A
A professor of medicine at Johns Hopkins University School of Medicine and the director of Education Initiatives at the Berman Institute of Bioethics at Johns Hopkins University in Baltimore, Maryland.
A professor of neurology at Johns Hopkins University School of Medicine and the director of the Lipid Enzymology Laboratory at the Kennedy Krieger Institute in Baltimore, Maryland.
AMA J Ethics. 2018 Oct 1;20(10):E948-959. doi: 10.1001/amajethics.2018.948.
Negative bias toward patients with obesity is an ethical challenge in patient care. Several interventions to mitigate medical students' negative weight bias have been tried but none with an explicit focus on ethics. Here we describe first-year medical students' attitudes toward obesity and our effort to improve their attitudes through an innovative ethics session embedded within the required course, "Obesity, Nutrition, and Behavior Change," at Johns Hopkins University School of Medicine.
Precourse survey data were collected from 6 first-year cohorts (2012-2017). Before the ethics session, students take the Implicit Association Test (IAT) to measure implicit weight bias. During the session, students discuss their classmates' personal struggles with weight, beliefs about causes of obesity, and the IAT results. They also watch and discuss video clips from the TV show depicting negative weight bias. In addition, the 2017 cohort was surveyed 4 months later to evaluate the impact of different components of the session on students' self-reported attitudes.
All students responded to the precourse survey. Across cohorts, IAT results revealed that 70% of students held a thin preference, 18% were neutral and 12% held a fat preference. Forty-seven percent had personally struggled with weight loss. While most students thought obesity is a disease (89%) or behavioral (88%), 74% thought it results from ignorance, and 28% thought people with obesity are lazy. Among the 59 respondents to the follow-up survey, 30% reported improvement in their attitudes after the session. Over 40% thought it was useful to discuss students' personal struggles with weight and the IAT and survey results, and over 70% thought the video clips were useful.
Medical students have negative attitudes about obesity that are consistent over time. Providing opportunities for students to discuss their personal experiences and beliefs about obesity within an ethics framework and using popular media as a basis for discussion might improve their attitudes toward obesity.
对肥胖患者的负面偏见是患者护理中的一个伦理挑战。已经尝试了几种减轻医学生负面体重偏见的干预措施，但没有一种明确侧重于伦理。在此，我们描述了一年级医学生对肥胖的态度，以及我们通过约翰霍普金斯大学医学院必修课程“肥胖、营养与行为改变”中嵌入的创新伦理课程来改善他们态度的努力。
从6个一年级班级（2012 - 2017年）收集课程前的调查数据。在伦理课程之前，学生参加内隐联想测验（IAT）以测量内隐体重偏见。在课程期间，学生讨论他们同学在体重方面的个人困扰、对肥胖原因的看法以及IAT结果。他们还观看并讨论来自电视节目的视频片段，这些片段描绘了负面体重偏见。此外，对2017年的班级在4个月后进行了调查，以评估课程不同组成部分对学生自我报告态度的影响。
所有学生都对课程前的调查做出了回应。在各个班级中，IAT结果显示70%的学生偏好瘦，18%持中立态度，12%偏好胖。47%的学生个人曾在减肥方面挣扎过。虽然大多数学生认为肥胖是一种疾病（89%）或与行为有关（88%），但74%的学生认为肥胖是由无知导致的，28%的学生认为肥胖者懒惰。在59名参与后续调查的受访者中，30%报告称课程后他们的态度有所改善。超过40%的学生认为讨论学生在体重方面的个人困扰以及IAT和调查结果是有用的，超过70%的学生认为视频片段是有用的。
医学生对肥胖持有负面态度，且这种态度随时间保持一致。为学生提供在伦理框架内讨论他们对肥胖的个人经历和看法的机会，并以大众媒体作为讨论基础，可能会改善他们对肥胖的态度。
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