Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Mar 18;13(1):50.
doi: 10.1186/s40337-025-01231-z.

Reckoning with the past: a qualitative analysis of medical students describing their formative experiences with weight bias

Elizabeth W Cotter  1 , Ashley Dunford  2 , Kirsten Gilchrist  3 , Tong Yan  3 , Lawrence Deyton  3 , Kofi Essel  3   4
Affiliations

Reckoning with the past: a qualitative analysis of medical students describing their formative experiences with weight bias

Elizabeth W Cotter et al. J Eat Disord. .

Abstract

Introduction: Most healthcare providers exhibit weight bias (i.e., negative assumptions, beliefs, or discriminatory acts toward someone based on their weight/body size) in their interactions with patients with obesity. Such bias can be exacerbated in medical training and may lead to reduced healthcare utilization and worsened patient outcomes. This study explored reflections of pre-clinical medical students on formative experiences they perceived to be related to their newly identified implicit weight bias.

Method: Seven hundred and sixteen second-year medical students completed the Weight Implicit Association Test (IAT) between April 2019-April 2022 and were instructed to write a reflective response based on their results. Of this sample, 212 students described experiences from childhood in their reflections, and these participant quotes were pulled for analysis. Inductive coding techniques were used to identify themes that were generated from medical students' reflections on formative experiences using the software program Dedoose Version 8.3.35.

Results: The identified themes highlighted medical students' own struggles with weight management and body dissatisfaction in childhood, a fear of having obesity, the prioritization of a "healthy" (i.e., thin) body and the stigmatization of larger bodies, and the influence of culture of origin on thin-ideal internalization. Results recognize the manifold experiences that these medical students have before entering their formalized medical training.

Discussion: Despite the proven negative impact on patient care caused by clinician weight bias there is a paucity of medical training programs that address weight bias. This research highlights the need for a more intentional educational curriculum to counteract the deeply rooted implicit weight bias existent in some future healthcare providers.

Plain language summary

Weight bias is common in healthcare settings and can lead to patients’ reduced healthcare utilization and worsened health outcomes. Weight bias is developed at a young age and influences how people think about and treat themselves and others, including in healthcare settings. In this article, we examine how medical students perceive their formative experiences as influencing their development of weight bias. We explore how these insights might inform the design of medical curricula that can mitigate weight bias and improve patient experiences and health outcomes.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: All procedures were approved by the Institutional Review Board of the George Washington University Office of Human Research (NCR202270). Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Themes and subthemes generated from the data. Themes from early formative experiences mapped onto the Bronfenbrenner’s Ecological Systems Model. Theme 1: “I Know What It’s Like” — Childhood Maltreatment in the Microsystem, Theme 2: “Fear of Obesity” Family Influence in the Microsystem, Theme 3: “Body Ideals are Shaped by Cultural Standards” — Cultural Pressures in the Exosystem, and Theme 4: “If I Can Do It, So Can You” — Social Comparison in the Microsystem
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity among adults and youth: united States, 2015–2016. Published online 2017. - PubMed
    1. Wang Y, Beydoun MA, Min J, Xue H, Kaminsky LA, Cheskin LJ. Has the prevalence of overweight, obesity and central obesity levelled off in the united States? Trends, patterns, disparities, and future projections for the obesity epidemic. Int J Epidemiol. 2020;49(3):810–23. 10.1093/ije/dyz273. - PMC - PubMed
    1. Phelps NH, Singleton RK, Zhou B, et al. Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet. 2024;403(10431):1027–50. 10.1016/S0140-6736(23)02750-2. - PMC - PubMed
    1. Wharton S, Lau DCW, Vallis M, et al. Obesity in adults: a clinical practice guideline. Can Med Assoc J. 2020;192(31):E875–91. 10.1503/cmaj.191707. - PMC - PubMed
    1. Phelan SM, Dovidio JF, Puhl RM, et al. Implicit and explicit weight bias in a National sample of 4,732 medical students: the medical student CHANGES study. Obesity. 2014;22(4):1201–8. - PMC - PubMed

LinkOut - more resources