Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Implicit anti-fat bias among health professionals: is anyone immune?

Abstract

OBJECTIVE: To investigate whether negative implicit attitudes and beliefs toward overweight persons exist among health professionals who specialize in obesity treatment, and to compare these findings to the implicit anti-fat bias evident in the general population.

DESIGN: Health care professionals completed a series of implicit and explicit attitude and belief measures. Results were compared to measures obtained from a general population sample.

SUBJECTS: A total of 84 health professionals who treat obesity (71% male, mean age 48 y, mean body mass index (BMI) 25.39).

MEASUREMENTS: Participants completed an attitude- and a belief-based lmplicit Association Test. This reaction time measure of automatic memory-based associations asked participants to classify words into the following target category pair. ‘fat people’ vs ‘thin people’. Simultaneously, the tasks required categorization of words into one of the following descriptor category pairs: good vs bad (attitude measure) or motivated vs lazy (stereotype measure). Participants also reported explicit attitudes and beliefs about fat and thin persons.

RESULTS: Clear evidence for implicit anti-fat bias was found for both the attitude and stereotype measures. As expected, this bias was strong but was lower than bias in the general population. Also as predicted, only minimal evidence for an explicit anti-fat bias was found. Implicit and explicit measures of the lazy stereotype were positively related although the attitude measures were not.

CONCLUSION: Even health care specialists have strong negative associations toward obese persons, indicating the pervasiveness of the stigma toward obesity. Notwithstanding, there appears to be a buffering factor, perhaps related to their experience in caring for obese patients, which reduces the bias.

Your institute does not have access to this article

Relevant articles

Open Access articles citing this article.

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

Figure 1

References

  1. Pronk NP, Tan AWH, O'Connor P . Obesity, fitness and health care costs Med Sci Sports Exercise 1999 31: 1535–1543.

    CAS  Article  Google Scholar 

  2. Rothblum ED, Miller CT, Garbutt B . Stereotypes of obese female job applicants Int J Eat Disord 1988 7: 277–283.

    Article  Google Scholar 

  3. Pagan JA, Davila A . Obesity, occupational attainment, and earnings Soc Sci Q 1997 78: 756–770.

    Google Scholar 

  4. Neumark-Sztainer D, Story M, Faibisch L . Perceived stigmatization among overweight African-American and Caucasian adolescent girls J Adol Health 1998 23: 264–270.

    CAS  Article  Google Scholar 

  5. Goffman E . Stigma: notes on the management of spoiled identity. Prentice-Hall: Englewood Cliffs, NJ 1963

  6. Pierce JW, Wardle J . Cause and effect beliefs and self-esteem of overweight children J Child Psychol Psychiat 1997 38: 645–650.

    CAS  Article  Google Scholar 

  7. Klein D, Najman J, Kohrman AF, Munro C . Patient characteristics that elicit negative responses from family physicians J Family Pract 1982 14: 881–888.

    CAS  Google Scholar 

  8. Maroney D, Golub S . Nurses' attitudes toward obese persons and certain ethnic groups Percep Motor Skills 1992 75: 387–391.

    CAS  Article  Google Scholar 

  9. Kristeller JL, Hoerr RA . Physician attitudes toward managing obesity: differences among six specialty groups Prev Med 1997 26: 542–549.

    CAS  Article  Google Scholar 

  10. Gibbs WW . Treatment that tightens the belt: is insurance part of America's obesity problem? Sci Am 1995 272: 34–35.

    CAS  PubMed  Google Scholar 

  11. Greenwald AG, Banaji MR . Implicit social cognition: attitudes, self-esteem, and stereotypes Psycho Rev 1995 105: 4–27.

    Article  Google Scholar 

  12. Crandall CS . Prejudice against fat people: ideology and self-interest J Person Soc Psychol 1994 66: 882–894.

    CAS  Article  Google Scholar 

  13. Fazio RH, Jackson JR, Dunton BC, Williams CJ . Variability in automatic activation as an unobtrusive measure of racial attitudes: a bona fide pipeline? J Person Soc Psychol 1995 69: 1013–1027.

    CAS  Article  Google Scholar 

  14. Dovidio JF, Kawakami K, Johnson C, Johnson B, Howard A . On the nature of prejudice: automatic and controlled processes J Exp Soc Psychol 1997 33: 510–540.

    Article  Google Scholar 

  15. Bessenoff GR, Sherman JW . Automatic and controlled components of prejudice toward fat people: evaluation versus stereotype activation Soc Cogn (in press).

  16. Greenwald AG, McGhee DE, Schwartz JLK . Measuring individual differences in implicit cognition: the implicit association test J Person Soc Psychol 1998 74: 1464–1480.

    CAS  Article  Google Scholar 

  17. Teachman B, Gapinski K, Brownell K . Stigma of obesity: implicit attitudes and stereotypes. Poster presented at the Society for Personality and Social Psychology, San Antonio, TX February 2001

    Google Scholar 

  18. Rudman L, Greenwald AG, McGhee DE . Powerful women, warm men? Implicit associations among gender, potency, and nurturance. Paper presented at the meeting of the Society of Experimental Social Psychology Sturbridge, MA October 1996

    Google Scholar 

  19. Dasgupta N, McGhee DE, Greenwald AG, Banaji MR . Automatic preference for White Americans: eliminating the familiarity explanation J Exp Soc Psychol 2000 36: 316–328.

    Article  Google Scholar 

  20. Teachman BA, Gregg A, Woody S . Implicit processing of fear-relevant stimuli among individuals with snake and spider fears J Abnorm Psychol 2001 110: 203–215.

    Article  Google Scholar 

  21. Rosenthal R, Rosnow RL . Essentials of behavioral research: methods and data analysis, 2nd edn. McGraw-Hill: New York 1991

  22. Cohen J . Statistical power analysis for the behavioral social sciences, 2nd edn. Lawrence Erlbaum: Hillsdale, NJ 1988

  23. Wiese HJ, Wilson JF, Jones RA, Neises M . Obesity stigma reduction in medical students Int J Obes Relat Metab Disord 1992 16: 859–868.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We are grateful to the Rudd Foundation for their support of this work, as well as Knoll Pharmaceutical Company for allowing us to collect data during their physicians' conference. In addition, the authors wish to thank Mahzarin Banaji, Subathra Jeyaram, Brian Nosek and members of the Yale Center for Eating and Weight Disorders research team for their assistance on this project and helpful comments in preparation of this manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to KD Brownell.

Appendix

Appendix

Sample portion of an IAT task measuring implicit associations among fat and thin people with lazy and motivated descriptors. This page would be compatible for people who have implicit anti-fat bias, since the pairings match negative automatic associations with overweight. The opposite pairing (fat people with motivated and thin people with lazy) would be incompatible or a mismatch for people who have implicit anti-fat bias.Table A1

Table 2

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Teachman, B., Brownell, K. Implicit anti-fat bias among health professionals: is anyone immune?. Int J Obes 25, 1525–1531 (2001). https://doi.org/10.1038/sj.ijo.0801745

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ijo.0801745

Keywords

  • implicit attitudes
  • bias
  • anti-fat
  • obesity

Further reading

Search

Quick links