Article | Published:

Behavior, Psychology and Sociology

The effects of a teaching intervention on weight bias among kinesiology undergraduate students

International Journal of Obesity (2019) | Download Citation



Weight bias is present among kinesiology professionals and this may cause a significant negative impact on their clients with obesity. Thus, our objective was to test if learning about uncontrollable cause of obesity and about weight bias would reduce explicit and implicit weight bias among kinesiology undergraduate students compared to the traditional curriculum which is more focused on controllable causes of weight gain.


We recruited undergraduates from two classes of the same kinesiology major course taught by the same instructor. In-class teaching activities consisted of 80 min lecture on day 1, video watching session and a group activity on day 3 for both groups. Intervention group (n = 33) learned about uncontrollable causes of obesity and about weight bias and had activities to evoke empathy. Control group (n = 34) learned the traditional curriculum where they learned the role of exercise and diet in weight management. We measured explicit and implicit weight bias using Anti-Fat Attitude Test (AFAT) and Implicit Association Test (IAT), respectively pre-intervention, immediate post intervention and 1 month later.


In mixed model analysis, AFAT Blame scores had significant group by time interaction (p < 0.001). Blame scores significantly reduced with mean differences (standard error (SE)) of −0.35 (0.08) post intervention (p < 0.001) and persisted to be reduced with mean differences (SE) of −0.39 (0.08) even after 4-week follow-up (p < 0.001) only in the intervention group. Odds of having less implicit weight bias was significantly lower at 4-week follow-up than pre-intervention (odds ratio = 0.4; 95% CI: 0.22–0.73) in the control group but no changes were seen in the intervention group.


“Blame” component of explicit weight bias significantly decreased when students learned about controllable causes of obesity and weight bias, but implicit bias did not reduce. However, implicit weight bias appears to increase when education on obesity is limited to diet and exercise interventions as taught in the traditional curriculum.

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  1. 1.

    Washington RL. Childhood obesity: issues of weight bias. Prev Chronic Dis. 2011;8:A94.

  2. 2.

    Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griffin JM, van Ryn M. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev. 2015;16:319–26.

  3. 3.

    Ryan D, Heaner M. Guidelines (2013) for managing overweight and obesity in adults. Obesity (Silver Spring). 2014;22 Suppl 2:S1–3.

  4. 4.

    Puhl RM, Heuer CA. The stigma of obesity: a review and update. Obesity. 2009;17:941–64.

  5. 5.

    Puhl R, Brownell KD. Bias, discrimination, and obesity. Obes Res. 2001;9:788–805.

  6. 6.

    Puhl RM, Andreyeva T, Brownell KD. Perceptions of weight discrimination: prevalence and comparison to race and gender discrimination in America. Int J Obes. 2008;32:992.

  7. 7.

    Tomiyama AJ. Weight stigma is stressful. A review of evidence for the Cyclic Obesity/ Weight-Based Stigma model. Appetite. 2014;82:8–15.

  8. 8.

    Robinson E, Sutin A, Daly M. Perceived weight discrimination mediates the prospective relation between obesity and depressive symptoms in U.S. and U.K. adults. Health Psychol. 2017;36:112–21.

  9. 9.

    Sutin AR, Stephan Y, Terracciano A. Weight discrimination and risk of mortality. Psychol Sci. 2015;26:1803–11.

  10. 10.

    Puhl RM, Heuer CA. Obesity stigma: important considerations for public health. Am J Public Health. 2010;100:1019–28.

  11. 11.

    Papadopoulos S, Brennan L. Correlates of weight stigma in adults with overweight and obesity: a systematic literature review. Obesity. 2015;23:1743–60.

  12. 12.

    Pearl RL, Wadden TA, Hopkins CM, Shaw JA, Hayes MR, Bakizada ZM, et al. Association between weight bias internalization and metabolic syndrome among treatment-seeking individuals with obesity. Obesity. 2017;25:317–22.

  13. 13.

    Langdon J, Rukavina P, Greenleaf C. Predictors of obesity bias among exercise science students. Adv Physiol Educ. 2016;40:157–64.

  14. 14.

    Chambliss HO, Finley CE, Blair SN. Attitudes toward obese individuals among exercise science students. Med Sci Sports Exerc. 2004;36:468–74.

  15. 15.

    Rukavina PB, Li W, Shen B, Sun H. A service learning based project to change implicit and explicit bias toward obese individuals in kinesiology pre-professionals. Obes Facts. 2010;3:117–26.

  16. 16.

    O’Brien KS, Hunter JA, Banks M. Implicit anti-fat bias in physical educators: physical attributes, ideology and socialization. Int J Obes (Lond). 2007;31:308–14.

  17. 17.

    Alberga AS, Pickering BJ, Alix Hayden K, Ball GD, Edwards A, Jelinski S, et al. Weight bias reduction in health professionals: a systematic review. Clin Obes. 2016;6:175–88.

  18. 18.

    van Leeuwen F, Hunt DF, Park JH. Is obesity stigma based on perceptions of appearance or character? Theory, evidence, and directions for further study. Evol Psychol. 2015;13:1–8.

  19. 19.

    Danielsdottir S, O’Brien KS, Ciao A. Anti-fat prejudice reduction: a review of published studies. Obes Facts. 2010;3:47–58.

  20. 20.

    Poustchi Y, Saks NS, Piasecki AK, Hahn KA, Ferrante JM. Brief intervention effective in reducing weight bias in medical students. Fam Med. 2013;45:345–8.

  21. 21.

    Cotugna N, Mallick A. Following a calorie-restricted diet may help in reducing healthcare students’ fat-phobia. J Community Health. 2010;35:321–4.

  22. 22.

    Falker AJ, Sledge JA. Utilizing a bariatric sensitivity educational module to decrease bariatric stigmatization by healthcare professionals. Bariatr Nurs Surg Patient Care. 2011;6:73–8.

  23. 23.

    Kushner RF, Zeiss DM, Feinglass JM, Yelen M. An obesity educational intervention for medical students addressing weight bias and communication skills using standardized patients. BMC Med Educ. 2014;14:53.

  24. 24.

    Roberts DH, Kane EM, Jones DB, Almeida JM, Bell SK, Weinstein AR, et al. Teaching medical students about obesity: a pilot program to address an unmet need through longitudinal relationships with bariatric surgery patients. Surg Innov. 2011;18:176–83.

  25. 25.

    Rukavina PB, Li W, Rowell MB. A service learning based intervention to change attitudes toward obese individuals in kinesiology pre-professionals. Social Psychol Educ. 2008;11:95–112.

  26. 26.

    Lewis RJ, Cash TF, Bubb-Lewis C. Prejudice toward fat people: the development and validation of the antifat attitudes test. Obes Res. 1997;5:297–307.

  27. 27.

    Schwartz MB, Chambliss HON, Brownell KD, Blair SN, Billington C. Weight bias among health professionals specializing in obesity. Obes Res. 2003;11:1033–9.

  28. 28.

    Robertson N, Vohora R. Fitness vs. fatness: implicit bias towards obesity among fitness professionals and regular exercisers. Psychol Sport Exerc. 2008;9:547–57.

  29. 29.

    Teachman BA, Brownell KD. Implicit anti-fat bias among health professionals: is anyone immune? Int J Obes Relat Metab Disord. 2001;25:1525–31.

  30. 30.

    O’Brien KS, Puhl RM, Latner JD, Mir AS, Hunter JA. Reducing anti-fat prejudice in preservice health students: a randomized trial. Obesity. 2010;18:2138–44.

  31. 31.

    Glass AL, Ingate M, Sinha N. The effect of a final exam on long-term retention. J Gen Psychol. 2013;140:224–41.

  32. 32.

    Puhl RM, Phelan SM, Nadglowski J, Kyle TK. Overcoming weight bias in the management of patients with diabetes and obesity. Clin Diabetes. 2016;34:44–50.

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We thank all the participants who took part in this study and Hunter Turnipseed (MS) for helping with the data collection.

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  1. Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX, USA

    • Nadeeja N. Wijayatunga
    • , Youngdeok Kim
    •  & Emily J. Dhurandhar
  2. Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA

    • Winfield S. Butsch


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The authors declare that they have no conflict of interest.

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Correspondence to Emily J. Dhurandhar.

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