Anti-Fat Attitude Development Among Medical Trainees: Evaluating a Theoretical Framework

Abstract

Medical school and residency mark a training period during which expected physicians form their professional values and attitudes. As many practicing doctors hold prejudicial attitudes towards higher-weight patients and cause harm via enacted stigma, it is important to elucidate how the medical training environment contributes to anti-fat attitudes over time. Previous studies suggest that role-modeling in the medical context, body insecurity, and controllability beliefs (i.e., blame) contribute to explicit anti-fat dislike. However, no studies to date have empirically tested a theoretical model to explain how these processes are integrated. The present study uses data collected from the Medical Student Cognitive Habits and Change Evaluation Study (CHANGES), a national longitudinal study of medical students from 49 allopathic medical schools at the following timepoints: year 4 of medical school (N=3,976), year 2 of Residency (N=3,579), and year 3 of Residency (N=3,057). A serial parallel mediation analysis using structural equation modeling is used to evaluate our model. We find overall support for our model: observing weight stigma is linked with heightened body concerns and explicit anti-fat attitudes, and body image concerns are associated with anti-fat blame and subsequent dislike. Intervention implications of these findings are discussed.