Obesity has been, and still is, the subject of much stigmatization. A new, proof-of-concept study uses role-play to reveal the bias against people with obesity among medical students.
doctor talking to person with obesity
Healthcare professionals may discriminate against people with obesity.

In all walks of life, people with obesity tend to face subconscious stigmatization and prejudice.

Many people with obesity have experienced this in their day-to-day experience, but scientific studies also back this phenomenon up.

For instance, gaze behavior studies showed that some people “stare” at the waistlines of people with obesity, thus paying less attention to their face and “de-individualizing” them.

Another study found that even experienced human resource professionals can sometimes discriminate against people with obesity — particularly women.

Healthcare professionals are no strangers to bias and prejudice against people with obesity, either. Research has found that doctors tend to be less respectful toward those with obesity, communicate less positively with them, and spend less time educating them about their health.

Instead, albeit mistakenly, physicians often “blame” obesity for the person’s symptoms, and they fail to explore other avenues for treatment besides weight loss.

So, what are some of the things we can do to eliminate the stigma around obesity?

Researchers led by Anne Herrmann-Werner, from the Department of Psychosomatic Medicine and Psychotherapy at the University Hospital Tuebingen in Germany, wanted to see if using an “obesity simulation suit” and conducting a role-playing experiment would help uncover and correct anti-obesity bias among medical students.

Herrmann-Werner and colleagues published the results of their proof-of-concept study in the journal BMJ Open.

Obesity bias and the value of a teaching aid

The researchers used role-playing to reenact a routine visit to the “family doctor.” They asked the participants to work in groups of 10 and assume either the role of a “patient with diabetes” or that of the doctor.

When playing the role of the patient, the participants had to wear an “obesity simulation suit.” This would simulate the appearance of a person with a body mass index (BMI) of 30–39.

The researchers used the weight control/blame section of the “Anti-Fat Attitudes Test” (AFAT) — a standard measure of prejudice against people with obesity — to examine attitudes toward obesity.

The AFAT uses a 5-point scale (ranging from “strongly disagree” to “strongly agree”) to rate a person’s adherence to statements such as:

  • “There is no excuse for being fat.”
  • “If fat people really wanted to lose weight, they could.”
  • “Fat people do not necessarily eat more than other people.”
  • “Fat people have no will power.”
  • “The idea that genetics causes people to be fat is just an excuse.”
  • “Most fat people are lazy.”

Herrmann-Werner and team also asked the participants how sympathetically they felt they communicated with the patient, how realistic the role-play and the “obesity simulation suit” were, how difficult the suit was to wear, and if they thought the suit was an effective teaching prop.

In addition to medical students, the study also included teachers. However, the latter group only answered AFAT questions, answered questions about the effectiveness of the suit, and observed the role-playing without taking part.

Students likely to express prejudice

The responses revealed that all the participants thought that the suit was realistic and effective. Participants also thought that the suit made the role-playing more believable and effectively enabled stereotyping.

Also, around 3 out of 4 participants said that they thought the suit helped them empathize more with the patient. However, over half of those who played the role of the patient reported feeling physically uncomfortable in the suit and said that it was difficult to put on and take off.

Overall, the students who participated in the role-playing exercise were more likely to agree with statements such as “fat people could lose weight if they really wanted to,” “most fat people are lazy,” and “there is no excuse for being fat” than teachers who did not partake or students who played the role of the patient.

The study authors recognize that they only used females to act as patients, so they could not account for any gender specific differences or biases.

A further limitation of the study was that the team did not assess the students’ attitudes toward people with obesity prior to the intervention, so they do not know if the exercise actually served to reduce the participants’ bias.

However, Herrmann-Werner and colleagues conclude:

“Despite these limitations, we strongly believe that integrating an [obesity simulation suit] into the routine undergraduate medical teaching context is a valuable tool. It can raise medical students’ awareness for communication encounters with patients with obesity.”