The Cascade Effect: How Weight Bias Impacts the Stress on Future Healthcare Professionals While in Medical School
Medical school is an extremely stressful time for its students. They juggle impossible schedules, complex learning material and demanding faculty and residents — with little sleep and little opportunity for a life outside of medical school. These factors contribute to high levels of student burnout, depression, anxiety, substance use, and fatigue. Because of that, medical students’ well-being has been an important topic of study in academic medicine.
Another reason for concern about medical student well-being is that students who are more stressed, who report experiencing abusive treatment and who are overly tired have less empathy — an important factor for providing patient-centered care.
Knowing all of this, we set out to investigate student well-being overall, and particularly the well-being of students who were members of stigmatized or marginalized groups, one of those groups being people with obesity. Obesity is a strongly and consistently stigmatized disease; and it is generally considered acceptable to hold explicit negative beliefs and attitudes, and to openly discriminate against people with the disease of obesity. We worry about the impact of these experiences on people with obesity.
“Stereotype threat” occurs when someone realizes that they are being viewed or treated in accordance with group stereotypes, and it leads to a cascade effect of stress and anxiety. Stereotype threat can occur when a person feels singled out, or when their stigmatized group category is being focused on.
Some medical professionals endorse stereotypes about people with obesity (no willpower, unintelligent, etc.), and those attitudes may come out when they talk about obesity or a patient with obesity. This can certainly trigger stereotype threat among students with obesity. Importantly, stereotype threat has consistently been shown to negatively affect performance in several areas for individuals experiencing it, suggesting that weight bias and stereotypes may hinder the performance of medical students with excess weight or obesity.
In the study “The Adverse Effect of Weight Stigma on the Well-Being of Medical Students with Overweight or Obesity: Findings from a National Survey,” we wanted to understand differences in well-being when students first enter medical school, so that later we can examine differences in the trajectory of well-being through medical school. To measure this, students were classified by their Body Mass Index (BMI) to evaluate the differences in well-being between students with a lower BMI, and those who were affected by excess weight or obesity.
There were some interesting results found in our work. Only 24 percent of medical students had BMIs in a range that classified them as having excess weight or obesity, and this number is much lower than the estimated 35 percent of college seniors who are affected by excess weight or obesity. We did not find many differences between students with excess weight and obesity and those at a normal weight, but the differences that were there are worrisome for a students’ ability to cope with the stress of medical school.
People with excess weight or obesity reported worse overall health, lower body self-esteem, less social support and more frequent use of drugs or alcohol to cope with stress. It’s important to note that each of these differences, though significant in our research, is very small, so we do not know if they are meaningful, or whether or not they signal differences in the outcome of a student’s success in medical school.
We also looked at the data of students with excess weight and obesity on its own to find out what was associated with differences in well-being within the group. We found that students who reported experiencing worse stigma or discrimination in their day-to-day lives had worse overall health, more frequent anxiety, depression and fatigue symptoms, as well as lowered self-esteem and less confidence about their overall intelligence.
These students felt lonelier, had less social support and were more likely to use drugs or alcohol to cope with the stress of their medical school program. Students who self-stigmatized, or agreed with the negative beliefs and assumptions made about people with excess weight or obesity, experienced many of the same problems relative to students who self-stigmatized themselves less
After learning all of this, our research team’s next step will be studying how these students’ performance and well-being changes throughout medical school. In the meantime, these findings suggest that weight bias has had a profound effect on the well-being of new medical students with excess weight or obesity. Medical educators should be aware of the experiences these students have likely had and try not to reinforce the stigma all too often associated with the disease of obesity. This can be accomplished, for example, by emphasizing the complex network of factors that cause obesity, and through talking about patients with obesity in a respectful manner.
About the Author:
Dr. Sean M. Phelan is an Assistant Professor of Health Services Research at the Mayo Clinic in Rochester, MN. Dr. Phelan is a core faculty member in the Mayo Research Program on Equity and Inclusion in Healthcare, where his research program is focused on reducing health disparities and improving health care quality and outcomes for patients with obesity, as well as patients from other stigmatized and marginalized groups. He is also a consultant on diversity and equity issues with Partners in Equity and Inclusion. Dr. Phelan can be reached at firstname.lastname@example.org or email@example.com.