Addressing Weight Stigma in Medical Education: Insights and Strategies From a Nutrition Curriculum Review

Weight stigma in healthcare settings is implicated in lower quality of care for higher-weight patients. Physicians' implicit and explicit antifat bias can undermine rapport, reduce health education, and discourage preventive care, eroding patient trust and fueling healthcare avoidance. Because medical education shapes trainees' attitudes through both formal curricula and hidden cultural norms, it represents a critical leverage point for stigma reduction. Yet most interventions are stand-alone workshops that remain separate from core content and have limited reach.

We conducted a grounded theory analysis of the preclerkship nutrition curriculum at a large US medical school to examine how weight stigma is embedded in core teaching. Fifteen pre-recorded lectures (10.2 h) delivered by 13 faculty members were independently reviewed by a multidisciplinary team of medical students and a faculty expert in weight stigma. Reviewers documented potential instances of stigma in structured memos. Through iterative coding and team consensus, we developed conceptual categories and integrated these into broader themes.

Reviewers generated 123 memos capturing stigmatizing language, attitudes, and framing. Five themes emerged: (1) stigmatizing terminology and imagery; (2) assumptions about the controllability of weight; (3) judgments about the behavior and health of higher-weight patients; (4) overemphasis on weight as a marker of health; and (5) statements that reinforce socially constructed body ideals and moralize food and eating. We propose a literature-informed framework for educators: adopt neutral, precise language; challenge weight-based stereotypes; highlight multifactorial determinants of health; avoid reinforcing body ideals or moralizing food; and use content warnings for sensitive topics.

Early exposure to weight-normative messages in foundational curricula can perpetuate antifat bias in clinical practice. Integrating stigma-reduction strategies into core teaching offers a promising approach to dismantle structural weight stigma and promote equitable, person-centered care, and warrants evaluation.