Anti-Obesity Bias Among Surgeons and Association With Clinical Decision Making

To assess implicit and explicit anti-obesity bias among surgical attendings and trainees, including residents and medical students, and if these biases impact clinical decision-making.

Cross-sectional web-based survey using case vignettes with multiple choice questions, implicit anti-obesity bias testing, and explicit anti-obesity bias testing. Implicit bias was evaluated using the Weight implicit association test (IAT) and explicit bias was tested using the beliefs about obese persons scale (BAOP). Pearson's correlation was used to evaluate correlation between implicit and explicit bias and ANOVA was used to compare bias across levels of training. Univariate and multivariable logistic regression were used to evaluate the associations of implicit and explicit bias and clinical decision making.

Single tertiary, academic medical center within OB/GYN and general surgery departments.

OB/GYN and surgery attendings, fellows, residents, and medical students rotating on these services during the study time period. One hundred fifty-eight participants completed the survey (45% response rate).

83.3% of participants had a thin preference on IAT and there was no difference based on training level. Mean explicit bias scores were also similar across training levels, but general surgery had lower explicit bias scores than OB/GYN. Implicit bias was not associated with clinical treatment choice or impression of the patient. Explicit bias was not associated with treatment choice, but those with less explicit anti-obesity bias had more favorable impression of standardized patients.

Rates of implicit and explicit anti-obesity bias are high across all levels of training within OB/GYN and general surgery. While bias did not appear to affect clinical decision making in our study, interventions to target bias are needed to ensure that all patients receive the care they need and there is no impact to care from either implicit or explicit bias.