Understanding medical trainees’ anti-fat dislike: roles of observed weight stigma, body image disturbance, and controllability beliefs

BACKGROUND: Studies have demonstrated that medical students' anti-fat prejudice increases over the course of training, although the mechanisms through which these prejudicial attitudes are heightened are not well understood. The present study aims to empirically examine a theoretical model that posits that the observation of weight stigma in the medical training context drives anti-fat dislike via its effects on trainees' body image and subsequent activation of weight-based stereotypes (i.e., controllability beliefs). METHODS: Data were collected from the Medical Student Cognitive Habits and Change Evaluation Study (CHANGES), a national longitudinal study conducted between 2010 and 2017. Medical students from 49 allopathic U.S. medical schools were surveyed at year 4 of medical school (MS4; N = 3,976), year 2 of residency (PGY2; N = 3,579), and year 3 of residency (PGY3; N = 3,057). A serial parallel mediation analysis using structural equation modeling was used to evaluate our model. RESULTS: Our model was largely supported; observations of weight stigma during medical school were directly and indirectly associated with greater anti-fat dislike at PGY3 via fear of weight gain and controllability beliefs about weight. CONCLUSIONS: Anti-fat prejudice reduction interventions in the medical training environment should (1) emphasize the importance of, and increase adherence to, positive attitudinal role modeling among faculty and residents, (2) promote body self-acceptance among trainees, and (3) provide education around the complex interplay of genetic and environmental contributors to combat blame-based stereotypes surrounding weight. METHODS: Data were collected from the Medical Student Cognitive Habits and Change Evaluation Study (CHANGES), a national longitudinal study conducted between 2010 and 2017. Medical students from 49 allopathic U.S. medical schools were surveyed at year 4 of medical school (MS4; N = 3,976), year 2 of residency (PGY2; N = 3,579), and year 3 of residency (PGY3; N = 3,057). A serial parallel mediation analysis using structural equation modeling was used to evaluate our model. RESULTS: Our model was largely supported; observations of weight stigma during medical school were directly and indirectly associated with greater anti-fat dislike at PGY3 via fear of weight gain and controllability beliefs about weight. CONCLUSIONS: Anti-fat prejudice reduction interventions in the medical training environment should 1) emphasize the importance of, and increase adherence to, positive attitudinal role modeling among faculty and residents, 2) promote body self-acceptance among trainees, and 3) provide education around the complex interplay of genetic and environmental contributors to combat blame-based stereotypes surrounding weight.