The Case

You are sitting in a committee meeting, discussing an application to promote another physician in your group to a leadership position. They are an outstanding candidate. A member on the committee comments that a leadership position should be awarded to a physician having a normal weight as opposed to one who is overweight. This makes you feel uncomfortable, and you wonder if you should speak up.

Clinical Question

Is there interphysician implicit, explicit, and/or professional weight bias in emergency medicine?

Background

Bias, as defined by the common English language, is “a particular tendency, trend, inclination, feeling, or opinion, especially one that is preconceived or unreasoned.”¹ It is a sense of prejudice or stereotyping and the formation of a foregone conclusion independent of current evidence.

Bias can be either implicit or explicit. Implicit bias is an unconscious and often subtle type of bias that is hard to pinpoint and difficult to measure. Explicit bias is a more outward bias expressed in words or actions that’s easier to identify in other people and ourselves.

Examples of these types of biases in the house of medicine include age, gender, socioeconomic status, and race. Weight bias has not received as much attention. There is literature on physicians’ weight biases toward patients.^2–4 However, there is limited information on physician-to-physician weight bias.⁵

Implicit weight bias (IWB) can be measured using the Implicit Association Test (IAT) based on work from Project Implicit, a Harvard-based research organization. Explicit weight bias (EWB) was quantified using a modified Anti-Fat Attitudes Questionnaire.⁶ Participants were asked to respond on a seven-point Likert scale from 1 (strongly agree) to 7 (strongly disagree), shown in Table 1.

Table 1: Modified Anti-Fat Attitudes Questionnaire

This recent study added a third category of bias called professional weight bias (PWB). This was defined as the reduced willingness to collaborate with, seek advice from, and foster mutually beneficial professional relationships with physician colleagues with obesity. The same seven-point Likert scale was used to assess PWB (see Table 2).

Table 2: Professional Weight Bias Questionnaire

Reference: McLean ME, McLean LE, McLean-Holden AC, et al. Interphysician weight bias: a cross-sectional observational survey study to guide implicit bias training in the medical workplace. Acad Emerg Med. 2021;28(9):1024-1034.

• Population: Practicing physicians and physicians-in-training in the United States and Canada
• Intervention: Survey instruments measuring IWB, EWB, and PWB
• Comparison: None
• Outcome: Descriptive analyses along with correlative models

Authors’ Conclusions

“Our findings highlight the prevalence of interphysician implicit WB; the strong correlations between implicit, explicit, and professional WB; and the potential disparities faced by physicians with obesity. These results may be used to guide implicit bias training for a more inclusive medical workplace.”