TABLE 1.
Summary of studies in healthcare professionals, trainees, and students
| Study | Population | Design | Intervention type and duration | Outcome measure | Main findings |
|---|---|---|---|---|---|
| Increased education | |||||
| Barra and Singh Hernandez (2018) | Nursing students (n = 103), USA | Pre‐post intervention | Weekly obesity sensitivity training (15 week) on weight‐based discrimination | Newly constructed 5‐item, 4‐point Likert scale questionnaire | Attitudes improved on all five items of the questionnaire |
| Gayer et al. (2017) | Medical students (n = 718), USA | Controlled trial | Standard obesity curriculum (8–10 h of lectures, virtual patient case presentations) | FPS | Stereotyping decreased (FPS: 3.65 vs. 3.37) and remained significant at 3‐year follow‐up |
| Geller et al. (2018) | Medical students (n = 59), USA | Pre‐post intervention | Ethics seminar within “Obesity, Nutrition, and Behaviour Change” course discussing personal experiences and weight bias norms | IAT, survey | 74% had high implicit bias; 4 months post‐intervention, attitudes improved in 30%, did not change in 53%, and worsened in 10% |
| Jones et al. (2019) | Physiotherapists (n = 27), Canada | Pre‐post intervention | Seminar (8 h) on obesity and osteoarthritis presented by respected opinion leaders | ATOP, BAOP | Beliefs improved (BAOP: 7.4 vs. 22.3), but attitudes towards people with obesity worsened (ATOP: 71.3 vs. 63.5) |
| Nickel et al. (2019) | Physicians, nurses, medical students and nursing trainees (n = 702), Germany | Randomized controlled trial | Video teaching (2.5 min) on obesity disease burden and treatment | FPS | Stereotyping did not change when compared with control group in physicians (FPS: 3.5 vs. 3.5), nurses (FPS: 3.3 vs. 3.3), medical students (FPS: 3.5 vs. 3.6) nor nursing students (FPS: 3.4 vs. 3.4) |
| Causal information and controllability | |||||
| Brochu (2020) | Psychology trainees (n = 45), USA | Pre‐post intervention | Seminar (3 h) on weight controllability and weight bias, informed by attribution‐value model of prejudice and HAES | AFA‐willpower, AFA‐dislike, attitudes toward fat clients | 1‐week post‐intervention, weight controllability beliefs (AFA‐willpower: 4.46 vs. 3.39) and attitudes (AFA‐dislike: 2.36 vs. 2.10) improved |
| Diedrichs and Barlow (2011) | Psychology students (n = 85), Australia | Controlled trial | Lecture (2 h) on behavioral, or multiple causes of obesity and weight bias, informed by HAES | AFAT | Beliefs and attitudes improved and remained significant at 3‐week follow‐up (AFAT: 2.18 vs. 2.04 vs. 2.00) |
| O'Brien et al. (2010) | Health promotion students (n = 159), USA | Randomized controlled trial | Weekly tutorials (3 week) on genetic/socioenvironmental causes of obesity, oral presentation, and written assignment | AFA, BAOP, pen and pencil version of IAT | Beliefs worsened (AFA‐willpower: 4.4 vs. 5.1) and improved (BAOP: 23.8 vs. 20.5), and attitudes (AFA‐dislike: 2.1 vs. 1.7) and implicit bias improved (IAT‐good/bad: 14.2 vs. 10.3, IAT‐lazy/motivated: 11.0 vs. 9.7) in gene/environment group; implicit bias worsened in diet/exercise group (IAT‐good/bad: 14.0 vs. 14.4, IAT‐lazy/motivated: 10.3 vs. 13.1) |
| Persky et al. (2010) | Medical students (n = 110), USA | Randomized controlled trial | Reading short article, clinical encounter via immersive virtual environment | Newly constructed single‐item questionnaire, OPTS | Beliefs improved and stereotyping decreased in genetics group compared with control (OPTS: 3.55 vs. 3.69); stereotyping did not change in behavioral group (OPTS: 3.75) compared with genetic and control groups |
| Empathy evoking | |||||
| Cotugna et al. (2010) | Dietetics students (n = 40), USA | Pre‐post intervention | Following a calorie‐restricted diet (1 week) | FPS, newly constructed questionnaire, journal entries | Stereotyping decreased (t = 3.184, p < 0.05) significantly |
| Harris et al. (1991) | Psychology students (n = 244), USA | Randomized controlled trial | Reading high status or empathy evoking interview with person with obesity together with or without interview with obesity expert | Newly constructed 18‐item, 7‐point Likert scale questionnaire | No changes in attitudes were seen in any of the groups |
| Hunter et al. (2018) | Nursing students (n = 29), UK | Pre‐post intervention | Wearing a bariatric empathy suit (30 min) | NATOOPS, focus group | Some attitudes (NATOOPS‐1: 25 vs. 33, NATOOPS‐2: 64 vs. 82, NATOOPS‐5: 56 vs. 64) improved, but beliefs and stereotyping did not change |
| Kushner et al. (2014) | Medical students (n = 127), USA | Pre‐post intervention | Reading and reviewing two weight stigma articles, clinical encounter (8 min) with standardized patients with overweight, case observations | Newly constructed questionnaire | Empathy increased in 48% and decreased in 23%; stereotyping decreased in 53% and increased in 33%; at 1‐year follow‐up, empathy remained significant, but stereotyping regressed to back to the baseline mean |
| Matharu et al. (2014) | Medical students (n = 129), USA | Randomized controlled trial | Dramatic reading (1 h) of a play script titled “The Most Massive Woman Wins,” nondirective group discussion | AFA, IAT, JSPE, two open‐ended questions | Empathy increased in both groups; attitudes improved only in intervention group (AFA: 42.6 vs. 38.1); implicit bias did not improve (IAT: 0.44 vs. 0.38) |
| Molloy et al. (2016) | Nursing students (n = 70), USA | Pre‐post intervention | Bariatric sensitivity training (1 h) using 6 trigger films (<4 min) with facilitated group debriefing | BAOP, NATOOPS | Beliefs (BAOP: 16.4 vs. 19.0) and some attitudes (NATOOPS‐2: 543 vs. 649, NATOOPS‐3: 515 vs. 452, NATOOPS‐4: 66 vs. 61) improved; at 30‐day follow‐up, beliefs remained significant (BAOP: 18.2), some attitudes (NATOOPS‐1: 571) reverted back |
| Weight‐inclusive approach | |||||
| McVey et al. (2013) | Health promoters (n = 325), Canada | Pre‐post intervention | Interactive workshop on weight bias, intuitive eating, weight‐centric health messaging and mental health promotion, informed by HAES | AFA, SATAQ, semi‐structured interview | Attitudes (AFA: 33.8 vs. 23.99 vs. 25.18) and internalization of sociocultural stereotypes (SATAQ: 13.61 vs. 11.48 vs. 12.28) improved and remained significant at 6‐week follow‐up |
| Werkhoven (2020) | Healthcare students (n = 124), Australia | Pre‐post intervention | Weekly lectures and tutorials (12 week) focusing on nutrition and stigma reduction, informed by HAES | AFA, FSQ, focus group | Attitudes improved (AFA: 47.0 vs. 43.1); stereotyping decreased (FSQ: −0.32 vs. − 0.24, p > 0.05) |
| Mixed methodology | |||||
| Falker et al. (2011) | Health professionals (n = 30), USA | Pre‐post intervention | Self‐learning bariatric sensitivity training (44 pg) aiming to evoke empathy, addressing multiple causes of obesity and weight stigma | Newly constructed survey | Self‐reported attitudes towards patients with obesity improved |
| Luig et al. (2020) | Medical residents (n = 32), Canada | Pre‐post intervention | Lectures with bariatric empathy suit experience, clinical encounter, narrative reflections | ATOP, BAOP, reflective writing | Beliefs improved (BAOP: 19.86 vs. 24.03), but attitudes did not improve (ATOP: 73.15 vs. 69.26) |
| Poustchi et al. (2013) | Medical students (n = 64), USA | Pre‐post intervention | Video (17 min) titled “Weight Bias in Health Care,” interactive discussion | ATOP, BAOP, FPS | Beliefs (BAOP: 16.53 vs. 19.27) and stereotyping (FPS: 3.65 vs. 3.45) improved; attitudes did not improve (ATOP: 66.14 vs. 64.90) |
| Swift et al. (2013) | Nutrition students (n = 43), UK | Randomized controlled trial | Two videos (34 min) titled “Weight Prejudice: Myths and Facts” and “Weight Bias in Healthcare” | Willpower and dislike subscales of AFA, BAOP, FPS, IAT | Beliefs (BAOP: 11.2 vs. 19.9, AFA‐willpower: 5.42 vs. 3.88), attitudes (AFA‐dislike: 1.86 vs. 1.45) and stereotyping (FPS: 3.7 vs. 3.2) improved; implicit bias did not change (IAT‐good/bad: 3.8 vs. 2.7, IAT‐lazy/motivated: 4.5 vs. 2.6); at 6‐week follow‐up, changes in beliefs remained significant (BAOP: 13.7, AFA‐willpower: 4.63), but attitudes (AFA‐dislike: 1.57) and stereotyping (FPS: 3.6) did not |
| Rukavina et al. (2008) | Kinesiology students (n = 69), USA | Pre‐post intervention | Multicomponent intervention including lecture (75 min), group activity and service‐learning project | AFAT, ERT | Beliefs improved (AFAT‐blame: 3.2 vs. 3.41, AFAT‐physical: 3.17 vs. 3.21, AFAT‐social: 4.1 vs. 4.1), but attitudes and stereotyping did not change |
| Rukavina et al. (2010) | Kinesiology students (n = 78), USA | Controlled trial | Multicomponent intervention including interactive discussions, audio tape listening, perspective taking, role‐playing and service‐learning project | AFAT, IAT, ERT | Beliefs about controllability (AFAT‐blame 2.88 vs. 2.59) and social value (AFAT‐social: 2.04 vs. 1.97) improved; attitudes, stereotyping and implicit bias did not change |
| Wiese et al. (1992) | Medical students (n = 75), USA | Randomized controlled trial | Seminar (2 h) including video, reading article about genetic causes of obesity, role‐playing, reflective writing | Newly constructed questionnaire | Beliefs, attitudes and stereotyping improved; at 1‐year follow‐up, changes in beliefs and stereotyping remained significant |
| Wijayatunga et al. (2019) | Kinesiology students (n = 67), USA | Controlled trial | Lecture (80 min), video, empathy‐evoking group activities and reflective writing | AFAT, IAT | Beliefs improved and remained significant at 4‐week follow‐up (AFAT‐blame: 2.79 vs. 2.43 vs. 2.40, AFAT‐physical: 2.59 vs. 2.63 vs. 2.53, AFAT‐social: 1.72 vs. 1.77 vs. 1.76); implicit bias did not change significantly (0.55 vs. 0.91) |
Abbreviations: AFA, Anti‐Fat Attitudes Questionnaire; AFAT, Anti‐Fat Attitudes Test; ATOP, Attitude Towards Obese Persons; BAOP, Beliefs About Obese Persons; ERT, Explicit Rating Test; FPS, Fat Phobia Scale; FSQ, Fat Stereotypes Questionnaire; HAES, Health at Every Size; IAT, Implicit Attitude Test; JSPE, Jefferson Scale of Physician Empathy; NATOOPS, Nurses Attitudes Towards Obesity and Obese Patients Scale; OPTS, Obese Persons Trait Survey; SATAQ, Sociocultural Attitudes Towards Appearance Questionnaire.