Measuring Medical Student Attitudes and Beliefs Regarding Patients Who Are Obese

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Research shows obesity bias to undermine the patient–doctor relationship and lead to substandard care. The authors developed and tested an instrument to measure medical students’ attitudes and beliefs about obese patients.


The authors conducted a literature search to identify validated measures of obesity bias. Because they identified no appropriate scale, they decided to design a novel survey instrument: the Nutrition, Exercise and Weight Management (NEW) Attitudes Scale. An expert panel generated items which focus groups of third-year medical students then discussed. Next, experienced medical educators judged and weighted the remaining revised items. Then, second- and fourth-year medical students completed the scale alongside two previously validated measures of obesity bias, the Anti-Fat Attitudes Questionnaire (AFA) and Beliefs About Obese Persons Scale (BAOP). Third-year students completed the NEW Attitudes Scale before and after a simulated encounter with an obese standardized patient instructor. The authors tested the validity and reliability.


The final instrument comprised 31 items. A sample of 201 judges rated the items. A sample of 111 second- and fourth-year medical students completed the survey (mean score 24.4, range −37 to 76 out of a possible −118 to 118; higher scores indicate more positive attitudes). Pearson correlations between the NEW Attitudes Scale and AFA and BAOP were, respectively, −0.47 and 0.23. Test–retest reliability was 0.89. Students scored 27% higher after completing the standardized patient–instructor encounter (P < .001).


The NEW Attitudes Scale has good validity and reliability and may be used in future studies.

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