Understanding Differences in Medical Student Perceptions of Treatment Adherence Based on Weight Status in Pediatric Care

Obesity biases in healthcare are detrimental. We explored medical student beliefs underlying perceptions that child-mother dyads with obesity are less likely to be treatment adherent. Participants viewed scenes of a 12-year-old, female virtual human presenting to a physician with back pain, accompanied by her mother. Patient and mother weight cues were manipulated across scenes. Out of 120, 35 participants perceived dyads with obesity as less adherent to hypothetical pain-related treatment recommendations relative to dyads with healthy weight. These participants were informed and asked why. Responses were analyzed for themes. Fifty-two responses revealed three codes relating to participants’ explanation of why they perceived lower adherence for dyads with obesity–obesity is associated with: 1) non-compliance with general health recommendations, 2) internal traits/factors (i.e., mothers’ less health consciousness, mental strength), 3) external factors (i.e., lower health literacy, socioeconomic status). The association of obesity with lower adherence is a bias that may exist among medical students and originate from assumptions about prior health adherence and maternal traits, some disparaging in nature. Such bias has potential to contribute to healthcare disparities. Findings highlight the utility of qualitative methods to understand beliefs driving perceptions and design bias-reducing interventions to trainee needs.