Signaling hostility: The relationship between witnessing weight-based discrimination in medical school and medical student well-being

Environments that are hostile to one or more marginalized groups are known to have a negative effect on the mental health and well-being of both targets and observers. Anti-fat attitudes have been well documented in medical education, including the use of derogatory humor and discriminatory treatment toward higher-weight patients. However, to date, it is not known what effect observing weight stigma and discrimination during medical school has on medical students’ psychological health and wellbeing, sense of belonging, and medical school burnout. The present study surveyed a total of 3994 students enrolled across 49 US medical schools at the start of their first year and at the end of their fourth year. Participants reported the frequency with which they had observed stigmatizing and discriminatory behaviors targeted at both higher-weight patients and higher-weight students during their four years of medical school. Observed weight stigma was prevalent, and was associated with worse psychological and general health, reduced medical school belonging and increased medical school burnout. The indirect effects of observed weight stigma on medical school burnout, via belonging, psychological health, and general health, were statistically significant in the sample as a whole, but were more pronounced in higher-weight students. This effect may be explained, in part, by the relationship between observed stigma and medical school belonging. Higher levels of observed stigma were associated with reduced feelings of belonging in higher-weight but not normative-weight students. Top-down institutional culture change is needed to rectify this situation, which is detrimental to both students and patients.