Clinicians' Implicit and Explicit Attitudes about Weight and Race and Treatment Approaches to Overweight for American Indian Children

Child Obes. 2015 Aug;11(4):456-65. doi: 10.1089/chi.2014.0125. Epub 2015 Jul 17.


Purpose: Obesity is one of the most serious health problems among American Indian/Alaska Native (AI/AN) children. We investigated Indian Health Service (IHS) primary care providers' implicit and explicit attitudes about weight and race and their association with treatment approaches to overweight in children.

Methods: We conducted an online survey of long-term primary care clinicians in two western regions of the IHS. We used the existing Weight Attitude Implicit Association Test (IAT) and developed a new Native American Attitude IAT to measure implicit attitudes. Explicit attitudes about weight and race were assessed through self-report. We assessed self-rated treatment approaches to childhood overweight. We used linear regression models to evaluate the association of attitudes about weight and race with treatment approaches.

Results: Our sample included 75 clinicians (56% response rate) who, on average, saw 74 patients per week. Fifty-five percent of clinicians reported that 30-60% of their child and adolescent patients were overweight or obese, and 25% of clinicians reported that 60-100% of their patients were overweight or obese. We found strong implicit bias favoring thin people (Cohen's d=1.44) and weak implicit bias favoring whites (Cohen's d=0.35). We found no association between implicit or explicit bias scores and self-reported treatment of childhood overweight. Continuing education on obesity was associated with self-rated success and competence in weight management.

Conclusions: Weight and race bias exists among long-term IHS clinicians, but may not influence treatment approaches for overweight AI/AN children. Further research should assess the effect of clinicians' attitudes on real-world weight management.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Attitude of Health Personnel*
  • Body Mass Index
  • Child
  • Child, Preschool
  • Health Care Surveys
  • Healthcare Disparities / statistics & numerical data*
  • Humans
  • Indians, North American*
  • Physician-Patient Relations
  • Physicians / psychology*
  • Prejudice* / psychology
  • Quality of Health Care / statistics & numerical data*
  • Stereotyped Behavior
  • Surveys and Questionnaires
  • United States / epidemiology