A role-playing game – involving a “patient” in a fat suit – should be a standard training exercise for medical students, a new study finds.

In an experiment conducted by researchers from the Department of Psychosomatic Medicine and Psychotherapy at the University Hospital Tuebingen in Germany, student doctors were taught to be more empathetic and respectful toward overweight and obese patients – and to confront their own, often profound, prejudices.

As the researchers write in their paper:

“Health professionals have been found to communicate in a less patient-oriented and respectful way with patients with obesity; in particular, they take less time for consultation and explanations, instead attributing the patients’ problems and symptoms to their weight rather than to other potential causes.”

The obesity simulation suit consists of two partas: the soft outer shell imitating the typical figure of a patient with obesity, and a series of weights worn inside to simulate the additional weight. Photo: University Hospital Tuebingen

In other words, they blame the patient for getting fat in the first place, and they fail to explore other avenues for treatment besides weight loss. On the other side, overweight patients, repeatedly and baldly stigmatised in a healthcare setting, have been found to give up seeking help, and sink further into their attendant depression.

What to do?

Lead researcher Dr Anne Herrmann-Werner had the idea of using an “obesity simulation suit” in a role-playing experiment to expose and remedy fat prejudice among medical students.

In the experiment, more than 200 students play-acted a routine encounter between a “family doctor” and a “patient with diabetes”.

Thirteen students from the university’s communication course played the patients – and 22 teachers also took part, to moderate the sessions, but also to assess the effectiveness of the experiment as a teaching aid.

The patient presented as a person with type 2 diabetes struggling to keep up with self-care (regular exercise, healthy eating, regular intake of medication) coming for a routine follow-up appointment to her GP.

The students had to take the patient’s medical history and explore psychosocial factors related to the diabetes.

The prejudice predictions all came true

The experiment took place in small groups of 10 students, one of whom took on the role of the doctor.

Following each session, students, teachers and patients completed questionnaires anonymously. These assessed how realistic the role play had been, whether the fat suit was an effective teaching aid, and how difficult it was to wear.

Attitudes to obesity were assessed, using the weight control/blame section of the validated Anti-Fat Attitudes Test (AFAT). AFAT scores responses on a five point scale, where one equals strong disagreement and five equals strong agreement to statements such:

• “If fat people really wanted to lose weight, they could”
• “Fat people have no will power”
• “Most fat people are lazy”

Although the medical students tended to agree the suit helped them empathise with the patient, their AFAT responses showed they harboured more negative attitudes towards obesity than either the teachers or the patients.

They were more likely to agree more strongly with statements that supported the idea that “there is no excuse for being fat”.

Good teaching aid, but hot and heavy to wear

Teachers rated the suit’s value as a teaching aid “quite highly”, with about three out of four respondents saying they felt it facilitated empathy in the role play – and most participants regarding it as realistic.

But more than half the patients – all of them played by women– mentioned the suit was very hot to wear and about one in four said it was cumbersome to put on and take off.

Still, the researchers concluded that the proof of concept study could work as a standard exercise in medical schools: “We strongly believe that integrating an obesity simulation suit into the routine undergraduate medical teaching context is a valuable tool. It can raise medical students’ awareness for communication encounters with patients with obesity.”