JOURNAL OF ADDICTIONS NURSINGNOLUME 12, NUMBER 1, 2000
Medical and Nursing Students’ Perceptions of Obesity*
Betty €.A. Petrich, R.N., M.S.
Abstract
This purpose of this qualitative, descriptive study
was to describe the perceptions of medical and nurs-
ing students towards obesity. This study utilized
King’s (1981, 1983, 1986, 1989, 1990, 1991, 1992,
1994, 1995, 1996, 1997a, 1997b) ideas and nursing
theory as a guide for achieving this purpose. The re-
search was conducted with 28 medical and 102 nurs-
ing students attending three universities in Southern
Ontario and one in Western New York. Students
were given a survey containing six open-ended ques-
tions. The research objectives were answered by an-
alyzing the themes that originated from the students’
responses to the survey questions. Although the
study findings identified similarities and differences
in perspectives between the two groups of students,
the theme that appeared most prevalent throughout
students’ writings was feeeling repulsed at the ap-
pearance of someone whom they perceived to be
overweight. Both groups of students also perceived
obesity as unhealthy and assumed that individuals
who were overweight were inactive, lazy, and lacked
self control. Further, the study’s findings indicated
that the majority of both groups of students had re-
ceived minimal instruction on the etiology and treat-
ment of obesity. Findings further demonstrated that
students had limited clinical experiences in caring
for, and/or treating patients who are overweight or
obese.
Introduction
The fear of fat and feelings of prejudice toward
people, especially women, who are obese are quite
Visiting Community Health Nurse, VON (Victorian Order of Nurses), Toronto,
Ontario, Canada.
*Written as a requirement for Graduate Nursing Study while at D’Youville
College, Buffalo, NY.
3
evident in today’s society (Fontaine, 1991; Kil-
bourne, 1994; Robinson et al., 1993; Vandereycken,
1993). North American culture is preoccupied with
both the pleasures of eating and the importance of a
beautiful body (Fontaine, 1991; Love and Seaton,
1991; Miller, 1991). Peternelj-Taylor (1989) ex-
plained that “society equates obesity with over-eat-
ing and perceives eating to be solely regulated by
controllable sensations, thus derogatory attitudes are
often directed to the obese person’s character” (p.
745). Peternelj-Taylor also noted that persons who
are obese are frequently snubbed at social functions,
discriminated against in the job market, and per-
ceived as inferior or of weaker character due to their
presumed lack of willpower. Craft (1972) stated that
the word “fatness” in itself has a negative tone, im-
plying weakness, laziness, and lack of self-control.
Obesity is associated with such unyielding social dis-
grace that eventually the obese persons’ predicament
is not the weight itself, but the way society perceives
them (Kaplan, 1982a; Peternelj-Taylor, 1989). Peo-
ple’s perceptions of their own body image often tend
to be based on the way other individuals and soci-
ety react to their appearance (King, 1981). King fur-
ther highlighted how stereotypes influence people’s
perceptions of others and themselves.
There is overwhelming evidence in the literature
that society discriminates against people who are fat.
The questions of concern then becomes, do nurses
and physicians perceive obesity in the same way?
Since only a small amount of research pertaining to
medical and nursing professionals’ perceptions of
obesity has been uncovered, the researcher felt that
this warranted further investigation.
Ciliska (1998) advocated that “cultural change in
our societal attitudes toward fat is necessary to re-
duce the emotional burden of body disparagement,
poor self-esteem, and social discrimination experi-
enced by some obese and normal weight women who
perceive themselves as deviant from the stringent
standards for thinness in women” (p. 132). Nurses
4 JOURNAL OF ADDICTIONS NURSINGNOLUME 12, NUMBER 1, 2000
and physicians must challenge these cultural values
by responding appropriately to people suffering from
obesity. Healthcare professionals must help each
other grow in self-awareness and in understanding
human behavior, especially in stressful life experi-
ences (King, 1981).
This study hopes to increase the awareness among
present and future healthcare professionals on how
negative stereotyping and prejudice can affect their
own interactions, behaviors, care, and treatment
(King, 1981). Physicians’ negative attitudes toward
obesity not only reinforce societal attitudes toward
fat, but also contribute to people’s avoidance of seek-
ing and receiving preventative care (Adams et al.,
1993; Robinson, et al., 1995; Fidell, 1980). Robin-
son et al. (1995) explained that the reasons given for
avoiding visits to physicians included physicians
criticism of body size, physicians’ insensitive re-
marks regarding weight, frequent suggestions to diet,
linking illness to weight, and assumptions of overeat-
ing.
Burgard and Lyons (1994) explained that health-
care professionals who offer criticism instead of sup-
port can emotionally devastate a client, resulting in
distrust and dissatisfaction with the healthcare sys-
tem. McBride (1988) remarked how one woman felt
that “being fat is going to kill me, not because the
strain on my heart but because of the strain on my
soul. I am going to have some warning signs and
avoid seeking health care until it is too late, because
I am sick and tired of the canned speeches from doc-
Table 1. Correlation of Research Questions with Survey Questions
Research questions
1. What are medical and nursing
students’ perceptions of obesity?
2. How do medical and nursing
students perceive women who
are obese?
3. How do medical and nursing
students perceive men who are
obese?
4. What amount of instruction
regarding obesity is included in
the students’ curriculum?
5. What amount of clinical
experience have students received
as part of their curriculum?
6 . What types of clinical experiences
have students received as part
of their curriculum?
tors and nurses blaming my weight for everything”
(p.12). Thus, the perceptions of future medical and
nursing professionals may be critical to the quality
of services and care they will provide to their pa-
tients who are obese. Adams et al. (1993) explained
that the effects of bias toward people who are obese
by healthcare professionals may well impact on pre-
ventive procedures offered to these people.
Purpose of the Research
This qualitative descriptive study endeavored to
identify and describe the perceptions of medical and
nursing students toward obesity.
Method
Population and Sample
Once full Institutional Review Board (IRB) ap-
proval had been granted, the study was conducted at
three universities in southern Ontario and one in
western New York. The study sample consisted of
130 volunteers from the entire population of third-
and/or fourth-year undergraduate nursing and/or
medical students at four universities. A purposive
sample (Babbie, 1995) of a 102 third- and/or fourth-
year nursing students and 28 first-, second-, third-,
and/or fourth-year medical students was obtained.
Babbie described purposive or judgmental sampling
Survey questions
1. Describe the feelings, thoughts, and gut
level reactions you have when you hear the
words “fat,” “obese,” and “overweight.”
2. Describe the feelings, thoughts, and gut
level reactions you have when you see a
woman you perceive to be overweight.
3. Describe the feelings, thoughts, and gut
level reactions you have when you see a man
you perceive to be overweight.
4. How many hours of class time have you
had on caring for or treating people who are
overweight?
5. How many patients who are overweight
have you cared for or treated in clinical
settings?
6. List the types of clinical settings you have
been in when caring for or treating patients
who are overweight or obese.
JOURNAL OF ADDICTIONS NURSINGNOLUME 12, NUMBER 1, 2000 5

as a type of nonprobability sampling method in
which the researcher uses his or her own judgment
in the selection of sample members.
Instruments
No questionnaire or survey that addressed the spe-
cific aims of this research was located in the pre-
liminary review of the literature. However, Feigen-
baum’s (1995) research had a similar focus since it
“sought to identify senior baccalaureate nursing stu-
dents’ perceptions of individuals who are substance
abusers” @. 90). This researcher had asked students
to write narratives of their thoughts, feelings, and re-
actions when they heard the words “drug addict” and
“alcoholic.” Hence, with J.C. Feigenbaum’s (per-
sonal communication 1997) verbal permission, the
researcher modified the questionnaire to meet the
aims of the study.
The survey’s questions (see Table 1) were based
on the ideas and information accumulated from the
literature review, Feigenbaum’s (1995) research, and
King’s (1981) conceptual framework. The questions
endeavored to have the medical and nursing students
describe their perceptions of obesity. The students
were asked to write a few sentences describing their
feelings, thoughts, and reactions to the terms “fat”
“obese” and “overweight.” Lastly, students were
asked to report the amount of instruction and clini-
cal experience they had received regarding obesity
and its treatment.
The open-ended questions allowed respondents to
express themselves freely, documenting in their own
words their feelings, thoughts, and beliefs. There-
fore, the open-ended questions allowed for elabora-
tion of students’ comments and decreased the po-
tential of researcher’s bias.
Data Collection
One of the most difficult aspects of this research
study was recruiting the sample. Once full IRB ap-
proval had been received from D’Youville College,
the researcher contacted seven universities regarding
the research study. Each university demanded that
the researcher go through an additional review
process, and each procedure was different. After sev-
eral months of waiting, four of the seven universi-
ties granted IRB approval. The recruiting process
was long and frustrating. Originally the researcher
hoped to recruit a much larger and more equal sam-
ple of third- and/or fourth-year medical and nursing

Table 2. Medical and Nursing: Students’ Perceptions of Obesity

Medical students Nursing students
Theme (n = 28) (n = 102) Total

Feels repulsed at person’s appearance 5 (54%) 25 (25%) 40 (31%)

Labels person as unhealthy 7 (25%) 22 (22%) 29 (22%)
Views person as inactive, lazy 0 (36%) 17 (17%) 27 (21%)
Labels person as lacking self-control 7 (25%) 20 (20%) 27 (21%)
Views labels negatively 2 (7%) 21 (21%) 23 (18%)
Differentiates meaning of terms 4 (14%) 17 (17%) 21 (16%)
Identifies reasons for obesity 7 (25%) 12 (12%) 19 (15%)
Views person as lacking control over eating 4 (14%) 16 (16%) 20 (15%)
Thinks of own failure to control weight 2 (7%) 16 (16%) 18 (14%)
Feels concern that person may be a
victim of discrimination 2 (7%) 14 (14%) 16 (12%)

Fears becoming fat, obese, overweight 2 (7%) 11 (11%) 13 (10%)

Feels empathy 3 (11%) 9 (9%) 12 (9%)
Views person as having low self-esteem 4 (14%) 7 (7%) 11 (8%)
Feels concerned about significant others 0 (0%) 5 (5%) 5 (4%)
Feels depressed 0 (0%) 5 (5%) 5 (4%)
Wonders why 1(4%) 2 (2%) 3 (2%)
Worries about how others view my
weight 0 (0%) 4 (4%) 4 (3%)
Feels people can be helped to lose weight 0 (0%) 3 (3%) 3 (2%)
Feels motivated to help 2 (7%) 0 (0%) 2 (2%)
Feels relief that person does not fit label 1(4%) 0 (0%) 1 (1%)
6 JOURNAL OF ADDICTIONS NURSINGNOLUME 12, NUMBER 1, 2000
students. However, due to the lack of volunteers,
medical students in their first and second year of
study were also invited to participate. Although hun-
dreds of surveys were distributed, only 130 were re-
turned. This reality resulted in the small and unequal
sample size. It is important to note that the researcher
did not ask volunteers to identify their gender or
specify which year of study they were in.
Once the surveys were returned to the researcher,
the data were systematically analyzed via content
analysis (Berg, 1995). The data collected were ana-
lyzed by the process of pattern coding in order to
identify themes inherent in the students’ answers to
the questions. Each theme or idea was highlighted
with a different color pen, and following this proce-
dure, the themes were analyzed. Medical and nurs-
ing students’ data were kept separate in order to as-
sertain what similarities and/or differences existed
initially within each of the two groups. Once all of
the data had been compared, an inductive approach
was taken, and conclusions were made regarding
medical and nursing students’ perceptions of obesity.
Findings
The answers to all of the research questions were
based on analyzing the themes derived from the 28
medical students’ and the 102 nursing students’ writ-
ten responses to the six questions on the survey.
What Are Medical and Nursing Students’
Perceptions of Obesity?
Twenty themes surfaced during the analysis of the
students’ answers to the first question as shown in
Table 2.
Feels Repulsed at Person’s Appearance. The
theme of feeling repulsed by the person’s appearance
was noted by the students’ statements of disgust,
pity, and repulsion. Twenty-five (25%) of the nurs-
ing students surveyed wrote about feeling disgusted
when hearing the terms “fat,” “overweight,” and
“obese.” Although 4 (4%) nursing students wrote
about feeling sorry for anyone who was overweight,
they also believed that overweight individuals did
not care about themselves or their appearance.
Twelve (12%) nursing students’ descriptions por-
trayed physically unattractive individuals while six
perceived overweight people to be “unclean,”
“sweaty,” and/or “sloppy.” Fifty-four percent of the
28 medical students also identified feeling repulsed
when hearing the terms “fat,” “overweight,” and
“obese.” This group described them as “ugly” and
“gross.” Other examples of students’ comments il-
lustrating this theme included:
“It usually brings forth a negative reaction, phys-
ically unattractive.”
“Pale skin, stuffing face . . . cellulite . . .”
“My gut reaction is usually a mild form of repul-
sion because I find fat unappealing.”
“Especially after dissection, fat seems pretty dis-
gusting.”
“I feel sorry for anyone who is obese-it’s un-
comfortable for them and everyone around them.”
“Greasy gross, globule . . . yellow, silvery stretch
marks.”
Labels Person as Unhealthy. The theme of la-
beling the person as unhealthy was identified when
students indicated that the terms “fat,” “overweight,”
and/or “obese” automatically implied poor health.
Health appeared to be a major concern in 22 (22%)
of the nursing students surveyed. Nursing students
accurately identified various diseases including dia-
betes, heart disease, stroke, and rheumatoid and os-
teoarthritis as a direct result of obesity. One student
believed that obesity could cause premature death.
Seven (25%) medical students perceived obesity as
unhealthy but did not associate specific diseases with
obesity. Some examples of students’ comments il-
lustrating this theme included:
“Obesity is unhealthy.”
“I11 health both present and future.”
“They have more medical problems, most not
taken seriously . . .”
“Unhealthy people.”
“Unhealthy lifestyle.”
“Fat, obese, and/or overweight are unhealthy, fu-
ture medical problems . . .”
Views Person as Inactive, Lazy. The theme of
viewing the person as being inactive and/or lazy was
based on students’ descriptions of the terms “fat,”
“obese,” and “overweight” in relation to a restrictive
and sedentary lifestyle. Seventeen (17%) of the nurs-
ing students and 10 (36%) of the medical students
believed that overweight individuals were less ac-
tive, did not exercise, and were lazy and lethargic.
Some of the students’ comments illustrating this
theme include:
“Out of shape. Sitting around.”
“Coach potato.”
“. . .restricting in terms of what one is able to do.”
JOURNAL OF ADDICTIONS NURSINGNOLUME 12, NUMBER 1, 2000
“. . . decrease in level of activities that can be phys-
ically accomplished . . .”
Labels Person as Lacking Self-Control. The
theme of labeling the person as lacking self-control
was designated when the students’ comments re-
flected their feelings of a weak individual, lacking
willpower, and not caring for self. Seven (25%) of
the medical students and 20 (20%) of the nursing
students believed that overweight individuals lacked
willpower and needed to gain control over their eat-
ing by dieting. Some students believed that over-
weight individuals just did not care about them-
selves, their health, or their appearance and
wondered how individuals could allow themselves
to become overweight. Some examples of comments
illustrating this theme included:
“. . . Most of this country is filled with fat people.
I feel that everyone should be thin. It is weak peo-
ple with no self-control who are fat.”
“Someone who is weak, cannot control themselves
around food.”
“My gut level reactions are in many ways that peo-
ple who are fat, obese, or overweight are out of con-
trol and do not consider what they put into their
mouths affects what goes on in their body.”
“I don’t understand how people let themselves go
and ruin the body they have.”
“Why don’t these people take care of themselves.”
“I feel that a healthy mind and body go hand in
hand-“obese” intimates lack of self control and dis-
cipline.”
“When I hear the words “obese” as a student nurse
I think big fat needs to lose weight.”
“Needs to control diet.”
“Why and how would someone allow themselves
to get that way.”
Views Labels Negatively. The theme of viewing
the labels negatively was evidenced as students
wrote about their distaste for the terms “fat,”
“obese,” and “overweight.” Two (7%) medical and
21 (21%) nursing students believed that the terms
were degrading, insulting, and demeaning, while fur-
ther perceiving these words to be prejudicial labels.
Some examples of comments illustrating this theme
included:
“Fat is a very harsh word to say about another . . .”
“I feel sick and disgusted when I hear the words.”
“I don’t feel . . . that an overweight person should
be called a negative name or . . . labeled as fat or
obese.”
7
“I believe the words . . . are derogatory in nature
and have negative connotations in this society . . .”
Differentiates Meaning of Terms. The theme of
“differentiates the meanings of the terms” was ob-
served when students noted differences in their in-
terpretations of their definitions of fat, obese, and
overweight. Seventeen (17%) of the nursing students
perceived the word “fat” to be a negative, conde-
scending, demeaning term, while 10 (10%) of this
group felt it was a clinical, acceptable, and kinder
term to use. One student stated that the word “fat”
described the type of body a person had, while an-
other felt it meant “chubby.” Four (14%) of the med-
ical students defined obesity in medical terms, while
2 (7%) students reported negative perceptions of the
word “fat.” Some examples of students’ comments
illustrating this theme included:
“Fat to me is a rude word that is used as an igno-
rant term. Obese and overweight are more medical
or technical terms that I have no problem using when
describing such a person.”
“Fat is a very harsh word to say about another . . .
Obese and overweight are much better terms to use.”
“Fat describes the kind of body not the size.
Obese, I think of an extremely large person, i.e., 300
pounds. Overweight refers to many people, it is a
perception.”
“Fat-feel negative connotations, a bad descrip-
tive term which connotes laziness and lack of
willpower. Obese also connotes negative images ex-
cept on a greater scale. I think of exceptionally large
(300-400) lbs. Overweight, a more human term
which calls for more descriptive terms . . .”
Identifies Reasons for Obesity. The theme of
identifying the reasons for obesity refers to the opin-
ions given by students that there may be various
physical, genetic, emotional, and psychological rea-
sons for the person being fat, obese, and overweight.
Seven (25%) medical and 12 (12%) nursing students
demonstrated this theme in their responses. Some ex-
amples of students’ comments illustrating this theme
included:
“After a while I think that maybe they’re ill and can-
not control their weight especially diabetes, thyroid.”
“. . . many if not most of whom are genetically
predisposed and in fact eat less than most, and largely
I think of the need for education.”
“. . . physiological problems, emotional distress.”
“Do they eat a lot to hide their problems? Are they
i i i ~
8 JOURNAL OF ADDICTIONS NURSINGNOLUME 12, NUMBER 1,2000
“It makes me think of genetic factors and social
factors contributing to one’s weight.”
Students listed genetic, cultural, medical, meta-
bolic, physiological, and/or psychosocial problems,
such as occupation and stress, as reasons for obesity.
Views Person as Lacking Control over Eating.
The theme of viewing the person as lacking control
over eating was based on the students’ references to
the poor nutritional habits and lack of willpower of
people who they perceive as fat, obese, and over-
weight. Four (14%)medical and 16 (16%) nursing
students stated that obesity was a result of eating too
much. Some examples of students’ comments that
illustrate this theme included:
“Poor diet habits. Lemon meringue pie with
whipped cream, chocolate covered sprinkles, greasy
French fries, all you can eat buffets, over indulge.”
“I think of people who need help and teaching how
to change their nutritional habits.”
“Overeating/gluttony.”
Thinks of Own Failure to Control Weight. The
theme of thinking of one’s own failure to control
weight was observed when students wrote about their
own personal struggles and feelings regarding
weight issues. When describing their feelings re-
garding obesity 36 (36%) of the nursing students
used the words “fat,” “overweight,” and “obese” to
describe their own personal situations. Within this
group, 16 (16%) described their own failures and
struggles with weight issues, 1 1 (1 1 %) reported their
fears regarding gaining weight and becoming fat, and
5 (5%) expressed concerns for their friends and fam-
ily members who struggle with obesity. Four (4%)
of the nursing students disclosed concerns about how
others would view their weight. A total of 5 (18%)
of the medical students also personalized their re-
sponses to these terms. Of this group, 2 (7%) ver-
balized concerns and frustration regarding their fail-
ures to control weight, 2 (7%) expressed fears of
gaining weight, and 1 (4%) disclosed gratitude and
relief at not being overweight. Some examples of stu-
dents’ comments illustrating this theme included:
“I feel fat at times and feel very uncomfortable
about my body and very unattractive.”
“Food, me, my body, ugly, depression.”
“I get upset and angry. I constantly look in the
mirror and every day I’m aware of my weight.”
“I feel self-conscious. I hear those words and I
think about myself and I feel negative toward my
own self-image.”
“When I hear the words “fat,” “obese,” “over-
weight,” my first thought is I couldn’t imagine my-
self being fat and also I could cope with being fat. I
would probably starve myself to lose weight.”
“Pray I never gain weight.”
“I hope that will never be me.”
“Hope no one ever uses those words to describe
me.”
“I’m glad I’m not.”
Feels Concern That the Person May Be a Vic-
tim of Discrimination. The theme of feeling con-
cern that the person may be a victim of discrimina-
tion was based on the students’ comments about
either their own personal feelings and prejudices or
society’s biases toward individuals who are fat,
overweight, and/or obese. Fourteen (14%) nursing
students expressed concern that the terms were prej-
udicial labels. These students believed that society
discriminates against overweight individuals and
noted that these derogatory words helped contribute
to fat bias. Two (7%) medical students were con-
cerned regarding the discrimination that overweight
individuals face. Some examples of students’ com-
ments illustrating this theme include:
“I think that they are stereotypical comments that
are the same as using racial comments or any other
slandering terms.”
“Our society has a false image of what beauty con-
sists o f . . .”
“These labels are very discriminatory and are used
to make a population feel bad about themselves and
try to enforce society’s norms upon them. Makes me
sad that people cannot look beyond the physical ap-
pearance of an individual.”
“I think of the personal and social consequences
of obesity, the prejudice obese individuals face . . .
I think of the need for education to bring about a
change in societal attitudes toward more under-
standing and compassionate, . . . realistic views of
fat and obesity. So that victims are no longer blamed
and the psychological harm associated with obesity
are reduced if not eliminated (e.g., poor self-esteem,
eating disorders, etc.).”
Feels Empathy. The theme of feeling empathy
for the person was identified when students evi-
denced an understanding, appreciation, and/or gen-
uine concern for the problems faced by an individ-
ual who is obese. Three medical (1 1%) and 9 (9%)
nursing students expressed feelings of compassion
and understanding for individuals who are over-
JOURNAL OF ADDICTIONS NURSINGNOLUME 12, NUMBER 1, 2000 9

Table 3. Medical and Nursing Students’ Perceptions of Women Who Are Overweight
Medical students Nursing students
Theme (n = 28) (n = 102) Total
~

Feels empathy 1(4%) 33 (33%) 34 (26%)

Blames women for lack of self-control 7 (25%) 26 (26%) 33 (25%)
Feels repulsed at women’s appearance 12 (43%) 17 (17%) 29 (22%)
Identifies reasons for weight problems 9 (32%) 15 (15%) 24 (18%)
Labels women as unhealthy 2 (7%) 21 (21%) 23 (18%)
Views women as lacking control, overeating 9 (32%) 14 (14%) 23 (18%)
Feels women need to make changes 7 (25%) 15 (15%) 22 (17%)
Views women as being lazy, inactive 7 (25%) 15 (15%) 22 (17%)
Tries to suspend judgment and focuses on
women’s overall being 2 (7%) 17 (17%) 19 (15%)
Views women as having low self-esteem 4 (14%) 13 (13%) 17 (13%)
Fears becoming fat, obese, overweight 0 (0%) 12 (12%) 12 (9%)
Feels concern that women might be
victims of discrimination 1(4%) 8 (8%) 9 (7%)
Feels relief that person does not fit label 1(4%) 7 (7%) 8 (6%)
Thinks of own failure to control weight 1(4%) 5 (5%) 6 (5%)
Feels desire to help women 1(4%) 5 (5%) 6 (5%)
Worries about how others view my weight 0 (0%) 2 (2%) 2 (2%)

weight. Some examples of students’ comments il-
lustrating this theme included:
“I feel sympathy for the person being discussed
because I can relate to the shame, guilt, and unwor-
thiness that an obese person can feel; thin people
don’t understand what it’s like and are often cruel to
a fat person when they try to get them to lose
weight.”
“I think of how hard it must be to be stared at and
ridiculed.”
“I feel sorry for people because it is so difficult to
lose.”
“I think of people’s feelings being hurt. Fat peo-
ple are unfortunate but they are still people with
hearts, souls, and feelings.”
Views Person as Having Low Self-Esteem. The
theme of viewing the person with low self-esteem
was identified when students’ comments associated
a lack of self-worth, love, respect, and/or confidence
with the words “fat,” “obese,” and/or “overweight.”
This theme was highlighted by 7 (7%) nursing and
4 (14%) medical students. Some examples of stu-
dents’ comments illustrating this theme include:
“. . . poor self-image and even a lack of self-es-
teem.”
“Overly self-conscious.”
“I think of a person who has low self-esteem.”
“. . . lack of self respect.”
Feels Depressed, Wonders Why. Five (5%) of
the nursing students expressed a feeling of sadness,
and 2 (2%) wondered how and why people ever be-
came overweight. Likewise, 1 (4%)medical students
puzzled over why obesity occurs.
Feels People Can Be Helped to Lose Weight,
Feels Motivated to Help. The theme of feeling that
people can be helped to lose weight was apparent
when the students’ responses indicated their percep-
tions that persons could control their lifestyle and
lose weight if they really wanted to. Two (2%) the
nursing students believed that if the desire is there,
obesity is a problem that can be treated through diet,
exercise, and emotional support. The theme “feels
motivated to help” was cited by 2 (7%) medical stu-
dents who expressed a desire to help inspire over-
weight individuals to lose weight.
How Do Medical and Nursing Students
Perceive Women Who Are Obese?
During the analysis of the responses to the second
question 16 themes emerged (see Table 3). These
10 JOURNAL OF ADDICTIONS NURSINGNOLUME 12, NUMBER 1, 2000

Table 4. Medical and Nursing Students’ Perceptions of Men Who Are Overweight
Medical students Nursing students
Theme (n = 28) (n = 102) Total
Feels repulsed at men’s appearance 6 (21%) 23 (23%) 29 (22%)
Views men as being inactive, lazy 7 (25%) 22 (22%) 29 (22%)
Labels men as unhealthy 4 (14%) 24 (24%) 28 (22%)
Feels men are not judged as harshly as women 5 (18%) 20 (20%) 15 (19%)
Perceives lack of care for self 9 (32%) 14 (14%) 23 (18%)
Labels men as lacking control over eating 7 (25%) 14 (14%) 21 (16%)
Tries to suspend judgment 1(4%) 16 (16%) 17 (13%)
Feels empathy 4 (14%) 11 (11%) 15 (12%)
Feels men need to change 4 (14%) 10 (10%) 14 (11%)
Views men as having low self-esteem 2 (7%) 5 (5%) 7 (5%)
Views men as being attractive 0 (0%) 7 (7%) 7 (5%)
Feels weight problems are not as obvious in men 3 (11%) 3 (3%) 6 (5%)
Blames weight on use of alcohol 0 (0%) 4 (4%) 4 (3%)
Feels less empathy for men than for women 1(3%) 3 (3%) 4 (3%)
Feels relief that image does not fit self 0 (0%) 3 (3%) 3 (2%)
Blames wife for man’s weight problem 0 (0%) 2 (2%) 2 (2%)
Thinks of own problems trying to control weight 1(4%) 1 (1%) 2 (2%)
Feels motivated to help 0 (0%) 2 (2%) 2 (2%)
Fears becoming fat, obese, overweight 1(4%) 0 (0%) 1 (1%)
Feels concern about significant others 0 (0%) 1 (1%) 1 (1%)
Feels men have an easier time controlling weight 0 (0%) 1(1%) 1 (1%)
Views men as jovial 0 (0%) I (1%) 1 (1%)

themes were similar to those that appeared when an-
alyzing the responses to the f i s t question.
How Do Medical and Nursing Students
Perceive Men Who Are Obese?
As shown in Table 4,the content analysis identi-
fied 22 themes when analyzing the answers to the
third question. The content analysis further showed
different themes illustrating how students perceived
differences between men and women whom they
perceived to be obese.
What Amount of Instruction Regarding
Obesity Is Included in the Students’
Curriculum?
The answer to the fourth research question was
based on analyzing the themes derived from the 28
medical students’ and 102 nursing students’ written
responses to the fourth question on the survey. The
results of this analysis are outlined in Table 5. This
process demonstrated that the majority of both
groups of students had received minimal classroom
instruction on the topic of obesity.

Table 5. Hours of Class Time Spent on Teaching Students How

to Care For and/or Treat Overweight, Obese Individuals
Class time Medical students (n = 28) Nursing students (n = 102)
0 hours 19 (68%) 37 (37%)
1-5 hours 5 (18%) 31 (31%)
6- 10 hours 0 (0%) 6 (6%)
11-15 hours 0 (0%) 4 (4%)
16+ hours 0 (0%) 9 (9%)
Little time spent 2 (7%) 7 (7%)
Unsure 1(4%) 8 (8%)
JOURNAL OF ADDICTIONS NURSINGNOLUME 12, NUMBER 1, 2000
It is important to note that the researcher did not
specifically ask the students to identify what year of
study they were enrolled in during the time of the
survey. The medical students who volunteered for
the study could have been either in their first, sec-
ond, third, or fourth year of medical school, and nurs-
ing students could have been either in their third or
fourth year of study. Therefore it is more likely that
nursing students may have been exposed to more in-
struction than medical students, since the study was
not open to nurses enrolled in their first or second
year.
Both groups of students reported that no specific
class time had been given on obesity as a topic. The
students also reported that most of the instruction
that they had received on obesity was how it related
to other health problems and risk factors, such as di-
abetes and cardiovascular disorders. Medical and
nursing students also noted that a small amount of
information was conveyed to them in nutrition
courses. Some nursing students reported that the sub-
ject of obesity was addressed in their classes in terms
of proper body mechanics when delivering basic
nursing care.
What Amount of Clinical Experiences Have
Students Had in Caring ForYTreating Patients
Who Are Overweight or Obese?
The answer to the fifth research question was
based on analyzing the themes derived from the 28
medical students’ and 102 nursing students’ written
responses to the fifth question on the survey. This
process demonstrated that both groups of students
have had limited clinical experiences in caring for
and/or treating patients who are overweight or obese.
Sixteen (57%) of the medical students surveyed
noted that they had not treated any patients who were
overweight or obese, 2 (7%) treated more than one
but less than ten, 1 (4%) treated between eleven and
twenty patients, 2 (7%) treated between twenty-one
and thirty, while 1 (4%) treated more than thirty-one
patients. Two (7%) medical students reported caring
for many patients who were overweight or obese, 1
(4%) noted treating less than twenty percent, 1 (4%)
treated between thirty to forty percent, and 1 (4%)
treated about sixty percent of patients who were
overweight or obese. One (4%) medical student did
not respond to this question.
Twenty-seven (27%) nursing students indicated
that they had not cared for any patients who were
overweight or obese, 32 (32%) cared for between
11
one and ten patients, 4 (4%) cared for more than
eleven patients but fewer than twenty, 2 (2%) cared
for between twenty-one and thirty, and 7 (7%) cared
for over thirty-one patients. Further, 1 (1%) nursing
student indicated that thirty percent of the patients
they cared for were overweight/obese, 1 (1%) stated
that eighty percent of the patients they cared for were
obese, while another (1 %) stated that one tenth of
the patients they cared for were obese. Seventeen
(17%) nursing students surveyed reported caring for
“many” patients and 9 (9%)reported that they were
“not sure” of the number of patients that they had
cared for who were overweight or obese.
What Types of Clinical Experiences Have
Students Had in Caring ForYTreating Patients
Who Are Overweight or Obese?
The answer to the sixth question was based on an-
alyzing the themes derived from the 28 medical stu-
dents’ and the 102 nursing students’ written re-
sponses to the sixth question on the survey. This
process demonstrated that students treated and cared
for patients who were obese and/or overweight in a
large variety of clinical settings. Considering the in-
formation obtained from both groups of students on
the amount of clinical experience that they had on
caring forheating obese and/or overweight patients,
this information does not seem to correlate. Perhaps
this is due to the fact that a large number of students
cited more than one clinical setting where they had
cared fodtreated patients who were overweight or
obese. This resulted in a greater total number of clin-
ical settings cited than students surveyed. It is also
important to note that students who had encountered
clients who were obese and/or overweight in clini-
cal settings may have been caring forheating these
clients for a nonrelated medical problem. The clients’
weight issues may not have been the primary focus
of their clinical visit.
Fourteen (50%) medical students did not respond
or cite any clinical settings. The remaining medical
students reported that they had treated patients who
were overweight or obese mainly in the office set-
ting, clinics, medicalhurgical units, oncology floor,
and emergency departments. Other clinical settings
cited were cardiology, neurology, geriatrics, ortho-
pedics, pediatrics, psychiatry, rehabilitation, and the
community.
Seventeen (17%) nursing students also did not re-
spond or cite any clinical settings. The remaining 85
(85%) nursing students noted that they had cared for
12
patients who were overweight or obese mostly in
nursing homes, the community, and hospitals. Fur-
ther, students reported caring for patients in geri-
atrics, obstetrics, psychiatry, rehabilitation, intensive
care units, coronary care units, pediab-ics, neurology,
and adult care. Other clinical settings cited were
adult care, emergency, long-term care, clinics, on-
cology, surgery, orthopedics, and cardiology.
How Do Medical and Nursing Students’
Perceptions of Obesity Compare?
The answer to this question was established from
the themes derived from the 28 medical students’ and
102 nursing students’ written responses to the first
three questions on the survey. The reality that the
difference in sizes in the samples of the two groups
of students was so great needs to be acknowledged.
Similarities in Perspectives Between Medical
and Nursing Students
When examining the 28 medical students’ and 102
nursing students’ perceptions of obesity, many sim-
ilarities were found. The theme that appeared most
prevalent throughout students’ writings was feeling
repulsed at the appearance of someone whom they
perceived to be overweight. Although there were dif-
ferences in the number of students feeling repulsed
at women who were overweight, the attitudes toward
men were similar.
Students perceived obesity as unhealthy and as-
sumed that individuals who were overweight were
inactive and lazy, lacked self-control, and needed to
make lifestyle changes in order to lose weight. Mean-
while, medical and nursing students believed that
men who were overweight were not judged as
harshly as women who were overweight.
Both groups of students blamed women, who they
perceived as being overweight, for their lack of self-
control. Students believed that these women had low
self-esteem. Although both medical and nursing stu-
dents felt empathy for men who were overweight,
they felt less empathy for men than for women who
were overweight.
Differences in Perspectives Between Medical
and Nursing Students
When examining medical and nursing students’
perceptions of obesity, some important differences
were noted. Although both groups of students felt
JOURNAL OF ADDICTIONS NURSINGNOLUME 12, NUMBER 1, 2000
disgusted at the appearance of a someone who was
overweight, 29% more medical students felt this
way. Nineteen percent more medical students as
compared to nursing students perceived a person
who was overweight as inactive and lazy. Seven per-
cent more medical than nursing students believed
that someone whom they perceived to be overweight
had low self-esteem. Further, more medical students
than nursing students identified specific reasons for
obesity and felt motivated to help people who were
overweight.
Fourteen percent more nursing students than med-
ical students did not like the terms “fat,” “over-
weight,” and “obese,” while perceiving the terms as
negative labels. Compared to medical students, 9%
more nursing students referred to their own personal
struggles with weight, felt concern for significant
others, and 4% worried about how others viewed
their weight (Table 2).
While examining medical and nursing students’
perceptions of women who are overweight, several
differences were noted. Even though students in both
groups reported feeling repulsed at the appearance
of a woman who was overweight, 26% more med-
ical students described these feelings. Seventeen per-
cent more medical than nursing students identified
specific reasons for women’s weight problems. Fur-
ther, 18% more medical students believed that
women lacked control over their eating habits, and
10% more believed that women needed to make
lifestyle changes in order to lose weight.
When compared to the responses of the medical
students, an overwhelming number of nursing stu-
dents felt more empathy toward women whom they
perceived to be overweight. Twenty-nine percent
more nursing students expressed compassion and un-
derstanding toward women with weight problems,
and 10% more tried not to be judgmental toward
those women. Interestingly, 15% more nursing than
medical students perceived women who were over-
weight as unhealthy. Another significant finding was
that 15% more nursing students than medical stu-
dents applied the terms “fat,” “overweight,” and
“obese” to themselves. Within this group, 12% of
the nursing students documented fears of becoming
overweight, and 3% more were glad that they had
not been labeled by those terms.
There were several differences between medical
and nursing students’ perceptions of men who were
overweight. Even though both medical and nursing
students stated that men who were overweight had
no control over their eating habits, 11% more med-
JOURNAL OF ADDICTIONS NURSINGNOLUME 12, NUMBER 1, 2000
ical students reported this feeling. As compared to
nursing students, 18% more medical students per-
ceived men as lacking care for self, while 8% more
medical students believed that weight problems are
not as obvious in men as in women.
Although both groups of students perceived men
who were overweight as unhealthy, 10% more nurs-
ing students reported this attitude. Within this group,
however, fewer nursing students than medical stu-
dents equated premature death with obesity in men.
As compared to medical students, 12% more nurs-
ing students tried to suspend judging men who were
overweight, and 7% more nursing students found
these men attractive. However, 4% more nursing stu-
dents blamed the use of alcohol, especially beer, for
men’s weight problems. Two percent of the nursing
students also blamed a man’s weight problem on his
wife and wondered why the wife could not help the
man lose weight.
However, it is important to state that no medical
students reported perceiving overweight men as at-
tractive or blamed men’s weight problems on their
wives or the use of alcohol. None of the medical stu-
dents reported feeling relieved at not being labeled
overweight, or feeling that men have an easier time
controlling weight than women. Further, medical
students did not report any concerns for their own
significant others whom they perceived as being
overweight, did not perceive obese men as jovial,
and did not feel motivated to help overweight men
to lose weight.
It is an assumption of the researcher that perhaps
there was a large percentage of female nursing stu-
dents and male medical students, which may ex-
plain some of the differences in their responses re-
garding obesity in women versus men. A future
study should compare differencedsimilarities of re-
sponses among male versus female nursing and
medical students.
Implications of the Findings for Nursing
The findings of this qualitative descriptive study
have several implications for nurses and nursing. Fu-
ture research is necessitated to verify if the findings
may be generalized to the entire medical and nurs-
ing student population.
The conclusions of this study indicated that nurs-
ing students have negative perceptions of men and
women who are overweight, fat, and/or obese. Since
13
perception is a fundamental aspect of all human com-
munication, interactions, and transactions, nurses’
perceptions will influence the quality of health care
that they will provide (King, 1981) to patients who
are struggling with obesity.
Nurses must understand that sociocultural factors
influence the standards in which a person’s body im-
age and weight are perceived. However, before
nurses can begin to change their perceptions of oth-
ers, they might first begin to examine their own at-
titudes toward their body image and themselves.
King (1981) stated that the “attitudes toward self are
often reflected in the attitudes toward others” (p. 27),
and interactions with others give an individual a
sense of self. Body image, a concept closely linked
to that of self, is “acquired or learned in the process
of growth and development” (p. 32). The findings of
this study concur with the concept that as products
of our society, nurses may internalize the prejudice
against fat that exists. As Fontaine (1991) stated,
“Understanding the process of transmissions of cul-
tural values allows us to rethink our values as adults
and rid ourselves of an unrealistic ideal. Before we
can intervene with clients, we must learn to love our
own bodies.” (p. 675).
Nursing management must allow time to educate
staff of the potential problems, causes, and treat-
ments for obesity and other eating disorders. Man-
agers must remind their staff how the individuals’
perceptions can affect their behavior and how this
behavior can affect quality nursing care.
Nursing managers must also teach their staff to
challenge cultural values and ideals by not pressur-
ing patients who are overweight to lose weight. They
must teach their nursing staff not to comment when
they see a patient or even other staff member lose or
gain weight. Feedback of this kind feeds into unre-
alistic cultural standards of beauty and thinness.
Nursing managers must also be role models to all
of their staff, especially when they interact with
physicians. Managers must also remind physicians
that when they offer criticism instead of support they
may increase the patients’ sense of humiliation and
deter them from seeking further health care (Burgard
and Lyons, 1994).
Since the findings of the study indicate over-
whelming negative perceptions toward individuals
who are obese and limited education of both nurses
and physicians regarding obesity, it would behoove
managers to hire more nurses who specialize in eat-
ing disorders. These nurses could be responsible for
continuing education and ongoing assessment and
14
evaluation of patients and staff dealing with weight
and body image issues.
The importance of this study’s findings in terms
of education is quite evident. The educational sys-
tem for medical and nursing students must include
more information regarding obesity and eating dis-
orders. The information taught must be based on
sound scientific knowledge.
Nurse educators need to be aware of the impor-
tance of increasing information on obesity and eat-
ing disorders in the students’ curriculum. Obesity is
a multifactorial problem that presents with negative
stereotypical prejudices. Weight loss through dieting
and exercise is seen as a solution to these problems.
However, dieting only exacerbates the situation
(Cachelin et al., 1997; Davis and Phillips, 1994;
Keller et al., 1997; Leermakers et al., 1999; Polivy
and Herman, 1992; Polivy and Herman, 1993; Pop-
kess-Vawter et al., 1998; Robinson, 1999; Robinson
and Bacon, 1996; Robinson et al., 1995; Simkin-
Silverman et al., 1998; Wadden and Frey, 1997;
Yanovski and Yanovski, 1999). Nursing educators
need to understand these complexities, by acting as
role models and teaching their students how to care
effectively for patients suffering with obesity.
Limitation
This study was limited by the relatively small sam-
ple size. Further, the volunteers for the sample were
from a small geographical area and were selected
through purposive sampling (Morse, 1996). Berg
(1995) stated that purposive sampling lacks general-
izability. Further, the gender and the cultural and
prior educational backgrounds of the students were
not known. Therefore, the implications of these fac-
tors on the findings are unknown. It is also impor-
tant to note that the biases of the researcher may have
influenced the process of data analysis. Berg (1995)
explained that open-ended responses must be coded
for analysis requiring the researcher to interpret the
meanings of responses. This reality introduces the
possibility of misunderstanding researcher bias. Due
to these limitations, the study results should not be
generalized to the entire populations of medical stu-
dents and nursing students.
Recommendations For Future Research
More research is needed in the area of healthcare
professionals’ perceptions of obesity. Further, this
JOURNAL OF ADDICTIONS NURSINGNOLUME 12, NUMBER 1, 2000
research study should be replicated with larger sam-
ples of medical students and nursing students. The
gender of the participants should be identified to ex-
plore how this variable influences the person’s per-
ceptions of obesity. It would also be interesting to
study the perceptions of medical and nursing stu-
dents from other cultural backgrounds to ascertain if
the same biases toward persons who are overweight
exist. Another study should be done to identify the
perceptions of nurses and physicians who have been
caring for people for at least five and ten years. Ex-
amining the influence of being employed in a spe-
cialty area on the healthcare professionals’ percep-
tions would also be important.
Another area for future research would examine
medical and nursing students’ perceptions of obesity
before and after receiving a course of study in eat-
ing disorders and obesity. Further, longitudinal stud-
ies might also prove interesting. Prior to entering a
program of study, students would be asked to com-
plete a questionnaire exploring perceptions regard-
ing obesity. At the end of the second and fourth years
of study, students would be asked to complete the
same questionnaire. Upon graduation, students
would again be contacted after completing two and
four years of working clinical experience. The data
would be then analyzed and evaluated in order to as-
sertain the effect of education and clinical practice
on the students’ perception of obesity.
Summary
This study contributes to the understanding of med-
ical and nursing students’ perceptions of obesity. It is
the expectation that this study’s findings will help
healthcare professionals become more aware of how
their perceptions may affect how they behave, com-
municate, and interact (King, 1981) with their patients.
It is important for healthcare professionals to treat and
care for patients who are overweight with respect, dig-
nity, and compassion. Further, the researcher hopes
that the need for more research and education in the
area of eating disorders and obesity will be realized.
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