Summary The objective of this study was to critically review the empirical evidence from all relevant disciplines regarding obesity stigma in order to (i) determine the implications of obesity stigma for healthcare providers and their patients with obesity and (ii) identify strategies to improve care for patients with obesity. We conducted a search of Medline and PsychInfo for all peer-reviewed papers presenting original empirical data relevant to stigma, bias, discrimination, prejudice and medical care. We then performed a narrative review of the existing empirical evidence regarding the impact of obesity stigma and weight bias for healthcare quality and outcomes. Many healthcare providers hold strong negative attitudes and stereotypes about people with obesity. There is considerable evidence that such attitudes influence person-perceptions, judgment, interpersonal behaviour and decision-making. These attitudes may impact the care they provide. Experiences of or expectations for poor treatment may cause stress and avoidance of care, mistrust of doctors and poor adherence among patients with obesity. Stigma can reduce the quality of care for patients with obesity despite the best intentions of healthcare providers to provide high-quality care. There are several potential intervention strategies that may reduce the impact of obesity stigma on quality of care.

The authors discussed the ways in which the distinction between the descriptive and prescriptive components of gender stereotypes may provide a context for thinking about the role of gender stereotyping in sex discrimination and sexual harassment. They reviewed the research literature involving the descriptive and prescriptive components of gender stereotypes, with particular emphasis on research published since the American Psychological Association's 1991 amicus brief in Price Waterhouse v. Hopkins (1989). They suggested that incidents of sex discrimination that involve disparate treatment are more likely to reflect the prescriptive component of gender stereotypes and that incidents of sex discrimination that result in disparate impact are more likely to reflect the descriptive component. The authors discussed the implications of this distinction for sex discrimination and sexual harassment litigation.Almost a decade after psychological research on gender stereotyping first was considered by the U.S. Supreme Court in Price Waterhouse v. Hopkins (1989), gender stereotyping research continues to play a role in litigation involving gender discrimination and sexual harassment (e.g.,

It is argued that members of low status groups are faced with a psychological conflict between group justification tendencies to evaluate members of one's own group favorably and system justification tendencies to endorse the superiority of higher status outgroups. In Study 1, members of low status groups exhibited less ingroup favoritism and more ingroup ambivalence than did members of high status groups. Perceptions that the status differences were legitimate increased outgroup favoritism and ambivalence among low status groups, and they increased ingroup favoritism and decreased ambivalence among high status groups. In Study 2, the belief in a just world and social dominance orientation increased ambivalence on the part of women toward female victims of gender discrimination, but they decreased ambivalence on the part of men. Evidence here indicates that system-justifying variables increase ingroup ambivalence among low status group members and decrease ambivalence among high status group members.

The paper sets forth a set of evidence-based recommendations for interventions to combat unintentional bias among health care providers, drawing upon theory and research in social cognitive psychology. Our primary aim is to provide a framework that outlines strategies and skills, which can be taught to medical trainees and practicing physicians, to prevent unconscious racial attitudes and stereotypes from negatively influencing the course and outcomes of clinical encounters. These strategies and skills are designed to: 1) enhance internal motivation to reduce bias, while avoiding external pressure; 2) increase understanding about the psychological basis of bias; 3) enhance providers' confidence in their ability to successfully interact with socially dissimilar patients; 4) enhance emotional regulation skills; and 5) improve the ability to build partnerships with patients. We emphasize the need for programs to provide a nonthreatening environment in which to practice new skills and the need to avoid making providers ashamed of having racial, ethnic, or cultural stereotypes. These recommendations are also intended to provide a springboard for research on interventions to reduce unintentional racial bias in health care.