title: Clinicians' Implicit and Explicit Attitudes about Weight and Race and Treatment Approaches to Overweight for American Indian Children.
abstract: OBJECTIVE
  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.
authors.affiliation: 1 Department of Biomedical Informatics and Medical Education, University of Washington , Seattle, WA.
authors.forename: Janice A
authors.initials: JA
authors.lastname: Sabin
authors.affiliation: 2 Centers for American Indian and Alaska Native Health, University of Colorado , Aurora, CO.
authors.forename: Kelly
authors.initials: K
authors.lastname: Moore
authors.affiliation: 3 Center for Clinical and Epidemiological Research, University of Washington , Seattle, WA.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Noonan
authors.affiliation: 3 Center for Clinical and Epidemiological Research, University of Washington , Seattle, WA.
authors.forename: Odile
authors.initials: O
authors.lastname: Lallemand
authors.affiliation: 4 Department of Epidemiology and Medicine, University of Washington , Seattle, WA.
authors.forename: Dedra
authors.initials: D
authors.lastname: Buchwald
mesh_terms: D000293:Adolescent; D001291:Attitude of Health Personnel; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007198:Indians, North American; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D011287:Prejudice / Q000523:psychology; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D013239:Stereotyped Behavior; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology