Exercise-based obesity simulation reduces weight bias and improves clinical decision-making in health professions students: a randomized controlled trial

BMC Medical Education https://doi.org/10.1186/s12909-026-09423-0 Article in Press Exercise-based obesity simulation reduces weight bias and improves clinical decisionmaking in health professions students: a randomized controlled trial Gregory N. Ruegsegger, Ricky L. Lopez & Joshua J. Bates Received: 16 February 2026 Accepted: 8 May 2026 Cite this article as: Ruegsegger G.N., Lopez R.L. & Bates J.J. Exercise-based obesity simulation reduces weight bias and improves clinical decisionmaking in health professions students: a randomized controlled trial. BMC Med Educ (2026). https://doi.org/10.1186/ s12909-026-09423-0 A S S We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply. IN E R P If this paper is publishing under a Transparent Peer Review model then Peer Review reports will publish with the final article. I T R E L C © The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. ACCEPTED ARTICLEMANUSCRIPT IN PRESS Title: Exercise-Based Obesity Simulation Reduces Weight Bias and Improves Clinical DecisionMaking in Health Professions Students: A Randomized Controlled Trial Authors: Gregory N. Ruegsegger1*, Ricky L. Lopez1,2, Joshua J. Bates1 Affiliations 1 Department of Health and Human Performance, University of Wisconsin-River Falls, River Falls, WI, United States 2 HealthPartners Neuroscience Center, Regions Hospital, St. Paul, MN, United States Running title: Embodied Obesity Simulation and Weight Bias Conflict of interest statement: The authors have declared that no conflict of interest exists * Corresponding author information: Gregory N. Ruegsegger, Ph.D. University of Wisconsin-River Falls A173 Falcon Center 410 S. 3rd St. E L C I T R A IN River Falls, Wisconsin 54022 Phone: 715-425-4945 Email: ORCID: 0000-0002-8018-0456 1 S S E R P ACCEPTED ARTICLEMANUSCRIPT IN PRESS ABSTRACT Background: Weight stigma among health professions students may negatively influence patient communication, clinical decision-making, and healthcare engagement for individuals with obesity. Educational approaches have demonstrated limited impact on implicit attitudes and affective competencies central to patient-centered care. This randomized controlled trial evaluated whether an exercise-based obesity simulation reduces weight bias and improves professional learning outcomes in health professions students. Methods: In a three-arm randomized controlled trial, 107 undergraduate health professions students were randomly allocated to one of three conditions: control (non-exercise session), S S E R P exercise-only, or exercise with an obesity simulation suit. The intervention consisted of a single 30-minute supervised treadmill session. Outcomes were assessed at baseline, 1-week, and 8week follow-up and included implicit weight bias, explicit weight bias, beliefs about obesity, IN clinical decision-making using patient-centered vignettes, behavioral intentions toward future E L C I T R A patients, and structured reflective learning. Group x time effects were examined using repeatedmeasures analysis of variance. Multiple regression analyses explored whether affective responses during the intervention were associated with changes in learning outcomes at eight weeks. Results: Significant group x time interactions were observed for implicit weight bias, explicit bias related to controllability beliefs, clinical decision-making, and behavioral intentions (all p < 0.05). Compared with control and exercise-only groups, participants in the simulation condition demonstrated reductions in implicit and explicit bias and increases in patient-centered decisionmaking at 1-week, with effects sustained at 8-week follow-up. Behavioral intentions toward weight-inclusive care also improved in the simulation group at both follow-up time points. Reflective learning scores were higher in the simulation group at 1-week. Lower positive affect during the simulation was associated with greater improvements in several learning outcomes. 2 ACCEPTED ARTICLEMANUSCRIPT IN PRESS Conclusions: A brief exercise-based obesity simulation reduced weight bias and improved clinical reasoning and professional intentions among health professions undergraduate students, with effects persisting for eight weeks. This single-session experiential intervention may offer a feasible and scalable strategy for integrating bias reduction and patient-centered competencies into health professions education. Trial registration: ClinicalTrials.gov NCT07430891. Registered February 23, 2026. Retrospectively registered. Keywords: Health professions education; obesity; weight bias; weight stigma; patient-centered care; experiential learning E L C I T R A IN 3 S S E R P ACCEPTED ARTICLEMANUSCRIPT IN PRESS BACKGROUND Obesity stigma remains a persistent barrier in healthcare, as individuals with higher body weight frequently encounter bias that negatively affects communication, decision-making, and quality of care (1, 2). Weight stigma operates through both implicit biases (automatic associations linking obesity to negative traits) and explicit stereotypes, such as beliefs that individuals with obesity lack willpower or personal responsibility (3-7). These attitudes may influence clinician behavior in subtle ways, including reduced patient-centered communication, altered treatment recommendations, and shorter consultation times (4). Concerningly, moderateto-high levels of weight bias have been documented among health professions students across S S E R P disciplines, raising concern that stigmatizing attitudes may persist into clinical practice (8, 9). Given that future clinicians serve as gatekeepers for preventive health, physical activity counseling, and rehabilitation, addressing weight bias during training is essential for promotin (...truncated)