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• Obesity simulation suit as opportunity to practice in a safe and standardized environment
  Teresa Loda
  Published on: 22 August 2019
• Obesity simulation suits: a superficial way of tackling a complex problem?
  Katherine J Lewis, Amber J S Moore and Giles O Chick
  Published on: 18 August 2019
• Fat Suits no substitute for a Fat Person
  Darliene M Howell
  Published on: 9 August 2019

• Published on: 22 August 2019

  Obesity simulation suit as opportunity to practice in a safe and standardized environment

  • Teresa Loda, psychologist University Hospital Tuebingen, Internal Medicine, Department of Psychosomatic Medicine and Psychotherapy, Tuebingen, Germany

  Dear Sir,
  Dear contributors,

  Thank you for the reactions to our article. We absolutely agree with the comments made.

  This study was never meant to give the idea that standardized patients (SP) wearing an obesity simulation suit (OSS) could replace the contact with real patients suffering from obesity.

  Simulation is a gold-standard method in medical education to prepare students for clinical work (1). It offers the opportunity to practice in a safe and standardized environment with structured feedback. Our students are used to encounter SP with various conditions as a teaching tool. It is important to acknowledge the purpose of this session: It is meant to be a basic step and is not about “true life experience” involving real patients. For example, medical faculties all over the world train their students on how to break bad news with SP (2). Here, it is also well accepted that this offers a good training opportunity despite the SP not having a serious condition themselves.

  Our first intention was to make a simulated scenario more realistic to support the concept of “suspended disbelief” (3). The other opportunity it offered was to sensitize towards the issue of patients with obesity and start a first reflection process on otherwise unnoticed prejudices. Many students appreciated the fact that due to the “before/after effect” (SP with OSS in simulation vs. SP of normal weight giving feedback) made them reflect even more on differences a...

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  Dear Sir,
  Dear contributors,

  Thank you for the reactions to our article. We absolutely agree with the comments made.

  This study was never meant to give the idea that standardized patients (SP) wearing an obesity simulation suit (OSS) could replace the contact with real patients suffering from obesity.

  Simulation is a gold-standard method in medical education to prepare students for clinical work (1). It offers the opportunity to practice in a safe and standardized environment with structured feedback. Our students are used to encounter SP with various conditions as a teaching tool. It is important to acknowledge the purpose of this session: It is meant to be a basic step and is not about “true life experience” involving real patients. For example, medical faculties all over the world train their students on how to break bad news with SP (2). Here, it is also well accepted that this offers a good training opportunity despite the SP not having a serious condition themselves.

  Our first intention was to make a simulated scenario more realistic to support the concept of “suspended disbelief” (3). The other opportunity it offered was to sensitize towards the issue of patients with obesity and start a first reflection process on otherwise unnoticed prejudices. Many students appreciated the fact that due to the “before/after effect” (SP with OSS in simulation vs. SP of normal weight giving feedback) made them reflect even more on differences and possible problems. This class is supposed to be a first step in training medical students on the issues of patients with obesity. Later on in our curriculum, they are of course in contact with patients with obesity and do get proper “first hand experience” as well as more theoretical background.

  1. Barry Issenberg S, Mcgaghie WC, Petrusa ER, et al. Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. 2005;27(1):10-28.
  2. Rosenbaum ME, Ferguson KJ, Lobas JGJAM. Teaching medical students and residents skills for delivering bad news: a review of strategies. 2004;79(2):107-17.
  3. Dieckmann P, Gaba D, Rall MJSiH. Deepening the theoretical foundations of patient simulation as social practice. 2007;2(3):183-93.

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  Conflict of Interest:
  None declared.

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• Published on: 18 August 2019

  Obesity simulation suits: a superficial way of tackling a complex problem?

  • Katherine J Lewis, Medical student Imperial College London
  • Other Contributors:
    • Amber J S Moore, Medical student
    • Giles O Chick, Medical student

  Dear Editor,

  Herrmann-Werner et al (2019) brought to our attention an increasingly relevant topic. The study proposed that the obesity simulation suit (OSS) could be used to address the issue of stigmatisation of obesity(1). We are medical students at Imperial College London. As part of our course, we have regularly attended clinical communication sessions in the form of simulated role play.

  We believe that whilst using a simulated patient in an OSS may be useful, it is a superficial way of addressing the deep-rooted societal problem of how obesity is viewed and may even reinforce the stigma. The use of simulated patients should be adapted to reduce prejudice towards obese patients, especially with reference to their physical and psychological comorbidities.

  The study argues that using healthy weight actors in the OSS was of benefit because using obese actors ‘entails the potential danger of issues becoming too personal for the patient’(1). However, we believe that using actors with a healthy BMI may reinforce to students that obese patients are embarrassed or ashamed to have a conversation about their weight. At Imperial College, we simulate consultations with real patients to better understand their conditions. Rees et al also prefer the use of real patients, arguing that it provides medical students with a more realistic experience(2). Therefore, we recommend that students talk to obese patients who are willing to partake and understand the sensitiv...

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  Dear Editor,

  Herrmann-Werner et al (2019) brought to our attention an increasingly relevant topic. The study proposed that the obesity simulation suit (OSS) could be used to address the issue of stigmatisation of obesity(1). We are medical students at Imperial College London. As part of our course, we have regularly attended clinical communication sessions in the form of simulated role play.

  We believe that whilst using a simulated patient in an OSS may be useful, it is a superficial way of addressing the deep-rooted societal problem of how obesity is viewed and may even reinforce the stigma. The use of simulated patients should be adapted to reduce prejudice towards obese patients, especially with reference to their physical and psychological comorbidities.

  The study argues that using healthy weight actors in the OSS was of benefit because using obese actors ‘entails the potential danger of issues becoming too personal for the patient’(1). However, we believe that using actors with a healthy BMI may reinforce to students that obese patients are embarrassed or ashamed to have a conversation about their weight. At Imperial College, we simulate consultations with real patients to better understand their conditions. Rees et al also prefer the use of real patients, arguing that it provides medical students with a more realistic experience(2). Therefore, we recommend that students talk to obese patients who are willing to partake and understand the sensitive nature of the session.

  Furthermore, actors with a healthy BMI may not have experienced the same physical and psychosocial problems endured by many obese people. This limits the usefulness of the session, especially the ways in which obese people feel stigmatised. Speaking to real patients during our time at Imperial College has furthered our understanding of the physical and psychosocial impact of disease. In addition, teaching sessions exploring how body image is portrayed in social media, the fashion industry and other areas of society may help medical students recognise and understand their own attitudes towards obese patients.

  Allowing students to talk to obese patients with related health conditions would be more beneficial than using actors with an OSS. Furthermore, the physical and psychosocial aspects of disease should be explored alongside formal teaching about disease pathology, to help reduce the stigma surrounding obesity.

  1 Herrmann-Werner A, Loda T, Wiesner LM, Erschens RS, Junne F, Zipfel S. Is an obesity simulation suit in an undergraduate medical communication class a valuable teaching tool? A cross-sectional proof of concept study. BMJ open. 2019 Jul 1;9(8):e029738.

  2 Rees C, Sheard C, McPherson A. Medical students’ views and experiences of methods of teaching and learning communication skills. Patient Education and Counseling. 2004 July;54(1): 119-121

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  Conflict of Interest:
  None declared.

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• Published on: 9 August 2019

  Fat Suits no substitute for a Fat Person

  • Darliene M Howell, Administrative Director NAAFA

  While it is important for medical students, along with those that teach them, to know how to communicate appropriately with their clients of all sizes, a simulation such as a fat suit is NEVER an accurate substitute for speaking with a client that lives every day with a fat body. Unless the person wearing a fat suit has lived with the stigma, discrimination and overt hatred of their body by a medical professional, their is no way the communication/conversation about their bodies will be the same. If you want to learn how to treat a fat client, please read the brochure NAAFA Guidelines for healthcare providers with fat clients available at https://www.naafaonline.com/dev2/about/Brochures/2017_Guidelines_for_Hea....

  Conflict of Interest:
  None declared.

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