Biases toward weight, diet, and exercise expressed by health science students and their professors

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Clark, Martha F. Wiszniak, Ricci Bicomong, Makayla Sousa, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5467293/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background Bias is a recognized to inhibit a holistic model of healthcare. Yet, little has been investigated into how bias in the educational process influences the development of bias in healthcare professionals. Methods 344 students and professors (152 M/172 F/ 20 other) completed an electronic survey regrading ideals of diet, exercise, health, body weight, and how one obtains information for developing or modeling healthy behaviors. Responses were analyzed based on group averages, Results Social media appears to be the most cited source for information on lifestyle interventions. Even with awareness of social pressures to be thin, “thinnest” body was deemed to be healthiest. A greater confirmation bias was expressed in older respondents regarding advice to overweight individuals, with younger respondents being more conscious of their approach. Conclusion For students, biases appear to develop through combination of preconceived ideals reinforced by educators. Recommendations appear to be based on personal beliefs and projection of biases by educators and students based on personal anecdotes or over-reliance on social media for modeling of appropriate healthy behaviors and attitudes. Health Confirmation Bias Weight Bias Education Students Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Introduction Over the last half-century there has been a push for establishing pro-health attitudes (i.e., changes in level of physical activity and diet) to reduce incidence of non-communicable diseases seen across population [ 1 – 3 ], that includes incorporation of aspects of lifestyle into the education of healthcare professionals coupled with growing awareness for tackling issues of the myths and misconceptions that many students have about body weight and health before entering the curriculum of becoming a healthcare profession [ 4 – 7 ]. Leading many faculty members to actively demonstrate or discuss how lifestyles might impact the function of the systems of the body being studied in the classroom or clinical settings. Unfortunately, we see many of the scenarios presented within textbooks and ancillary materials that perpetuate an idea that body weight or body mass index (BMI) might indicate one’s overall health, oversight that fails to correct commonly held misconceptions and opinions that are recognized to influence a practitioner’s care of patients [ 8 – 12 ]. Perpetuating a bias that exists in perception of the health and physical abilities based solely on weight [ 11 – 16 ]. Bias when combined with reliance on personal heuristics and preferences toward specific lifestyle interventions by healthcare providers (i.e., doctors, nurses, physical therapists, dieticians) filters into the type, and quality, of lifestyle interventions being recommended [ 11 , 12 , 14 – 22 ]. Recommendations that all too frequently, come without considering a holistic approach for care that incorporates preferences of the patient, impacting long-term potential to improve overall health [ 18 , 23 – 25 ]. Or are made based on appeasing a cognitive bias for interventions based on social norms and attitudes [ 26 – 29 ]. Leading to a growing concern about how developing these biases will impact recommendations being offered and behaviors being modeled to establish healthy lifestyles across one’s lifespan [ 18 , 26 , 28 , 30 – 32 ]. Modeling practices that could have limited validity and accuracy as they may develop from students following personal preferences and biases of a behavior being healthy presented by their professors-as it is a well-established position that personal biases influence many of the choices that one makes on everyday activities related to one's health [ 13 , 17 , 18 , 23 , 30 , 33 ]. Bias leading to self-selection, or avoidance, of distinct behaviors that impact the acceptance of ideals as being correct by the student in an attempt to mirror or parrot the professor’s attitudes in an attempt to achieve the grade independent of becoming an active critical thinker necessary in healthcare [ 34 – 36 ]. Possibly leading students to retain and reflect biases and opinions presented to them by their faculty in ways that the faculty may not intend [ 30 ]. Modeling of attitudes that have lasting impacts on the student’s future abilities to provide information to a patient without relying upon their internalized biases and opinions about individuals of select groups (e.g., demographic stereotypes) [ 9 , 11 – 13 , 17 – 19 ]. A point that must be reflected upon, for both educators and students, as healthcare professionals will interact with patients from various backgrounds, personal beliefs, and lifestyle choices that might not agree with personal opinions or beliefs [ 19 , 21 ]. As at any point in time a patient can experience the impact of unconscious biases, which unfortunately come to impact care and has led to a growing awareness within the literature, especially for the unintentional cognitive biases derived from cultural stereotypes that might perpetuate health inequities within underrepresented populations [ 13 , 14 , 17 , 19 , 21 ]. Yet, there has been very limited research into understanding how these biases impact the expression weight bias, how one obtains information pertaining to diet and exercise, or how personal heuristics toward one’s selected lifestyle can blind the educator or healthcare provider to what recommendations are offered to others. Problems of bias and blindness to bias need to be addressed given the constant exposure to recommendations provided across various media platforms (e.g., television, Podcast, Internet, or social media (TikTok, Instagram, X (formerly known as Twitter), Facebook, Reddit), many of which contain a disproportionate amount of scientifically invalid, or at least highly questionable, lifestyle interventions purported to have an ability to improve one’s overall health [ 8 , 37 – 42 ]. Messaging that typically is centered on the faulty assumption that weight or BMI act as a determinant of overall health and can lead some to developing body dysmorphic behaviors, even if not diagnosed [ 39 – 42 ]. Messaging and misinformation that must be countered either by continuing educational opportunities, or through integration of concepts of weight bias or diet and exercise within the curriculum for future healthcare providers [ 6 , 7 , 38 , 43 ]. Messaging that some professors and healthcare professionals may not be able to counter due to relying upon personal beliefs or confirmation bias in recommendations offered within rebuttal to misinformation they encounter [ 19 , 30 – 32 ]. These unconscious biases have the potential to be transmitted in the guise of education, even without awareness of the transmission by those expressing bias [ 18 – 20 , 43 – 45 ]. And while we recently speculated that awareness of one’s bias can limit overt action on that bias [ 18 , 30 ], very little is seen in how educators truly impact the unconscious perceptions of body image or suggested lifestyle interventions (i.e., diet and exercise) that are meant to improve overall health [ 20 , 43 – 45 ]. Thus, the purpose for this study is to continue our work on the evaluation of bias in presenting health information in the classroom [ 30 ]. Where we intend to evaluate first if personal bias exists toward body weight, diet or exercise exists and how personal attitudes and biases may impact how topics of health are reflected to others, and second how these beliefs reflect current scientific understanding on the topics. To address these points, we will test the three following hypotheses. First, that personal beliefs have a greater influence than scientific awareness in forming weight ideals and in recommending diet and exercise to improve one’s health. Second, students are less open-minded to information pertaining to diet and exercise than faculty due to the necessity to appease the professor’s point-of-view within their course work. Third, that there is a confirmation bias in the selection and transmission of information by both faculty and students for behaviors they already use and ideas that they already hold to be true. METHODS Participants and Selection Process Prior to the selection process, a power calculation was run to determine the number of potential respondents necessary to have statistical power. Based on assessment methods, a minimum sample size of respondents (N) was determined to be 310. N= ((Z-score for 95% CI) 2 *SD*(1-SD))/ (margin of error) 2 . All methods were approved by IRB panel of Scientific Health: Education and Human Performance (EHP-12-2019/8-2023) prior to publication of the survey or initiation of recruitment. Selection for participants began with a random selection of 100 colleges and universities representing 30 states within the United States of America (USA), followed by a second random selection of professors from publicly available listings of courses being taught by the professor. Identified professors were then emailed invitations with an informed consent and an active link to the survey. Other potential participants were invited to participate via posting on discussions boards (e.g., the Human Anatomy and Physiology Society (HAPS) listserv, American Physiology Society (APS) hubs). Potential student participants were identified and contacted from contact information publicly available for clubs and organizations on the randomly selected colleges and universities or through messages posted to discussion boards by professors that volunteered to post the invitation for their courses. All recruitment and invitation for participation occurred between May 1 and December 10, 2023, with data analysis occurring after January 15, 2024. To be included in the study, participants need to be an adult between the ages 18–99 years that either teach or are students in a health or biomedical science college or graduate program, able to read and respond to questions written in American-English, able to access the survey through an Internet service provider (ISP). Anyone not currently active in teaching or enrolled in a health or biomedical science college program, those without access to an ISP, or those unable to comprehend American-English were not able to participate. Any participant that accepted the invitation provided informed consent understanding the purpose of the survey and all safeguards taken to protect their identity during and after participating in the survey. Beyond the initial email or posting onto discussion boards, there was no contact between survey respondents and researchers while respondents completed the survey. A total of 344 responses were tabulated from those invited through discussion board posting invitations to teaching groups (via HAPS listservs and APS Hubs) and 3000 invitations that were sent via email, Table 1 . We received responses from participants living in 25 of the 50 states within the United States (most frequently represented states being California, Texas, Florida, New York) along with responses from Canada and a few from outside of Canada or the United States. Respondents were a representative population with a variety of gender identifications (i.e., female, male, non-binary/transgender), professional standings (i.e., professor/instructor, student) and socioeconomic backgrounds. A plurality of respondents identified as being middle class (41%) or lower middle class (33%),i.e., annual income between $ 75,000 and $ 100,000/year, while 15% of respondents identifying as being upper-middle class (i.e., annual income between $ 100,000 and $ 500,000/year), and the remainder (9%) identified as being either lower class (i.e., annual income between $ 16,000 and $ 32,000/year) or preferred to not disclose. Table 1 Summary of demographic information from respondents. Total Respondents N (%) 344 (100%) Female 172 (50%) Male 152 (44.2%) Other response (non-binary, fluid, prefer not to say) 20 (5.8) Ethnicity N (%) White/Caucasian 222 (64.5%) Black/African American 24 (6.9%) Asian/Asian American 34 (9.8%) Hispanic/Latin 20 (5.8%) Arab/Middle Eastern/Arab American 6 (1.7%) Native American, Alaskan, Hawaiian 16 (4.7%) Mixed Race 10 (2.9%) Other Response 12 (3.5%) Professional Standing N (%) Undergraduate Student 114 (33.1%) Nursing Student 30 (8.8%) Medical Student 12 (3.5%) Graduate Student 24 (6.9%) Professor or Instructor 164 (47.6%) Age (years) N (%) 18-to-20 4 (1.2%) 21-to-25 88 (25.6%) 26-to-30 66 (19.2%) 31-to-35 44 (12.8%) 36-to-40 30 (8.7%) 41-to-45 24 (6.9%) 46-to-50 22 (6.4%) 51-to-55 28 (8.1%) <> Survey Question Development and Clustering All researchers worked to edit questions that were previously used in a validated survey[ 30 ] to ascertain the agreement or disagreement with general positions on diet and exercise, history of diet plan or exercise regimen that has been used or currently used, perspective on commonly held beliefs and opinions regarding body image and body morphology, where information about diet and exercise is generally obtained, if any implicit or overt biases are expressed to students or colleagues, and whose advise about diet and exercise regimens should be followed. These questions were developed to answer the indicated purpose of the study regarding how bias might impact advocacy of diet and exercise or how being healthy is discussed or modeled. Survey questions were written using a Likert scale (strongly disagree-to-strongly agree on a 5-point scale) to the given statement, selection of potential options from a list regarding diet programs and exercise regimens and select open-ended response question that could be used for analysis of common word/phrase about what the individual felt about dieting, exercising, or being healthy. One researcher (JEC) then clustered the questions into sections-based commonality of topic being addressed and was published for administration via a Google Form survey link with questions clustered based on following groupings: general demographics what you think about body image and pressures regarding body image where you get information pertaining to diet and exercise personal perspectives on diet and programs that have been followed personal perspective on exercise and regimens that have been used what you would recommend to others. Full survey is available upon request. Data Analysis Following the conclusion of the survey window, data was downloaded into an Excel (Microsoft, 2024) worksheet and stored for analysis once all survey windows have been completed. After conclusion of the survey, responses were tabulated (data available upon request) for 2 specific focus to address our 3 principal hypotheses: 1. respondents ideals of body weight/image and health issues, pressures surrounding the concept of body image, and how subjective understanding of these pressures might influence recommendations being made. 2. what information is used to form one’s opinion about diet or exercise, the reliability and validity of that information, what programs have been used and the likelihood to recommend that diet or exercise regimen. After extraction of these questions, all responses were tabulated and analyzed for measures of central tendencies (average +/- standard deviation, median). Additionally, the percentage of response for each question related to understanding healthy and ideal body images and scalar response for the awareness of pressures related to body image was determined. For all non-Likert objective data obtained (i.e., select your body image, select “healthy body image), each option was converted into a reference number and tabulated by one researcher (JEC) for purposes of analysis. After tabulation, responses were analyzed (via R 4.0.5, R-project, r-project.org) for differences in response via one-way analysis of variance (ANVOA) between subgroups of respondents, along with Pearson correlation for comparison of responses between answers to questions within clustered by topic (i.e., body image ideals, awareness of social pressures, ability to provide appropriate information). Categorical differences between subgroups were analyzed via Chi-Square analysis of 2x2, yes/no x subgroup, or 3x2, agree/neutral/disagree x subgroup, for responses between subgroups of respondents based on gender, age groups (via generational classification 31-years old , e.g. Gen-y , and Gen-x), and professional standing (e.g., student, professor/instructor, nursing/medical student). All analysis was conducted with a level of significance set at p < 0.05. RESULTS Self-identification of body image and “healthy” body image As shown in Fig. 1 , there is an indication for agreement with the idea that respondents are content with their body image, that their body image is what they would consider to be a healthy body image, and that other’s would ask for advice because they are seen as healthy or fit . While at the same time, they generally agreed with the idea that they tend to compare their body image with other’s in their social network but disagree with the idea that they compare their body image with body images that are expressed in media. <> Within this pattern of responses, 54% respondents were able to correctly indicate a healthy body image for a female, while only 39% of respondents were able to indicate a healthy body image for males, Figs. 2 – 3 . There was significant difference (p < 0.01) in the association of the thinnest image being the healthy body image for a female (15%) relative to the male (8%). Moreover, 59% of respondents misjudged their designation of body image as being one that would be healthy based on generalized pattern of body fat expressed within the image used for this survey. Further, those that indicated being 1-level higher in the scale used here for body fat relative to a healthy body fat were more apt to indicate as being healthy than others that fall within this 59% of respondents, c 2 = 5.85 (p = 0.016), and were more likely to indicate their body image to the gender-matched body image for healthy body image, c 2 = 4.51 (p = 0.044). Additionally, those within this subset of respondents indicated both being more likely to compare themselves with friends and colleagues they perceive as being “skinnier”, c 2 = 34.76 (p < 0.001), but also to those that they see in media, c 2 = 29.29 (p < 0.001), relative to the other respondents. <> There is no difference seen based on professional standing (i.e., professor/instructor, students) relative to the group as a whole, on the ability to relate their body image the indicated image of healthy body image based on fat mass in the images used in the survey. Parsing the responses into gender-specific categorizations, there was no difference seen between the total number of male respondents and female respondents that present this mismatch (p > 0.065), yet categorical analysis show that male respondents had a significant pattern to mismatch their body image with what would be considered a healthy body image relative to female respondents, c 2 = 14.79 (p < 0.001). <> Based on age-classifications there were a significant difference between those that see themselves as having a healthy body image but do not report having a healthy body image. There are significantly more respondents > 31-years old who are significantly more likely to have a mismatch between their reported body image and the healthy body image they proport to have, p < 0.05. Moreover, categorical analysis of body image classifications indicates that those who are 31-years old, c 2 = 12.31 (p < 0.001). Awareness of body image and body composition issues There is a tendency among respondents to not view body mass index (BMI) as a reflection of one’s overall health, Fig. 1 . Along with an indication to agree that exhibiting body positivity as being a positive in promoting healthy versus ideal body images and expressed equality in the concern for those that are seen as being overweight relative to those that are underweight and for females relative to males. Yet, as seen in Fig. 4 , there is a general agreement that respondents are aware of social pressures to have a certain body image. While there are no differences in responses based on the gender of the respondents, p > 0.44, there are differences seen in regard to the gender being identified in the survey question. Yet, a small but significant difference (p = 0.018) is noted in the awareness of the social pressures that are applied to females relative to males. In this spectrum of pressures, there is an indication among respondents that they are able to change behaviors of individuals that are unhealthy or exhibit unhealthy body images. A position that is poorly but significantly correlated with expression of attitude toward the willingness to recommend diet to females (r = 0.39) and males (r = 0.38) or exercise to females (r = 0.33) and females (r = 0.36) that exhibit weight issues, Fig. 6 . Yet at the same time there is an indication that respondents see themselves as being qualified to offer advice and indicate that they are conscious about how they discuss diet and exercise around individuals who have expressed having weight issues. <> Differences are seen in attitudes regarding body image and awareness to pressures based on professional standing (i.e., professor/instructor, student), Fig. 4 . Professors and instructors indicate being more aware of social pressures than students, regardless of academic pursuit, for females needing to align their body image with an ideal body image seen in media, c 2 = 9.89 (p = 0.016) and were slightly less likely to agree with body positivity campaign being helpful in making people aware of what a "healthy" or "normal" body image might be, c 2 = 4.56 (p = 0.039). Interestingly, there was lower general agreement by all respondents to the idea that there are social pressures facing males to obtain an ideal body image relative their female counterparts, Fig. 4 . There is an agreement with acknowledgment of an ability to change someone’s behavior if they express an unhealthy lifestyle, with a non-significant difference for undergraduate students expressing greater agreement with an inability to change one’s behavior, Fig. 5 . Moreover, there is a significant agreement between those that mismatched their body image with a healthy body image and agreed with the inability to change someone else’s behaviors, c 2 = 7.46 (p = 0.029). Based on who is the most qualified to offering advice, medical and nursing students were more likely to agree with medical and health professionals being the most qualified, c 2 = 9.02 (p = 0.02). While there is a general agreement that simply being seen as “fit,” or being a personal trainer, does not automatically make one the most qualified. <> There are no significant differences based on age of the respondents to their awareness of pressures placed on individuals to have a distinct ideal body image, p > 0.567. In this, an interesting pattern arises where a parallel state of agreement in perspective occurs between those that are youngest of the age groups (i.e., 18-to-25) with those that are the oldest of the age groupings (i.e., 45-to-55) that differs from those between 25 and 45 years old. This pattern however does not hold when examination of concerns regarding genders, where there is a perceived equality of concern for male and females in those respondents that are 45-years old voice an opinion for greater concern for female relative to their male counterparts. Based on likeliness to offer advice, Fig. 5 , there is a general trend where younger respondents (i.e., ≤ 30 years old) indicate a higher likelihood to make dietary and exercise recommendations to those that seem overweight relative to the older respondents (i.e., ≥ 31 years old), c 2 = 13.19 (p < 0.001) and are more conscious of how they address diet and exercise with those that appear to have weight issues, c 2 = 7.99 (p = 0.004). This pattern holds with the small but significant correlations expressed between willingness to make a recommendation and likelihood to recommend either diet, r = 0.37, or exercise, r = 0.33, for those < 31-years old. Opinions and scientific understanding <> When looking into understanding the consensus presented by science, Fig. 6 – 7 , there are significant differences seen between respondents based on gender identification. Where male respondents were more likely to indicate agreement with the idea that scientific consensus shows that GMO foods were safe to eat, relative to their female counterparts, c 2 = 6.45 (p = 0.04). While females were more apt to indicate agreement with the faulty statement that scientific consensus shows that exercise is able to generate body region specific changes, spot reduction, c 2 = 9.145 (p = 0.01). Differences were also seen between professors and students based on understanding of scientific consensus. Where professors relative to students (regardless of level of academic pursuit) were more apt to agree with the consensus opinion that GMO foods were safe to eat (c 2 = 10.42,p = 0.005) and that dietary supplements are not safe or effective for weight loss (c 2 = 6.45,p = 0.04), with the only difference seen surrounding the consensus related to exercise is the students showing agreement with the scientifically invalid concept of sport reduction more often than professors (c 2 = 10.42,p = 0.005). <> There is a general agreement between personal opinions regarding diet, food safety, and the necessity to use exercise to be healthy; with a mixture of opinions regarding the necessity to use dietary supplements. With were moderate and small, but significant, correlations seen between personal opinions on diet and exercise with the general opinion about scientific consensus between need for vitamin supplements (r = 0.51), that organic food is safer than non-organic foods (r = 0.62), and the need for exercise to be healthy (r = 0.31) or that spot reduction is possible (r=-0.21). While an inverse relationship was noted between opinions about GMO safety and ideas of scientific consensus on the topic (r=-0.28) and between the need to exercise with the idea that aerobic exercise is the best (r=-0.16). Additionally, we see moderate correlation between the beliefs regarding "superfoods" with the need to supplement one's diet with antioxidants and vitamins (r = 0.40), and between beliefs regarding organic foods being safer and healthier (r = 0.52). There is a direct relationship between ideas that organic foods are safer and healthier with the idea that GMOs are unsafe (r = 0.54).There is also a direct relationship seen between disliking exercise due to an adverse event with being hesitant to start an exercise program, r = 0.55, but not with finding gyms and fitness centers intimidating (r = 0.03). Interestingly, there is a small but direct relationship between the disliking exercise with seeing benefits of health coming from exercise (r = 0.32). <> A majority of respondents indicated that they read peer-reviewed scientific journal articles to keep up on the latest information pertaining to diet and exercise, Fig. 8 . Yet, there was indication that the scientific information being presented led to confusion that was coupled with the indication that it was difficult to keep up with the trove of information being published. There is general acknowledgement that campuses are involved with wellness programs but that resources are not freely and openly accessible by faculty or students, Fig. 9 . <> Professors indicated a higher willingness to agree with the comment that they read scientific reports or magazine articles that disagree with (or do not support) their opinions, relative to the students (regardless of level of academic pursuit), c 2 = 6.45 (p = 0.04). With further division of responses based on beliefs of reliable and valid information, students (regardless of level of academic pursuit) were more apt to agree that they found exercise regimens presented through health websites to be more valid and reliable than professors, c 2 = 7.122 (p = 0.024). While the only difference noted between gender identification was seen with female respondents being more apt to agree that exercise regimens found in health-based magazines being valid and reliable relative to their male counterparts, c 2 = 6.45 (p = 0.04). When advising on diet and exercise, there is a general trend to rely on information that is presented from medical professionals and institutions, even if the information does not support the preferences of the respondents. Yet, at the same time being more inclined to recommend programs and routines that worked for the respondent. Moreover, there are differences noted between likeliness to follow suggestions for regimens between professors and students. Where professors indicated a greater likeliness to agree that they would be more apt to follow suggestions from their primary-care provider than students, p = 0.02. Reliance on Internet and multimedia resources <> When obtaining information, there is a general trend to not find valid or reliable information within the popular sources of information available to the public, Fig. 10 . The greatest reliability was seen in publications by medical professionals (55.1% and 55.8%, respectively being somewhat valid or valid) followed by fitness professionals on the Internet offering exercise advice (49.4% somewhat valid or valid). With no differences seen in categorizations of validity or reliability across resources, p > 0.05. Yet, within categories the sites indicated as being authored by medical professionals offering exercise recommendations were seen as being more valid and reliable than not-valid or reliable, c 2 = 13.36 (p = 0.003). Interestingly, and not surprisingly given the population of respondents, social media influencers were seen as being not valid or reliable, c 2 = 5.85 (p = 0.015). As shown in Table 2 , there was a greater reliance on social media for staying informed on diet and exercise than on information from medical Internet sources (61% versus 10% of respondents. Moreover, respondents indicated using multiple sources to gain insight on diet and exercise with an average 2.4 categories of Internet or media resources being used, Table 2 . Table 2 Reliance on Internet and multimedia sources of information on diet and exercise, based on responses to question "I get the majority of my information.” # denotes significantly greater based on being professor or student, $ denotes significantly greater based on age-range, ^ denotes significantly greater based on gender identification (c 2 value significant, p < 0.05). Resource Category Group Subgroups %Yes %No % Yes % No Social Media Application sources Social Media (TikTok, Twitter, Instagram, Pinterest) 61 39 Professor:39.9 Student: 53.9 # 31-yr old: 38.5 Female: 55.8 Male: 50.2 Other Gender: 51.9 Professor:59.1 # Student: 46.1 31-yr old: 61.5 $ Female: 44.2 Male: 49.8 Other Gender:48.1 Self-Indicated "Expert" Celebrity, Social Media Influencers, or Healthcare Professionals 34 65 Non-Expert Celebrity or Social Media Influencers 8 92 Fitness Internet sources Lifestyle Blogs or Websites (BeautyBean, Goop, Corporette, A Cup of Jo, Jezebel) 21 76 Professor:: 21.3 Student: 26.1 31-yr old: 18.8 Female: 25.3 Male: 23.5 Other Gender: 20.0 Professor: 78.7 Student: 73.9 31-yr old: 81.2 $ Female: 74.7 Male: 76.5 Other Gender:80.0 Fitness Blogs from Popular Press Websites (Lifestyle, Health) 15 85 Company Websites (Weight Watchers, Jenny Craig, Atkins) 12 88 Medical Internet sources Insurance Company sites (Aetna, UnitedHealth, Blue Cross/Blue Shield, Kaiser Permanente) 26 74 Professor: 32.9 Student: 31.1 31-yr old: 33.3 Female: 40.4 ^ Male: 24.7 Other Gender: 23.1 Professor:67.1 Student: 68.9 31-yr old: 66.7 $ Female: 59.6 Male: 75.3 ^ Other Gender:76.9 ^ Internet medical sites (WebMD, Healthline) 10 90 Television sources TV medical shows (Dr. Oz, The Doctors) 27 72 Professor: 12.2 Student: 26.1 # 31-yr old: 16.1 Female:20.3 Male: 19.9 Other Gender:16.7 Professor:87.8 # Student: 73.9 31-yr old: 83.9 $ Female: 79.7 Male: 80.1 Other Gender:83.3 TV News Programs 11 88 <> From these trends in resource utilization, there are significant differences found within subgroups of the respondents. Younger respondents ( 31-years old), p < 0.029. Moreover, there was a significantly higher number of older respondents, 31%, indicating that they did not use Internet or multimedia resources relative to their younger counterparts, 9%, as their primary source of information on diet or exercise, p < 0.001. A significant difference within the group is furthered with 5% of younger respondents that indicated using all possible categories of Internet or media resources versus 0% in the older respondents indicated this reliance, p < 0.001. There were also significant differences when viewed by professional standing (i.e., professor/instructor, student). Student respondents (regardless of level of study) on average relied upon 2.6 categories of Internet or media resources relative to the average of 2.2 categories relied upon by professor/instructor, p < 0.001. Moreover, there was a significantly higher number of professors, 32.5%, that indicated not relying upon Internet or multimedia resources relative to students (regardless of level of study), 8.8%, as their primary source of information on diet or exercise, p < 0.0001. Lastly, there are also significant differences seen within subgroups of the respondents based on gender identifications. Female respondents relied upon a significantly greater number of categories of Internet or media resources relative to either male respondents or those respondents that did not indicate as being either male or female, 2.6 versus 2.2 versus 2.00 categories, respectively (p = 0.031). Unlike what was indicated based on age or professional status (i.e., professor/instructor, student) there were no significant differences in the percentage of respondents indicating that they did not use Internet or multimedia resources. There were also noted differences in what type of resource was relied upon for information pertaining to diet and exercise. As a group, there was a greater reliance upon information being published via social media or by self-proclaimed experts than what was seen for resources coming from medical and professional websites, c 2 = 25.40 (p < 0.0001). This difference was further seen when responses were broken into subcategories based on age. Younger respondents (< 31-years old) were more likely to rely upon social media and self-proclaimed experts than the older respondents, c 2 = 13.36 (p = 0.003). A difference that was carried into the comparison between professors and students (regardless of level of study), c 2 = 5.85 (p = 0.015), with students being more reliant on the social media posts for their information relative to professors. But no significant differences were noted among students based on their indication of pursuing a generic undergraduate degree versus those in pursuit of a nursing or medical degree, c 2 = 1.04 (p = 0.308). Likewise, there were no significant differences noted in reliance on social media relative to the use of medical and professional websites being noted for comparisons made based on the gender identification for the respondent, c 2 = 0.025 (p = 0.87) . Bias in recommendations for diet and exercise As seen in Table 3 , older respondents (i.e., > 31-years old) report trying significantly more mass-marketed diets than younger respondents, while at the same time, younger respondents were significantly more likely to recommend diets that they were following (even if reporting fewer total dietary plans having been attempted), p < 0.05. Female respondents were more likely to try more total diets, relative to their male counterparts, p < 0.05. But at the same time, they were not any more likely to make recommendations for diets that they have followed, diets that they have not attempted or diets that they heard more negatives than positives about. Additionally, medical and nursing students reported trying the fewest mass-marketed diets, while undergraduate students reported trying significantly more diets than professors or medical and nursing students. Respondents that identified as being a professor indicated a significantly greater willingness to recommend diets that they had not tried, p < 0.05. Table 3 Utilization and recommendation of mass-marketed diets. # denotes significantly greater based on being professor or student, $ denotes significantly greater based on age-range, ^ denotes significantly greater based on gender identification (ANOVA, p < 0.05) Tried 3 Mass-Marketed Diets Will recommend diet that has not be used Will only recommend diets followed Will recommend diet with greater negatives All respondents 18% 50% 32% 15% 66% 18% Females 19% 9% 72% ^ 18% 80% 15% Males 41% ^ 27% ^ 32% 15% 83% 17% 31-years old 15% 30% 55% $ 31% 68% 25% Professor 29% 51% 20% 45% # 77% 18% All Students 19% 65% 16% 24% 85% 10% Medical and Nursing Student 40% # 51% 19% 31% 79% 15% Undergraduate Student 10% 21% 69% # 18% 72% 9% <> When recommending and following the various mass-marketed diet plans, Table 3 , there was a relationship between seeing diets as being something restrictive and number of plans that respondents had attempted (r = 0.65). There was a significantly greater percentage of respondents that have attempted 2–3 of the mass-marketed dietary plans than less than 1 or more than 3, p < 0.05. Moreover, respondents were 4-times as likely to recommend a diet plan that they tried relative to those that they have nor tried. Were 3.5-times more likely to recommend plans that they followed and heard more positive things than negative things rate than those plans that they had only heard positive things about. And were 5-times more likely to recommend plans that they followed than plans that they heard more negative things than positive things about or had no opinion about. As shown in Table 4 , there was overall a greater likeliness to try more exercise regimens than was seen in attempting to follow a mass-marketed dietary plan. We see a significantly higher percentage of professors reported trying fewer than 2 of the indicated exercise regimens, while were more likely to recommend exercise regimens that they both have never used and have used relative to a student responder, p < 0.05. The undergraduate student responder indicated having attempted significantly more exercise regimens than either professors or medical and nursing students, p < 0.05. There were few differences noted between subcategorization of respondents based on either age grouping or gender identifications. In which males were significantly more likely to try less than 2 exercise regimens listed and were significantly more likely to recommend exercise regimens that they have been using, while female respondents show a significantly higher likeliness to recommend exercise regimens that they have not personally attempted, p < 0.05. Table 4 Utilization and recommendation of mass-marketed exercise programs and other training regimens. # denotes significantly greater based on being professor or student, $ denotes significantly greater based on age-range, ^ denotes significantly greater based on gender identification (ANOVA, p < 0.05) Tried 4 exercise regimens Will recommend exercise regimens not used Will recommend exercise regimens used Will recommend exercise regimens with greater negatives All respondents 5% 38% 57% 25% 85% 10% Females 9% 29% ^ 62% 49% ^ 80% 15% Males 15% ^ 17% 66% 18% 93% ^ 17% 31-years old 4% 35% 61% 44% 68% 25% Professor 19% # 41% 40% 78% # 97% # 18% All Students 1% 65% # 34% 54% 85% 10% Medical and Nursing Student 5% 46% 49% 51% 79% 15% Undergraduate Student 3% 28% 69% # 18% 82% 9% <> Based on what exercise is being used and recommended, female respondents show a higher percentage of responses toward trying an endurance training regimen versus resistance training (65% versus 34%). Younger respondents (i.e., 31-years old) appear to have a preference toward group exercise and more traditional endurance exercise modalities (e.g., spin class, group exercise classes, long-duration training). There was very limited indication to having selected powerlifting, Olympic lifting, or plyometric training. Of the respondents that indicated having used CrossFit and HIIT training (35% of all respondents), they would not only recommend these training regimens but would also at 90% agreement recommend training through plyometrics, strongman, and Olympic lifting. Discussion With the growing awareness of the impact that lifestyle choices have on noncommunicable chronic illness, there is a growing push among healthcare professionals and public health advocates to generate a holistic approach to health through the promotion of pro-health behaviors [ 1 , 18 , 23 , 46 ]. The ability to present these pro-health behaviors through a holistic and unbiased approach to lifestyle interventions is the ideal that many healthcare professionals attempt to achieve [ 18 ]. An approach that means needing to present information in an educational setting independent of one’s personal bias [ 7 , 30 ]. Even though there is an expansion on the inclusion of such topics within undergraduate and career specific courses with the added intention of making practitioners more informed on the role that diet and nutrition has on overall health [ 47 , 48 ], educational approaches are often done without awareness of the accuracy or validity of the information or the extent that personal bias impacts the presentation of such information. Reliance on such biases in education not only perpetuate misconceptions about what body weight might mean about health but has the potential to impact the selection of information being transmitted and how that information gets transmitted (i.e., tone of voice, word choice) in the attempt to persuade one to follow the professional’s recommendation [ 11 , 12 , 18 , 19 , 49 ]. Something that has been noted across multiple healthcare disciplines not only with personal biases regarding body image, but also with the adherence to behaviors are considered socially acceptable behaviors based on gender, body morphology, or age of their patients [ 3 , 8 , 12 – 14 , 16 , 17 , 19 , 20 , 22 , 26 , 31 , 32 ]. Additionally, it is important to acknowledge that the ability to challenge these biases are quite difficult, especially given the increasing reliance on social media for obtaining information as to what should be seen as ideal and should that ideal also be seen as healthy for both behaviors along with body weight [ 39 , 42 , 50 ]. Something that has only become more difficult given the growing reliance on digital interactions that has the potential to distort reality [ 8 , 39 , 51 – 53 ]. All of which leads to the question that we have endeavored to address. Where, when, and how does a future health professional develop some of these biases? The answers to which lie not only with what information is sought to provide rationales for making selections and then offering recommendations to others, but also with the influence that mentors and educators have on validating rationales and recommendations used for selection of pro-health behaviors [ 5 , 7 , 38 , 48 , 54 – 57 ]. Actions that reinforce personal heuristics which serve as foundations of the biases expressed. Where, just as with respondents here, individuals will be more likely than not to seek evidence to support their perspectives or recommend behaviors that they have either used or heard positive things about, without seeking out if scientific consensus supports their opinions. While at the same time discourage the use of diets and exercise that they have not attempted or that they have heard negative things about. An alarming pattern, given that faculty must actively combat the information and biases in perspective stemming from excessive reliance on unreliable sources (e.g., social media, Internet publication) that are overwhelmingly used to stay informed on diet and exercise. As it is readily acknowledged that it requires more effort to dispel misinformation, disinformation, and myths than it does to teach the correct concept [ 7 , 38 , 43 , 58 ] or provide compelling rationales for options that are antithesis to popular or socially acceptable norms for behaviors [ 8 , 18 , 26 , 30 , 41 , 42 , 59 ]. Hampering this effort is the reliance on unreliable sources (i.e., social media or internet sources) that nearly 40% faculty members use to stay informed about diet and exercise coupled with limited exposure to primary and secondary source material (e.g., scientific journals, conference presentations) related to diet and exercise. Meaning that faculty may be at a disadvantage to counter misinformation and disinformation that students enter the classrooms have already learned [ 2 , 7 , 38 , 45 , 60 ]. Faulty viewpoints that can influence and guide the development of opinions about the patients that they will treat in the future, and viewpoints that get reinforced through personal biases. The biases that are presented in the information selection falls along the lines of confirmation bias, even when respondents here indicate an openness to information. Biases that not only impact selection of information that only agrees with opinions already held, but also with the recommendations that are being offered to others and the subjective feelings that respondents have toward diet and exercise. A general trend that seems to agree with what has been previously reported on regarding subjective biases in recommendations to patients by healthcare professionals, or biases that have been noted in students across multiple disciplines within the health sciences [ 13 , 14 , 16 , 17 , 19 , 21 , 54 , 61 ]. It is this latter point regarding subjective feelings that also directly impacts the likelihood that they have for others to seek them for their opinions or their willingness to offer advice regarding diet or exercise. Moreover, those that tended to voice negative words regarding diet (e.g., restrictive, punishing) or exercise (e.g., hard, tiring, punishment) or felt that exercise allowed them to eat whatever they wanted not only projected weight bias in their selection of appropriate body image for what is considered healthy but to also indicate a general agreement that they cannot influence someone else’s diet or exercise habits. A pattern of thought that is coupled with a feeling of being overwhelmed when trying to keep up with the information about diet and exercise trends. Moreover, students who strive for the “perfect grade” that they believe is necessary to become a successful healthcare provider, may through repetition inherently engrave the biases of professors, mentors, and other faculty as being true, versus what can be deduced or inferred by the student actually thinks for themselves [ 7 , 26 , 30 , 36 , 45 , 58 , 62 , 63 ]. As educators may express all too often their opinions devoid of application of the scientific consensus (i.e., GMO-food is not safe to consume, organic food is healthier than non-organic, and the ability to have spot reduction of fat mass) that permeate many conversations and media postings about diet, exercise and health or expressing personal values about diets (e.g., something restrictive) or exercise (e.g., finding gyms and fitness centers intimidating). Opinions that might align with preconceived notions held by students, or challenge students to alter their ideals to align the perspectives offered by the faculty that whether implicit or overt serve as means to persuade and influence students and others to accept the faculty’s perspective as being correct. Encouraging future healthcare professionals to potentially spread biased opinions onto others. Yet, we know that openness to opposing ideas and ideals is significant in current and future healthcare [ 5 , 19 , 22 , 28 , 31 , 32 , 38 , 58 , 64 ]. An important idea to remember as we have previously noted the importance of utilizing a collaborative holistic effort that includes the patient in the treatment choices and not the historical approach of coercion and deferral to the healthcare professional [ 18 ]. Unfortunately, we tend to see something antithesis to this ideal, a degree of close-mindedness with high rates of bias expressed in what would be recommended to individuals regarding diet or exercise as it pertains to health. Even if half of the group identified a multitude of exercise regimens and diets having been attempted, they are still more apt to recommend one that was attempted over those that were not. Additionally, the willingness to suggest something that worked for them when giving advice, which may or may not have been recommended by a healthcare provider, is further complicated as half of the respondents here stated only referencing resources that support their preferences when giving advice. Meaning that they not only will recommend what worked for them but will reinforce this opinion through cherry-picking of the information so as to not challenge that idea when giving advice. Issues given where information is being culled, i.e., social media, that is acknowledged as being less than valid and reliable. Sources of information (i.e., social media) where there is also a tension between cultivating a following and providing meaningful truthful information to listeners and viewers. Tension that all too often includes an inability to accept that their stipulations might not be supported by empirical evidence, compounded by the influence that social cues have on how information gets disseminated. Tensions that can be lessened should one review the context of information based on what is available in peer-reviewed scientific publications, yet respondents showed limited adherence to this idea while also being more likely than not to have difficulty in staying informed with current understanding being published in these reliable resources. Meaning that even though this group is a population that should use the scientific consensus to guide understanding, students and faculty alike are susceptible to popular beliefs for recommendations pertaining to diet, exercise, and health. Beliefs and tenets that are formed through the social influences that regulate much of our social interaction and behaviors that are meant to form a means of acceptance within our social cliques and not our scientific understandings. Social influences that are commonly determined by the similarities of likes, dislikes, and rationalizations offered; the expression of social values (i.e., traditional versus progressive influence); what gets culturally accepted amongst different ethnic subgroups that all persuade the biases across and within each group of our society; or what gets accepted based on generational and gender groups. Social influences that can impact the willingness to advise others regarding diet and exercise or how to discuss the pros and cons of diet and exercise when asked by others for their understanding and advice. And then there is the issue of body image and weight biases. While we have come to an agreement that societally we must combat the historically-held view of a female body image that overtly stresses the need for being thin for both attractiveness as well as health [ 39 , 50 , 53 , 65 ], a historically-held view that gets expressed here. Reliance on this point of view imparts unseen stresses on students to meet a socially acceptable body image for a healthcare professional, while at the same time causes distress as we have accepted the need to show a greater awareness of the social pressures presented about body images for females versus what is acknowledged as pressure presented onto males [ 10 , 22 , 39 , 50 , 51 , 57 , 65 , 66 ]. Even with the extraordinary level of awareness of social pressures on females to meet a selected body image and some growing awareness of the pressures faced by males [ 10 , 22 , 39 , 50 , 51 , 57 , 65 – 67 ], we still see a selection of a desirable body image in lieu of one that might actually be the healthy body image. A possible expression of weight bias and body image bias occurring, even within a population that expresses an awareness that a difference exists between the two labels (i.e., ideal and healthy). Yet, we also see an equal attention to concerns of weight issues that are actively expressed by males and females, meaning that studying to enter healthcare as a profession, or function as an educator in this career pathway might allow for changing perception about social pressures and concerns that males also experience possible weight biases. Even if such thinking is at odds with historical social opinions about the overall social pressures and discussions of body weight/body image that too often result in hypersensitivity around females and hyposensitivity around males. Where social influences might impact biases around body weight along with personal experiences of bullying or being subjected to demeaning comments about their personal body image, and the implicit sense of perfection of body image as portrayed in media or an overtly imposed idea of body image and fitness related to athletic endeavors [ 3 , 10 , 15 , 22 , 28 , 32 , 49 , 53 , 66 – 70 ] This connection between what the majority perceives to be “healthy” is interesting and may reflect some degree of body image and weight bias, influenced by several social factors (i.e., cultural norms, generational societal norms, social media, popular opinions, internalized self-body image), being expressed by our respondents [ 3 , 8 , 10 , 19 , 22 , 26 , 32 , 39 , 49 – 51 , 53 , 60 , 64 – 66 , 69 , 71 ]. The impact that social norms have on cultural and generational differences on these accepted norms. As we must stipulate that social norms about ideal and healthy body images are not only inconsistent within any society but are also constantly changing from generation to generation. Variability and inconsistency in acceptable norms mean that what is acceptable and modeled is also going to change, something that is seen here between generations (i.e., millennials versus Generation-X) more than what we see between social classifications of genders or race. To alleviate much of the social and cultural pressures that are evident in body image issues and biases there has been a recent push toward being more accepting of variability of weight and body images [ 57 , 72 ]. An idea commonly referred to as body positivity, coupled with a growing awareness that being healthy is not directly linked with one’s calculated body mass index (BMI) [ 2 , 49 , 57 , 64 , 72 , 73 ]. Important perspectives given how many have an internalized ideal that weight and body image is a reflection of not only self-worth but also from who one might seek advice from in order to achieve health and fitness via diet and exercise, or how we might offer advice to others that might see us as presenting that idealized image of being healthy or fit [ 15 , 19 , 22 , 52 , 68 , 71 ]. What is interesting is that while there is awareness for cultural and societal pressures on the appropriate body image to project health, there is a disconnect between self-rating of body image and determination of projecting a body image that would elicit a desire from others to seek advice for improving health. With nearly 60% of respondents indicating that they had a healthy body image that did not match the standard for healthy body image (see Figs. 2 and 3 ), with 25% of all respondents indicated having a body image that would lead others to ask advice from, even if they did not indicate having a healthy body image. Within this disconnect, there was a higher percentage fitting this mismatch within older respondents (i.e., older Generation-Y and Generation-X respondents) and might be an indication of expertise regarding health due to academic and professional background more than any insinuation about what their body image might represent. Yet, it is the differences between generations seen here that deserve more research to evaluate changing ideology across generations. We also noted that approximately two-thirds of all respondents indicated they become more conscious about diet and exercise in front of those who express concerns of being overweight. A valuable insight as we know that both patients and practitioners are apt to pass judgements on each other as being unhealthy simply due to perceived weight issues without knowing personal beliefs, actions, and level of personal care [ 11 , 12 , 15 , 19 , 22 , 45 , 66 ]. Moreover, given that we did not ask about directionality of concern (e.g., change of topic or word choice) it might serve as a reflection of body positivity to make them feel more comfortable with their provider and be more open to holistic care plans by minimizing personal biases [ 11 , 12 , 18 , 19 , 57 , 74 ]. Biases that can be corrected prior to work as a healthcare professional by having an educational experience that minimizes the projection of biases by faculty. Unfortunately, both health science students and faculty are not only more likely to compare themselves with their peers but will also compare themselves to what they see through media feeds. A comparison with the latter is known to have negative impacts on the internalized sense of one’s body image and heath, along with projection of ideals to others based on these internalized feelings [ 15 , 68 ]. A negative internalization that has recently been on the rise leading to higher incidence of mental health issues (e.g., eating disorders or body dysmorphia) across the population associated with the transition to a digital world of interactions during and following the SARS-Covid 19 pandemic coupled with surges in use of digital and social media [ 15 , 22 , 39 , 50 , 52 ]. Where even with awareness to the detrimental effects of these comparisons, health science students and their faculty indicate that they tend to listen to those that project an ideal of being fit and healthy for how to incorporate diet and exercise into their lifestyle. An opinion that aligned with what we see broadcasted across media platforms (i.e., traditional broadcast, Internet, social media) by self-anointed influencers who hold themselves as the standard of being fit and healthy , advertising their expertise and habits to the general public. Which can be dangerous as the projection of expertise from these influencers may not come with the appropriate academic or clinical understanding of the physiological complexity of health or how body composition is established, modified, or maintained over time [ 2 , 18 , 24 , 26 , 38 , 42 ]. Where acceptance for what is best can be exaggerated, coming from the praise and compliments regularly seen on social media posts from those that we ascribe expertise to, simply due to their body image which perpetuates the misguided notion that body image portrayed equates to a level of health or fitness [ 26 , 39 , 42 , 50 , 52 , 53 ]. A connection that subsequently causes many to undertake and promote the habits espoused by these individuals in the hope of achieving and receiving similar attention that further adds to existing social pressures for achieving a body image that mirrors what becomes popularly accepted. A point of view that can negatively affect the authenticity of advice offered and reflects an internalized bias regarding weight issues that may be expressed by others [ 15 , 18 , 22 , 26 , 28 , 52 , 68 ]. Countering this narrative, we do see nursing and medical students overtly indicate that they are more likely to see other healthcare providers as providing the greatest level of expertise for being healthy. An opinion which may reflect an implicit bias (whether warranted or not) that healthcare professionals, or those that are studying to be a healthcare professional, are healthy or fit , or attempt to undertake behaviors to improve overall fitness simply due to their profession [ 8 , 9 , 19 , 28 , 46 ]. Even if there is a general opinion that there is limited influence that respondents had on changing one’s behavior to improve body. A disconnect that might reflect implicit weight bias among respondents. Along these lines, we stipulate that it is important to acknowledge that those we socially deem to be ideal for displaying a body image of fit , or health , may experience more stress than the average person to meet that ideal . A pattern of thought that can be transferred to healthcare professionals that are expected to project a body image of health, where they too must abide by social norms for this ideal or provide exquisite rationale for why they might differ from that ideal. Simply put, the weight and body image bias projected by healthcare professionals to their patients may stem from weight bias that has been projected upon the healthcare professional throughout their education and training. And while respondents here have indicated understanding that body mass index (BMI) does not indicate overall health for a person, the patients that we classify as “overweight” or “obese” based on BMI may not; and can internalize the labels and with thoughts of “What makes me appear unhealthy ?” or “Am I too overfat ?” impacting psyche and mental well-being [ 3 , 11 , 15 , 52 , 66 , 68 , 71 ]. A situation where updated curriculum and course materials may be of benefit [ 5 , 7 , 30 , 47 , 48 , 58 , 62 , 63 , 75 ]. While efforts have been made toward increased inclusion of underrepresented groups (i.e., LGBTQIA+, non-Europeans, gender) in health science textbooks and instruction, there is still a struggle for issues of weight. As such there seems to be limited updating to the consequences of using a metric like BMI, or other outdated ideals of fitness which unfortunately prompts incorrect attributions onto a person that may adversely impact treatment and subsequently their overall health, physical and mental [ 2 , 3 , 19 , 23 , 31 , 32 , 47 , 48 , 71 , 73 ]. As such, we would highly recommend updating curriculum and resources meant to educate health science students to focus on facts and scientific consensus regarding health and fitness, without biases from faculty that focuses on the complex interaction of modifiable and non-modifiable factors while addressing fallacy of familiar opinions that influence weight bias in the care for patients that tend to lead to poor resolutions [ 3 , 12 , 18 – 23 , 26 , 28 , 31 , 32 , 60 , 73 ]. Without such changes, the validity and accuracy of the practices performed by health professionals become compromised from the biases for what can be deemed healthy versus unhealthy based on how the patient’s weight aligns with a preconceived notion for what a healthy body looks like [ 17 , 19 , 31 , 32 ]. Biases seen here and throughout the general population are susceptible to group thought because of the undue influence that social media influencers seem to have on what is deemed as healthy by current social standards [ 8 , 39 , 50 , 67 , 76 ]. The projection of such attitudes within the education of healthcare professionals can lead to the modeling of biases [ 62 , 75 ], yet if future healthcare providers can be provided information in an unbiased manner, asked to critically evaluate information based on scientific veracity then bias of care can be minimized [ 7 , 18 , 47 , 57 , 63 , 64 ]. Allowing for treatment without the incorporation of judgment around ideal weight and allow for the holistic approach to care that incorporates the ideals of self-motivation and self-monitoring over the authoritarian coercive care that is commonly used towards those that are seen as being unhealthy simply because of body weight [ 18 , 23 , 25 , 28 , 44 , 46 , 58 , 77 ]. While we have found many interesting points from the responses obtained there are some limitations to this study that need to be indicated. The major limitation that needs to be noted is the limited population (N = 344), that even though large enough to have statistical power may not be large enough to offer definitive conclusions. There is also a degree of population of convenience, based on the means of recruitment may not include an open invitation to anyone that might teach a health science course or be enrolled in a health science program.. The major limitation that needs to be noted is that the population we are reporting is limited (N = 344), even if large it is enough to offer us the population necessary to have power in statistical analysis. There is also a degree of population of convenience being surveyed here, based on how we recruited there was no way to ensure an open invitation to any person that might teach health science students or were enrolled as a health science student at any college or university. There are many factors that impact healthy behaviors and while our survey looked at many of these components it eliminated other factors that might impact responses analyzed here. We also did not examine backgrounds of the respondents to understand what social stresses, or if cultural and generational emphasis influenced opinions expressed here. To address these limitations, it is the intention to repeat this survey with a larger population of respondents, integrate questions to examine social stresses and cues that might impact view of body image and preference towards healthy and ideal body image, and understanding of body composition as it relates to health. We would also encourage other researchers to begin examining the role that biases have in how we present body image, health, and lifestyles throughout the educational system. As the development or correction of bias may be pivotal in the holistic approach to treatment of lifestyle disease. CONCLUSION There is evidence of weight bias presented by both health science students and faculty, with a bias appearing to parallel what is seen in the general population for preferring thinness as a reflection for being healthy. An opinion that is reflected even with greater scientific awareness of the faulty connection of body weight, or BMI, being an indication of health, indicating that personal and unscientific opinions being offered by faculty members may ultimately impact student awareness and application of evolving understanding. A conclusion that helps us to better understand how biases projected by educators impact how ideals about health and lifestyle that allows for healthiness is built by future healthcare professionals three ways. First, faculty see themselves as being a person that others look to for information on diet and exercise regardless of their self-described body image being deemed subjectively as being healthy. Second, everyone feels overwhelmed keeping informed given the glut of information pertaining to diet, exercise and healthy living bombarding anyone on a daily basis and are overly reliant on social media to stay informed. Third, a degree of blindness toward bias is noted leading to reliance on personal opinions and confirmation bias when making recommendations regarding diet or exercise that can be used to improve one’s health. From these points, we can surmise that bias development in future healthcare professionals arise from a combination of preconceived notions that are reinforced by modeling and educational tendencies to emphasize personal beliefs by faculty. Biases that without modification or corrections may have a negative impact on the holistic approach to care that has become a focus of patient care. Declarations Conflict of Interest: No author has a conflict of interest in publication of this manuscript or conclusions being offered Responsibilities: All authors contributed to the formatting and writing of the survey, distribution of the survey, and the writing or editing of this manuscript. JEC was also responsible for coding and data analysis of responses provided from the survey. 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Machtmes, Student Perception of How to Succeed in a Pre-Nursing Anatomy and Physiology Course. HAPS Educator, 2020. 24 (2): p. 5-20DOI: 10.21692/haps.2020.014. Habibi, S.A. and L. Salim, Static vs. dynamic methods of delivery for science communication: A critical analysis of user engagement with science on social media. PLoS One, 2021. 16 (3): p. e0248507DOI: 10.1371/journal.pone.0248507. Talumaa, B., et al., Effective strategies in ending weight stigma in healthcare. Obes Rev, 2022. 23 (10): p. e13494DOI: 10.1111/obr.13494. Ravaldi, C., et al., Eating disorders and body image disturbances among ballet dancers, gymnasium users and body builders. Psychopathology, 2013. 36 (5): p. 247-254DOI: 10.1159/000073450. Ginot, I., Body schema and body image. At the crossroad of Somatics and social work. Journal of Dance and Somatic Practices, 2011. 3 (1&2): p. 151-165. Gultzow, T., et al., Male Body Image Portrayals on Instagram. Cyberpsychol Behav Soc Netw, 2020. 23 (5): p. 281-289DOI: 10.1089/cyber.2019.0368. Greenleaf, C., et al., Weight-related words associated with figure silhouettes. Body Image, 2004. 1 (4): p. 373-384DOI: 10.1016/j.bodyim.2004.10.004. Othman, M.S., et al., Motivations, barriers and exercise preferences among female undergraduates: A need assessment analysis. PLoS One, 2022. 17 (2): p. e0264158DOI: 10.1371/journal.pone.0264158. Thedinga, H.K., R. Zehl, and A. Thiel, Weight stigma experiences and self-exclusion from sport and exercise settings among people with obesity. BMC Public Health, 2021. 21 (1): p. 565DOI: 10.1186/s12889-021-10565-7. Stewart, S.F. and J. Ogden, The Role of BMI Group on the Impact of Weight Bias Versus Body Positivity Terminology on Behavioral Intentions and Beliefs: An Experimental Study. Front Psychol, 2019. 10 : p. 634DOI: 10.3389/fpsyg.2019.00634. McCallum, M., et al., Body Positivity and Self-Compassion on a Publicly Available Behavior Change Weight Management Program. Int J Environ Res Public Health, 2021. 18 (24)DOI: 10.3390/ijerph182413358. Clark, J.E., An overview of the contribution of fatness and fitness factors, and the role of exercise, in the formation of health status for individuals who are overweight. J Diabetes Metab Disord, 2012. 11 (1): p. 19DOI: 10.1186/2251-6581-11-19. Patnode, C.D., et al., Behavioral Counseling to Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Known Cardiovascular Disease Risk Factors: Updated Systematic Review for the U.S. Preventive Services Task Force , U.S.D.o.H.a.H. Services, Editor. 2017, Kaiser Permanente Center for Health Research, Portland OR: Portland, OR. Brown, S.J., S. White, and N. Power, Introductory anatomy and physiology in an undergraduate nursing curriculum. Adv Physiol Educ, 2017. 41 (1): p. 56-61DOI: 10.1152/advan.00112.2016. Cohen, R., T. Newton-John, and A. Slater, The case for body positivity on social media: Perspectives on current advances and future directions. Journal of Health Psychology, 2021. 26 (13): p. 2365-2373DOI: 10.1177/1359105320912450. Bindl, U.K., et al., Fuel of the self-starter: How mood relates to proactive goal regulation. Journal of Applied Psychology, 2012. 97 (1): p. 134-150DOI: 10.1037/a0024368. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 08 May, 2025 Reviews received at journal 08 May, 2025 Reviewers agreed at journal 17 Feb, 2025 Reviews received at journal 15 Feb, 2025 Reviewers agreed at journal 05 Feb, 2025 Reviewers invited by journal 05 Feb, 2025 Editor assigned by journal 17 Nov, 2024 Submission checks completed at journal 17 Nov, 2024 First submitted to journal 16 Nov, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5467293","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":379184625,"identity":"116754c5-fdf0-4591-9a75-4b545b0a160b","order_by":0,"name":"James E. 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Note: \u0026nbsp;option F, followed by option E, represent “healthiest” body image.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-5467293/v1/7614dd74afc034f525c5501b.png"},{"id":71657850,"identity":"ea4417ce-6f82-41e0-92d1-51286db07f10","added_by":"auto","created_at":"2024-12-17 13:11:13","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":650484,"visible":true,"origin":"","legend":"\u003cp\u003eWhat males see as the representation of their body image and what all respondents would consider being a healthy body image for a male. Note: option F, followed by option E, represent “healthiest” body image.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-5467293/v1/71bb3b48a2aacc4236ab849d.png"},{"id":71657860,"identity":"3645d367-a247-48d7-a291-b43a066e9cc4","added_by":"auto","created_at":"2024-12-17 13:11:14","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":1188974,"visible":true,"origin":"","legend":"\u003cp\u003eAwareness of social pressures to achieve \u003cem\u003eideal\u003c/em\u003eweight (or body image) and reflexive changes in conversation around diet and exercise based on the appearance of someone having weight issues.\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-5467293/v1/2c6ca9d54dcb9009020fc79b.png"},{"id":71657859,"identity":"721dd313-7a14-4f29-af1c-f2049533acf8","added_by":"auto","created_at":"2024-12-17 13:11:14","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":1205076,"visible":true,"origin":"","legend":"\u003cp\u003eSubjective attitudes for the ability to influence someone to change their unhealthy behaviors and lifestyle and who should be seen as being most qualified to make diet and exercise recommendations.\u003c/p\u003e","description":"","filename":"Figure5.png","url":"https://assets-eu.researchsquare.com/files/rs-5467293/v1/f9cd9917081f1791e0315ec9.png"},{"id":71657858,"identity":"c1bf2254-e292-42a1-b2d3-72f8b54f51b6","added_by":"auto","created_at":"2024-12-17 13:11:14","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":1359560,"visible":true,"origin":"","legend":"\u003cp\u003eRespondents understanding of diet and exercise and willingness to provide advice to others.\u003c/p\u003e","description":"","filename":"Figure6.png","url":"https://assets-eu.researchsquare.com/files/rs-5467293/v1/2cf079cd684284f0661c971c.png"},{"id":71657856,"identity":"258c9324-792c-4669-b0d2-6889090cfc3e","added_by":"auto","created_at":"2024-12-17 13:11:14","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":1120316,"visible":true,"origin":"","legend":"\u003cp\u003eSummary of the understanding of scientific consensus regarding diet and exercise.\u003c/p\u003e","description":"","filename":"Figure7.png","url":"https://assets-eu.researchsquare.com/files/rs-5467293/v1/9b5afaf9a85c76f5cb96d8d4.png"},{"id":71658622,"identity":"63b534f4-f0a8-4a3b-98ac-ebf888a9f4d3","added_by":"auto","created_at":"2024-12-17 13:19:14","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":1232978,"visible":true,"origin":"","legend":"\u003cp\u003eSubjective evaluation of importance of diet and exercise and willingness to project that opinion to others.\u003c/p\u003e","description":"","filename":"Figure8.png","url":"https://assets-eu.researchsquare.com/files/rs-5467293/v1/3d97e425c1f63f205555f02a.png"},{"id":71658623,"identity":"80ba642d-0da9-455a-ac66-3743ef8c88cb","added_by":"auto","created_at":"2024-12-17 13:19:14","extension":"png","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":1074161,"visible":true,"origin":"","legend":"\u003cp\u003eEvaluation of sources and importance of information used in formulating the opinion of diet and exercise.\u003c/p\u003e","description":"","filename":"Figure9.png","url":"https://assets-eu.researchsquare.com/files/rs-5467293/v1/6eac44701d942e3a9e9a39fb.png"},{"id":71657853,"identity":"5adf3bdc-66ea-472c-aaff-aa9ac408ba0e","added_by":"auto","created_at":"2024-12-17 13:11:14","extension":"png","order_by":10,"title":"Figure 10","display":"","copyAsset":false,"role":"figure","size":1371734,"visible":true,"origin":"","legend":"\u003cp\u003eSubjective views of the validity and reliability of sources of information for forming opinions about diet and exercise.\u003c/p\u003e","description":"","filename":"Figure10.png","url":"https://assets-eu.researchsquare.com/files/rs-5467293/v1/b5cf0290c2fa0f57c19f7e6f.png"},{"id":71659749,"identity":"214d543a-e318-4a21-b5ac-dc39c1a263c0","added_by":"auto","created_at":"2024-12-17 13:27:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":12082109,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5467293/v1/79317ea2-1eee-4e1a-aa29-dde8b8dbd549.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Biases toward weight, diet, and exercise expressed by health science students and their professors","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOver the last half-century there has been a push for establishing pro-health attitudes (i.e., changes in level of physical activity and diet) to reduce incidence of non-communicable diseases seen across population [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], that includes incorporation of aspects of lifestyle into the education of healthcare professionals coupled with growing awareness for tackling issues of the myths and misconceptions that many students have about body weight and health before entering the curriculum of becoming a healthcare profession [\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Leading many faculty members to actively demonstrate or discuss how lifestyles might impact the function of the systems of the body being studied in the classroom or clinical settings.\u003c/p\u003e \u003cp\u003eUnfortunately, we see many of the scenarios presented within textbooks and ancillary materials that perpetuate an idea that body weight or body mass index (BMI) might indicate one\u0026rsquo;s overall health, oversight that fails to correct commonly held misconceptions and opinions that are recognized to influence a practitioner\u0026rsquo;s care of patients [\u003cspan additionalcitationids=\"CR9 CR10 CR11\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Perpetuating a bias that exists in perception of the health and physical abilities based solely on weight [\u003cspan additionalcitationids=\"CR12 CR13 CR14 CR15\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Bias when combined with reliance on personal heuristics and preferences toward specific lifestyle interventions by healthcare providers (i.e., doctors, nurses, physical therapists, dieticians) filters into the type, and quality, of lifestyle interventions being recommended [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan additionalcitationids=\"CR15 CR16 CR17 CR18 CR19 CR20 CR21\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Recommendations that all too frequently, come without considering a holistic approach for care that incorporates preferences of the patient, impacting long-term potential to improve overall health [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Or are made based on appeasing a cognitive bias for interventions based on social norms and attitudes [\u003cspan additionalcitationids=\"CR27 CR28\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Leading to a growing concern about how developing these biases will impact recommendations being offered and behaviors being modeled to establish healthy lifestyles across one\u0026rsquo;s lifespan [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan additionalcitationids=\"CR31\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eModeling practices that could have limited validity and accuracy as they may develop from students following personal preferences and biases of a behavior being \u003cem\u003ehealthy\u003c/em\u003e presented by their professors-as it is a well-established position that personal biases influence many of the choices that one makes on everyday activities related to one's health [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Bias leading to self-selection, or avoidance, of distinct behaviors that impact the acceptance of ideals as being correct by the student in an attempt to mirror or parrot the professor\u0026rsquo;s attitudes in an attempt to achieve the grade independent of becoming an active critical thinker necessary in healthcare [\u003cspan additionalcitationids=\"CR35\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Possibly leading students to retain and reflect biases and opinions presented to them by their faculty in ways that the faculty may not intend [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Modeling of attitudes that have lasting impacts on the student\u0026rsquo;s future abilities to provide information to a patient without relying upon their internalized biases and opinions about individuals of select groups (e.g., demographic stereotypes) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA point that must be reflected upon, for both educators and students, as healthcare professionals will interact with patients from various backgrounds, personal beliefs, and lifestyle choices that might not agree with personal opinions or beliefs [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. As at any point in time a patient can experience the impact of unconscious biases, which unfortunately come to impact care and has led to a growing awareness within the literature, especially for the unintentional cognitive biases derived from cultural stereotypes that might perpetuate health inequities within underrepresented populations [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Yet, there has been very limited research into understanding how these biases impact the expression weight bias, how one obtains information pertaining to diet and exercise, or how personal heuristics toward one\u0026rsquo;s selected lifestyle can blind the educator or healthcare provider to what recommendations are offered to others. Problems of bias and blindness to bias need to be addressed given the constant exposure to recommendations provided across various media platforms (e.g., television, Podcast, Internet, or social media (TikTok, Instagram, X (formerly known as Twitter), Facebook, Reddit), many of which contain a disproportionate amount of scientifically invalid, or at least highly questionable, lifestyle interventions purported to have an ability to improve one\u0026rsquo;s overall health [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR38 CR39 CR40 CR41\" citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMessaging that typically is centered on the faulty assumption that weight or BMI act as a determinant of overall health and can lead some to developing body dysmorphic behaviors, even if not diagnosed [\u003cspan additionalcitationids=\"CR40 CR41\" citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Messaging and misinformation that must be countered either by continuing educational opportunities, or through integration of concepts of weight bias or diet and exercise within the curriculum for future healthcare providers [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Messaging that some professors and healthcare professionals may not be able to counter due to relying upon personal beliefs or confirmation bias in recommendations offered within rebuttal to misinformation they encounter [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan additionalcitationids=\"CR31\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. These unconscious biases have the potential to be transmitted in the guise of education, even without awareness of the transmission by those expressing bias [\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan additionalcitationids=\"CR44\" citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. And while we recently speculated that awareness of one\u0026rsquo;s bias can limit overt action on that bias [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], very little is seen in how educators truly impact the unconscious perceptions of body image or suggested lifestyle interventions (i.e., diet and exercise) that are meant to improve overall health [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan additionalcitationids=\"CR44\" citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThus, the purpose for this study is to continue our work on the evaluation of bias in presenting health information in the classroom [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Where we intend to evaluate first if personal bias exists toward body weight, diet or exercise exists and how personal attitudes and biases may impact how topics of health are reflected to others, and second how these beliefs reflect current scientific understanding on the topics. To address these points, we will test the three following hypotheses. First, that personal beliefs have a greater influence than scientific awareness in forming weight ideals and in recommending diet and exercise to improve one\u0026rsquo;s health. Second, students are less open-minded to information pertaining to diet and exercise than faculty due to the necessity to appease the professor\u0026rsquo;s point-of-view within their course work. Third, that there is a confirmation bias in the selection and transmission of information by both faculty and students for behaviors they already use and ideas that they already hold to be true.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\"\u003e\n \u003ch2\u003eParticipants and Selection Process\u003c/h2\u003e\n \u003cp\u003ePrior to the selection process, a power calculation was run to determine the number of potential respondents necessary to have statistical power. Based on assessment methods, a minimum sample size of respondents (N) was determined to be 310. N= ((Z-score for 95% CI)\u003csup\u003e2\u003c/sup\u003e*SD*(1-SD))/ (margin of error)\u003csup\u003e2\u003c/sup\u003e. All methods were approved by IRB panel of Scientific Health: Education and Human Performance (EHP-12-2019/8-2023) prior to publication of the survey or initiation of recruitment.\u003c/p\u003e\n \u003cp\u003eSelection for participants began with a random selection of 100 colleges and universities representing 30 states within the United States of America (USA), followed by a second random selection of professors from publicly available listings of courses being taught by the professor. Identified professors were then emailed invitations with an informed consent and an active link to the survey. Other potential participants were invited to participate via posting on discussions boards (e.g., the Human Anatomy and Physiology Society (HAPS) listserv, American Physiology Society (APS) hubs). Potential student participants were identified and contacted from contact information publicly available for clubs and organizations on the randomly selected colleges and universities or through messages posted to discussion boards by professors that volunteered to post the invitation for their courses. All recruitment and invitation for participation occurred between May 1 and December 10, 2023, with data analysis occurring after January 15, 2024.\u003c/p\u003e\n \u003cp\u003eTo be included in the study, participants need to be an adult between the ages 18\u0026ndash;99 years that either teach or are students in a health or biomedical science college or graduate program, able to read and respond to questions written in American-English, able to access the survey through an Internet service provider (ISP). Anyone not currently active in teaching or enrolled in a health or biomedical science college program, those without access to an ISP, or those unable to comprehend American-English were not able to participate. Any participant that accepted the invitation provided informed consent understanding the purpose of the survey and all safeguards taken to protect their identity during and after participating in the survey. Beyond the initial email or posting onto discussion boards, there was no contact between survey respondents and researchers while respondents completed the survey.\u003c/p\u003e\n \u003cp\u003eA total of 344 responses were tabulated from those invited through discussion board posting invitations to teaching groups (via HAPS listservs and APS Hubs) and 3000 invitations that were sent via email, Table \u003cspan\u003e1\u003c/span\u003e. We received responses from participants living in 25 of the 50 states within the United States (most frequently represented states being California, Texas, Florida, New York) along with responses from Canada and a few from outside of Canada or the United States. Respondents were a representative population with a variety of gender identifications (i.e., female, male, non-binary/transgender), professional standings (i.e., professor/instructor, student) and socioeconomic backgrounds. A plurality of respondents identified as being middle class (41%) or lower middle class (33%),i.e., annual income between \u003cspan\u003e$\u003c/span\u003e75,000 and \u003cspan\u003e$\u003c/span\u003e100,000/year, while 15% of respondents identifying as being upper-middle class (i.e., annual income between \u003cspan\u003e$\u003c/span\u003e100,000 and \u003cspan\u003e$\u003c/span\u003e500,000/year), and the remainder (9%) identified as being either lower class (i.e., annual income between \u003cspan\u003e$\u003c/span\u003e16,000 and \u003cspan\u003e$\u003c/span\u003e32,000/year) or preferred to not disclose.\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 1\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eSummary of demographic information from respondents.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"2\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal Respondents N (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e344 (100%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e172 (50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e152 (44.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther response (non-binary, fluid, prefer not to say)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEthnicity N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWhite/Caucasian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e222 (64.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBlack/African American\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24 (6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAsian/Asian American\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34 (9.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHispanic/Latin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (5.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eArab/Middle Eastern/Arab American\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNative American, Alaskan, Hawaiian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16 (4.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMixed Race\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (2.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther Response\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (3.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProfessional Standing N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUndergraduate Student\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e114 (33.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNursing Student\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30 (8.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedical Student\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (3.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGraduate Student\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24 (6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProfessor or Instructor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e164 (47.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge (years) N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18-to-20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21-to-25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88 (25.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26-to-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66 (19.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31-to-35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44 (12.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36-to-40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30 (8.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41-to-45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24 (6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46-to-50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (6.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51-to-55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28 (8.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u0026lt;\u0026lt;INSERT TABLE 1 ABOUT HERE\u0026gt;\u0026gt;\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\"\u003e\n \u003ch2\u003eSurvey Question Development and Clustering\u003c/h2\u003e\n \u003cp\u003eAll researchers worked to edit questions that were previously used in a validated survey[\u003cspan\u003e30\u003c/span\u003e] to ascertain the agreement or disagreement with general positions on diet and exercise, history of diet plan or exercise regimen that has been used or currently used, perspective on commonly held beliefs and opinions regarding body image and body morphology, where information about diet and exercise is generally obtained, if any implicit or overt biases are expressed to students or colleagues, and whose advise about diet and exercise regimens should be followed. These questions were developed to answer the indicated purpose of the study regarding how bias might impact advocacy of diet and exercise or how being healthy is discussed or modeled. Survey questions were written using a Likert scale (strongly disagree-to-strongly agree on a 5-point scale) to the given statement, selection of potential options from a list regarding diet programs and exercise regimens and select open-ended response question that could be used for analysis of common word/phrase about what the individual felt about dieting, exercising, or being healthy. One researcher (JEC) then clustered the questions into sections-based commonality of topic being addressed and was published for administration via a Google Form survey link with questions clustered based on following groupings:\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003egeneral demographics\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003ewhat you think about body image and pressures regarding body image\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003ewhere you get information pertaining to diet and exercise\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003epersonal perspectives on diet and programs that have been followed\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003epersonal perspective on exercise and regimens that have been used\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003ewhat you would recommend to others.\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003eFull survey is available upon request.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\"\u003e\n \u003ch2\u003eData Analysis\u003c/h2\u003e\n \u003cp\u003eFollowing the conclusion of the survey window, data was downloaded into an Excel (Microsoft, 2024) worksheet and stored for analysis once all survey windows have been completed. After conclusion of the survey, responses were tabulated (data available upon request) for 2 specific focus to address our 3 principal hypotheses:\u003c/p\u003e\n \u003cp\u003e\u003cspan\u003e1. respondents ideals of body weight/image and health issues, pressures surrounding the concept of body image, and how subjective understanding of these pressures might influence recommendations being made.\u003cbr\u003e\u003c/span\u003e\u003cspan\u003e2. what information is used to form one\u0026rsquo;s opinion about diet or exercise, the reliability and validity of that information, what programs have been used and the likelihood to recommend that diet or exercise regimen.\u003cbr\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003eAfter extraction of these questions, all responses were tabulated and analyzed for measures of central tendencies (average +/- standard deviation, median). Additionally, the percentage of response for each question related to understanding healthy and ideal body images and scalar response for the awareness of pressures related to body image was determined. For all non-Likert objective data obtained (i.e., select your body image, select \u0026ldquo;healthy body image), each option was converted into a reference number and tabulated by one researcher (JEC) for purposes of analysis.\u003c/p\u003e\n \u003cp\u003eAfter tabulation, responses were analyzed (via R 4.0.5, R-project, r-project.org) for differences in response via one-way analysis of variance (ANVOA) between subgroups of respondents, along with Pearson correlation for comparison of responses between answers to questions within clustered by topic (i.e., body image ideals, awareness of social pressures, ability to provide appropriate information). Categorical differences between subgroups were analyzed via Chi-Square analysis of 2x2, yes/no x subgroup, or 3x2, agree/neutral/disagree x subgroup, for responses between subgroups of respondents based on gender, age groups (via generational classification\u0026thinsp;\u0026lt;\u0026thinsp;31-years old, e.g., Gen-y and Gen-z, versus \u003cem\u003e\u0026gt;\u0026thinsp;31-years old\u003c/em\u003e, \u003cem\u003ee.g. Gen-y\u003c/em\u003e, and Gen-x), and professional standing (e.g., student, professor/instructor, nursing/medical student). All analysis was conducted with a level of significance set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec8\"\u003e\n \u003ch2\u003eSelf-identification of body image and \u0026ldquo;healthy\u0026rdquo; body image\u003c/h2\u003e\n \u003cp\u003eAs shown in Fig. \u003cspan\u003e1\u003c/span\u003e, there is an indication for agreement with the idea that respondents are content with their body image, that their body image is what they would consider to be a \u003cem\u003ehealthy\u003c/em\u003e body image, and that other\u0026rsquo;s would ask for advice because they are seen as \u003cem\u003ehealthy\u003c/em\u003e or \u003cem\u003efit\u003c/em\u003e. While at the same time, they generally agreed with the idea that they tend to compare their body image with other\u0026rsquo;s in their social network but disagree with the idea that they compare their body image with body images that are expressed in media.\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026lt;\u0026lt;INSERT FIGURE 1 ABOUT HERE\u0026gt;\u0026gt;\u003c/p\u003e\n\u003cp\u003eWithin this pattern of responses, 54% respondents were able to correctly indicate a \u003cem\u003ehealthy\u003c/em\u003e body image for a female, while only 39% of respondents were able to indicate a \u003cem\u003ehealthy\u003c/em\u003e body image for males, Figs. \u003cspan\u003e2\u003c/span\u003e\u0026ndash;\u003cspan\u003e3\u003c/span\u003e. There was significant difference (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) in the association of the thinnest image being the healthy body image for a female (15%) relative to the male (8%).\u003c/p\u003e\n\u003cp\u003eMoreover, 59% of respondents misjudged their designation of body image as being one that would be \u003cem\u003ehealthy\u003c/em\u003e based on generalized pattern of body fat expressed within the image used for this survey. Further, those that indicated being 1-level higher in the scale used here for body fat relative to a healthy body fat were more apt to indicate as being \u003cem\u003ehealthy\u003c/em\u003e than others that fall within this 59% of respondents, c\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;5.85 (p\u0026thinsp;=\u0026thinsp;0.016), and were more likely to indicate their body image to the gender-matched body image for \u003cem\u003ehealthy\u003c/em\u003e body image, c\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;4.51 (p\u0026thinsp;=\u0026thinsp;0.044). Additionally, those within this subset of respondents indicated both being more likely to compare themselves with friends and colleagues they perceive as being \u0026ldquo;skinnier\u0026rdquo;, c\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;34.76 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), but also to those that they see in media, c\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;29.29 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), relative to the other respondents.\u003c/p\u003e\n\u003cp\u003e\u0026lt;\u0026lt;INSERT FIGRUE 2 ABOUT HERE\u0026gt;\u0026gt;\u003c/p\u003e\n\u003cp\u003eThere is no difference seen based on professional standing (i.e., professor/instructor, students) relative to the group as a whole, on the ability to relate their body image the indicated image of \u003cem\u003ehealthy\u003c/em\u003e body image based on fat mass in the images used in the survey. Parsing the responses into gender-specific categorizations, there was no difference seen between the total number of male respondents and female respondents that present this mismatch (p\u0026thinsp;\u0026gt;\u0026thinsp;0.065), yet categorical analysis show that male respondents had a significant pattern to mismatch their body image with what would be considered a healthy body image relative to female respondents, c\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;14.79 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n\u003cdiv id=\"Sec11\"\u003e\n \u003cp\u003e\u0026lt;\u0026lt;INSERT FIGURE \u003cspan\u003e3\u003c/span\u003e ABOUT HERE\u0026gt;\u0026gt;\u003c/p\u003e\n \u003cp\u003eBased on age-classifications there were a significant difference between those that see themselves as having a \u003cem\u003ehealthy\u003c/em\u003e body image but do not report having a \u003cem\u003ehealthy\u003c/em\u003e body image. There are significantly more respondents\u0026thinsp;\u0026gt;\u0026thinsp;31-years old who are significantly more likely to have a mismatch between their reported body image and the \u003cem\u003ehealthy\u003c/em\u003e body image they proport to have, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Moreover, categorical analysis of body image classifications indicates that those who are \u0026lt;\u0026thinsp;31-years old were less likely to report this mismatch between reflection of self-body image and what would be considered \u003cem\u003ehealthy\u003c/em\u003e relative to those\u0026thinsp;\u0026gt;\u0026thinsp;31-years old, c\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;12.31 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\"\u003e\n \u003ch2\u003eAwareness of body image and body composition issues\u003c/h2\u003e\n \u003cp\u003eThere is a tendency among respondents to not view body mass index (BMI) as a reflection of one\u0026rsquo;s overall health, Fig. \u003cspan\u003e1\u003c/span\u003e. Along with an indication to agree that exhibiting body positivity as being a positive in promoting healthy versus ideal body images and expressed equality in the concern for those that are seen as being overweight relative to those that are underweight and for females relative to males. Yet, as seen in Fig. \u003cspan\u003e4\u003c/span\u003e, there is a general agreement that respondents are aware of social pressures to have a certain body image. While there are no differences in responses based on the gender of the respondents, p\u0026thinsp;\u0026gt;\u0026thinsp;0.44, there are differences seen in regard to the gender being identified in the survey question. Yet, a small but significant difference (p\u0026thinsp;=\u0026thinsp;0.018) is noted in the awareness of the social pressures that are applied to females relative to males. In this spectrum of pressures, there is an indication among respondents that they are able to change behaviors of individuals that are unhealthy or exhibit unhealthy body images. A position that is poorly but significantly correlated with expression of attitude toward the willingness to recommend diet to females (r\u0026thinsp;=\u0026thinsp;0.39) and males (r\u0026thinsp;=\u0026thinsp;0.38) or exercise to females (r\u0026thinsp;=\u0026thinsp;0.33) and females (r\u0026thinsp;=\u0026thinsp;0.36) that exhibit weight issues, Fig. \u003cspan\u003e6\u003c/span\u003e. Yet at the same time there is an indication that respondents see themselves as being qualified to offer advice and indicate that they are conscious about how they discuss diet and exercise around individuals who have expressed having weight issues.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\"\u003e\n \u003cp\u003e\u0026lt;\u0026lt;INSERT FIGURE \u003cspan\u003e4\u003c/span\u003e ABOUT HERE\u0026gt;\u0026gt;\u003c/p\u003e\n \u003cp\u003eDifferences are seen in attitudes regarding body image and awareness to pressures based on professional standing (i.e., professor/instructor, student), Fig. \u003cspan\u003e4\u003c/span\u003e. Professors and instructors indicate being more aware of social pressures than students, regardless of academic pursuit, for females needing to align their body image with an ideal body image seen in media, c\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;9.89 (p\u0026thinsp;=\u0026thinsp;0.016) and were slightly less likely to agree with body positivity campaign being helpful in making people aware of what a \u0026quot;healthy\u0026quot; or \u0026quot;normal\u0026quot; body image might be, c\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;4.56 (p\u0026thinsp;=\u0026thinsp;0.039). Interestingly, there was lower general agreement by all respondents to the idea that there are social pressures facing males to obtain an \u003cem\u003eideal\u003c/em\u003e body image relative their female counterparts, Fig. \u003cspan\u003e4\u003c/span\u003e.\u003c/p\u003e\n \u003cp\u003eThere is an agreement with acknowledgment of an ability to change someone\u0026rsquo;s behavior if they express an unhealthy lifestyle, with a non-significant difference for undergraduate students expressing greater agreement with an inability to change one\u0026rsquo;s behavior, Fig. \u003cspan\u003e5\u003c/span\u003e. Moreover, there is a significant agreement between those that mismatched their body image with a healthy body image and agreed with the inability to change someone else\u0026rsquo;s behaviors, c\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;7.46 (p\u0026thinsp;=\u0026thinsp;0.029). Based on who is the most qualified to offering advice, medical and nursing students were more likely to agree with medical and health professionals being the most qualified, c\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;9.02 (p\u0026thinsp;=\u0026thinsp;0.02). While there is a general agreement that simply being seen as \u0026ldquo;fit,\u0026rdquo; or being a personal trainer, does not automatically make one the most qualified.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\"\u003e\n \u003cp\u003e\u0026lt;\u0026lt;INSERT FIGURE \u003cspan\u003e5\u003c/span\u003e ABOUT HERE\u0026gt;\u0026gt;\u003c/p\u003e\n \u003cp\u003eThere are no significant differences based on age of the respondents to their awareness of pressures placed on individuals to have a distinct \u003cem\u003eideal\u003c/em\u003e body image, p\u0026thinsp;\u0026gt;\u0026thinsp;0.567. In this, an interesting pattern arises where a parallel state of agreement in perspective occurs between those that are youngest of the age groups (i.e., 18-to-25) with those that are the oldest of the age groupings (i.e., 45-to-55) that differs from those between 25 and 45 years old. This pattern however does not hold when examination of concerns regarding genders, where there is a perceived equality of concern for male and females in those respondents that are \u0026lt;\u0026thinsp;25-years old, while those who are \u0026gt;\u0026thinsp;45-years old voice an opinion for greater concern for female relative to their male counterparts.\u003c/p\u003e\n \u003cp\u003eBased on likeliness to offer advice, Fig. \u003cspan\u003e5\u003c/span\u003e, there is a general trend where younger respondents (i.e., \u0026le; 30 years old) indicate a higher likelihood to make dietary and exercise recommendations to those that seem overweight relative to the older respondents (i.e., \u0026ge;\u0026thinsp;31 years old), c\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;13.19 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and are more conscious of how they address diet and exercise with those that appear to have weight issues, c\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;7.99 (p\u0026thinsp;=\u0026thinsp;0.004). This pattern holds with the small but significant correlations expressed between willingness to make a recommendation and likelihood to recommend either diet, r\u0026thinsp;=\u0026thinsp;0.37, or exercise, r\u0026thinsp;=\u0026thinsp;0.33, for those\u0026thinsp;\u0026lt;\u0026thinsp;31-years old.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\"\u003e\n \u003ch2\u003eOpinions and scientific understanding\u003c/h2\u003e\n \u003cp\u003e\u0026lt;\u0026lt;INSERT FIGURE \u003cspan\u003e6\u003c/span\u003e HERE\u0026gt;\u0026gt;\u003c/p\u003e\n \u003cp\u003eWhen looking into understanding the consensus presented by science, Fig. \u003cspan\u003e6\u003c/span\u003e\u0026ndash;\u003cspan\u003e7\u003c/span\u003e, there are significant differences seen between respondents based on gender identification. Where male respondents were more likely to indicate agreement with the idea that scientific consensus shows that GMO foods were safe to eat, relative to their female counterparts, c\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;6.45 (p\u0026thinsp;=\u0026thinsp;0.04). While females were more apt to indicate agreement with the faulty statement that scientific consensus shows that exercise is able to generate body region specific changes, spot reduction, c\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;9.145 (p\u0026thinsp;=\u0026thinsp;0.01). Differences were also seen between professors and students based on understanding of scientific consensus. Where professors relative to students (regardless of level of academic pursuit) were more apt to agree with the consensus opinion that GMO foods were safe to eat (c\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;10.42,p\u0026thinsp;=\u0026thinsp;0.005) and that dietary supplements are not safe or effective for weight loss (c\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;6.45,p\u0026thinsp;=\u0026thinsp;0.04), with the only difference seen surrounding the consensus related to exercise is the students showing agreement with the scientifically invalid concept of sport reduction more often than professors (c\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;10.42,p\u0026thinsp;=\u0026thinsp;0.005).\u003c/p\u003e\n \u003cp\u003e\u0026lt;\u0026lt;INSERT FIGURE \u003cspan\u003e7\u003c/span\u003e HERE\u0026gt;\u0026gt;\u003c/p\u003e\n \u003cp\u003eThere is a general agreement between personal opinions regarding diet, food safety, and the necessity to use exercise to be healthy; with a mixture of opinions regarding the necessity to use dietary supplements. With were moderate and small, but significant, correlations seen between personal opinions on diet and exercise with the general opinion about scientific consensus between need for vitamin supplements (r\u0026thinsp;=\u0026thinsp;0.51), that organic food is safer than non-organic foods (r\u0026thinsp;=\u0026thinsp;0.62), and the need for exercise to be healthy (r\u0026thinsp;=\u0026thinsp;0.31) or that spot reduction is possible (r=-0.21). While an inverse relationship was noted between opinions about GMO safety and ideas of scientific consensus on the topic (r=-0.28) and between the need to exercise with the idea that aerobic exercise is the best (r=-0.16). Additionally, we see moderate correlation between the beliefs regarding \u0026quot;superfoods\u0026quot; with the need to supplement one\u0026apos;s diet with antioxidants and vitamins (r\u0026thinsp;=\u0026thinsp;0.40), and between beliefs regarding organic foods being safer and healthier (r\u0026thinsp;=\u0026thinsp;0.52). There is a direct relationship between ideas that organic foods are safer and healthier with the idea that GMOs are unsafe (r\u0026thinsp;=\u0026thinsp;0.54).There is also a direct relationship seen between disliking exercise due to an adverse event with being hesitant to start an exercise program, r\u0026thinsp;=\u0026thinsp;0.55, but not with finding gyms and fitness centers intimidating (r\u0026thinsp;=\u0026thinsp;0.03). Interestingly, there is a small but direct relationship between the disliking exercise with seeing benefits of health coming from exercise (r\u0026thinsp;=\u0026thinsp;0.32).\u003c/p\u003e\n \u003cp\u003e\u0026lt;\u0026lt;INSERT FIGURE \u003cspan\u003e8\u003c/span\u003e HERE\u0026gt;\u0026gt;\u003c/p\u003e\n \u003cp\u003eA majority of respondents indicated that they read peer-reviewed scientific journal articles to keep up on the latest information pertaining to diet and exercise, Fig. \u003cspan\u003e8\u003c/span\u003e. Yet, there was indication that the scientific information being presented led to confusion that was coupled with the indication that it was difficult to keep up with the trove of information being published. There is general acknowledgement that campuses are involved with wellness programs but that resources are not freely and openly accessible by faculty or students, Fig. \u003cspan\u003e9\u003c/span\u003e.\u003c/p\u003e\n \u003cp\u003e\u0026lt;\u0026lt;INSERT FIGURE \u003cspan\u003e9\u003c/span\u003e HERE\u0026gt;\u0026gt;\u003c/p\u003e\n \u003cp\u003eProfessors indicated a higher willingness to agree with the comment that they read scientific reports or magazine articles that disagree with (or do not support) their opinions, relative to the students (regardless of level of academic pursuit), c\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;6.45 (p\u0026thinsp;=\u0026thinsp;0.04). With further division of responses based on beliefs of reliable and valid information, students (regardless of level of academic pursuit) were more apt to agree that they found exercise regimens presented through health websites to be more valid and reliable than professors, c\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;7.122 (p\u0026thinsp;=\u0026thinsp;0.024). While the only difference noted between gender identification was seen with female respondents being more apt to agree that exercise regimens found in health-based magazines being valid and reliable relative to their male counterparts, c\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;6.45 (p\u0026thinsp;=\u0026thinsp;0.04).\u003c/p\u003e\n \u003cp\u003eWhen advising on diet and exercise, there is a general trend to rely on information that is presented from medical professionals and institutions, even if the information does not support the preferences of the respondents. Yet, at the same time being more inclined to recommend programs and routines that worked for the respondent. Moreover, there are differences noted between likeliness to follow suggestions for regimens between professors and students. Where professors indicated a greater likeliness to agree that they would be more apt to follow suggestions from their primary-care provider than students, p\u0026thinsp;=\u0026thinsp;0.02.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\"\u003e\n \u003ch2\u003eReliance on Internet and multimedia resources\u003c/h2\u003e\n \u003cdiv id=\"Sec17\"\u003e\n \u003cp\u003e\u0026lt;\u0026lt;INSERT FIGURE \u003cspan\u003e10\u003c/span\u003e\u0026gt;\u0026gt;\u003c/p\u003e\n \u003cp\u003eWhen obtaining information, there is a general trend to not find valid or reliable information within the popular sources of information available to the public, Fig. \u003cspan\u003e10\u003c/span\u003e. The greatest reliability was seen in publications by medical professionals (55.1% and 55.8%, respectively being somewhat valid or valid) followed by fitness professionals on the Internet offering exercise advice (49.4% somewhat valid or valid). With no differences seen in categorizations of validity or reliability across resources, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05. Yet, within categories the sites indicated as being authored by medical professionals offering exercise recommendations were seen as being more valid and reliable than not-valid or reliable, c\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;13.36 (p\u0026thinsp;=\u0026thinsp;0.003). Interestingly, and not surprisingly given the population of respondents, social media influencers were seen as being not valid or reliable, c\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;5.85 (p\u0026thinsp;=\u0026thinsp;0.015).\u003c/p\u003e\n \u003cp\u003eAs shown in Table \u003cspan\u003e2\u003c/span\u003e, there was a greater reliance on social media for staying informed on diet and exercise than on information from medical Internet sources (61% versus 10% of respondents. Moreover, respondents indicated using multiple sources to gain insight on diet and exercise with an average 2.4 categories of Internet or media resources being used, Table \u003cspan\u003e2\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv\u003e \u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 2\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eReliance on Internet and multimedia sources of information on diet and exercise, based on responses to question \u0026quot;I get the majority of my information.\u0026rdquo; \u003csup\u003e#\u003c/sup\u003edenotes significantly greater based on being professor or student, \u003csup\u003e$\u003c/sup\u003edenotes significantly greater based on age-range, \u003csup\u003e^\u003c/sup\u003edenotes significantly greater based on gender identification (c\u003csup\u003e2\u003c/sup\u003e value significant, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eResource Category\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eSubgroups\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%Yes\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%No\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e% Yes\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e% No\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003eSocial Media Application sources\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSocial Media (TikTok, Twitter, Instagram, Pinterest)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eProfessor:39.9\u003c/p\u003e\n \u003cp\u003eStudent: 53.9\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;31-yr old:58.2\u003csup\u003e$\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;31-yr old: 38.5\u003c/p\u003e\n \u003cp\u003eFemale: 55.8\u003c/p\u003e\n \u003cp\u003eMale: 50.2\u003c/p\u003e\n \u003cp\u003eOther Gender: 51.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eProfessor:59.1\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eStudent: 46.1\u003c/p\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;31-yr old: 41.8\u003c/p\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;31-yr old: 61.5\u003csup\u003e$\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eFemale: 44.2\u003c/p\u003e\n \u003cp\u003eMale: 49.8\u003c/p\u003e\n \u003cp\u003eOther Gender:48.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSelf-Indicated \u0026quot;Expert\u0026quot; Celebrity, Social Media Influencers, or Healthcare Professionals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNon-Expert Celebrity or Social Media Influencers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eFitness Internet sources\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLifestyle Blogs or Websites (BeautyBean, Goop, Corporette, A Cup of Jo, Jezebel)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eProfessor:: 21.3\u003c/p\u003e\n \u003cp\u003eStudent: 26.1\u003c/p\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;31-yr old: 29.7\u003csup\u003e$\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;31-yr old: 18.8\u003c/p\u003e\n \u003cp\u003eFemale: 25.3\u003c/p\u003e\n \u003cp\u003eMale: 23.5\u003c/p\u003e\n \u003cp\u003eOther Gender: 20.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eProfessor: 78.7\u003c/p\u003e\n \u003cp\u003eStudent: 73.9\u003c/p\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;31-yr old: 70.3\u003c/p\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;31-yr old: 81.2\u003csup\u003e$\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eFemale: 74.7\u003c/p\u003e\n \u003cp\u003eMale: 76.5\u003c/p\u003e\n \u003cp\u003eOther Gender:80.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFitness Blogs from Popular Press Websites (Lifestyle, Health)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCompany Websites (Weight Watchers, Jenny Craig, Atkins)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedical Internet sources\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInsurance Company sites (Aetna, UnitedHealth, Blue Cross/Blue Shield, Kaiser Permanente)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eProfessor: 32.9\u003c/p\u003e\n \u003cp\u003eStudent: 31.1\u003c/p\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;31-yr old: 30.3\u003c/p\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;31-yr old: 33.3\u003c/p\u003e\n \u003cp\u003eFemale: 40.4\u003csup\u003e^\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eMale: 24.7\u003c/p\u003e\n \u003cp\u003eOther Gender: 23.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eProfessor:67.1\u003c/p\u003e\n \u003cp\u003eStudent: 68.9\u003c/p\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;31-yr old: 69.7\u003c/p\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;31-yr old: 66.7\u003csup\u003e$\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eFemale: 59.6\u003c/p\u003e\n \u003cp\u003eMale: 75.3\u003csup\u003e^\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eOther Gender:76.9\u003csup\u003e^\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInternet medical sites (WebMD, Healthline)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eTelevision sources\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTV medical shows (Dr. Oz, The Doctors)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eProfessor: 12.2\u003c/p\u003e\n \u003cp\u003eStudent: 26.1\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;31-yr old: 22.8\u003csup\u003e$\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;31-yr old: 16.1\u003c/p\u003e\n \u003cp\u003eFemale:20.3\u003c/p\u003e\n \u003cp\u003eMale: 19.9\u003c/p\u003e\n \u003cp\u003eOther Gender:16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eProfessor:87.8\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eStudent: 73.9\u003c/p\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;31-yr old:77.2\u003c/p\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;31-yr old: 83.9\u003csup\u003e$\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eFemale: 79.7\u003c/p\u003e\n \u003cp\u003eMale: 80.1\u003c/p\u003e\n \u003cp\u003eOther Gender:83.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTV News Programs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u0026lt;\u0026lt;INSERT Table \u003cspan\u003e2\u003c/span\u003e ABOUT HERE\u0026gt;\u0026gt;\u003c/p\u003e\n \u003cp\u003eFrom these trends in resource utilization, there are significant differences found within subgroups of the respondents. Younger respondents (\u0026lt;\u0026thinsp;31-years old) relied upon 2.8 categories of Internet or media resources relative to the 1.99 categories relied upon by older respondents (\u0026gt;\u0026thinsp;31-years old), p\u0026thinsp;\u0026lt;\u0026thinsp;0.029. Moreover, there was a significantly higher number of older respondents, 31%, indicating that they did not use Internet or multimedia resources relative to their younger counterparts, 9%, as their primary source of information on diet or exercise, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001. A significant difference within the group is furthered with 5% of younger respondents that indicated using all possible categories of Internet or media resources versus 0% in the older respondents indicated this reliance, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/p\u003e\n \u003cp\u003eThere were also significant differences when viewed by professional standing (i.e., professor/instructor, student). Student respondents (regardless of level of study) on average relied upon 2.6 categories of Internet or media resources relative to the average of 2.2 categories relied upon by professor/instructor, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001. Moreover, there was a significantly higher number of professors, 32.5%, that indicated not relying upon Internet or multimedia resources relative to students (regardless of level of study), 8.8%, as their primary source of information on diet or exercise, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001. Lastly, there are also significant differences seen within subgroups of the respondents based on gender identifications. Female respondents relied upon a significantly greater number of categories of Internet or media resources relative to either male respondents or those respondents that did not indicate as being either male or female, 2.6 versus 2.2 versus 2.00 categories, respectively (p\u0026thinsp;=\u0026thinsp;0.031). Unlike what was indicated based on age or professional status (i.e., professor/instructor, student) there were no significant differences in the percentage of respondents indicating that they did not use Internet or multimedia resources.\u003c/p\u003e\n \u003cp\u003eThere were also noted differences in what type of resource was relied upon for information pertaining to diet and exercise. As a group, there was a greater reliance upon information being published via social media or by self-proclaimed experts than what was seen for resources coming from medical and professional websites, c\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;25.40 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). This difference was further seen when responses were broken into subcategories based on age. Younger respondents (\u0026lt;\u0026thinsp;31-years old) were more likely to rely upon social media and self-proclaimed experts than the older respondents, c\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;13.36 (p\u0026thinsp;=\u0026thinsp;0.003). A difference that was carried into the comparison between professors and students (regardless of level of study), c\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;5.85 (p\u0026thinsp;=\u0026thinsp;0.015), with students being more reliant on the social media posts for their information relative to professors. But no significant differences were noted among students based on their indication of pursuing a generic undergraduate degree versus those in pursuit of a nursing or medical degree, c\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1.04 (p\u0026thinsp;=\u0026thinsp;0.308). Likewise, there were no significant differences noted in reliance on social media relative to the use of medical and professional websites being noted for comparisons made based on the gender identification for the respondent, c\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.025 (p\u0026thinsp;=\u0026thinsp;0.87) .\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\"\u003e\n \u003ch2\u003eBias in recommendations for diet and exercise\u003c/h2\u003e\n \u003cp\u003eAs seen in Table \u003cspan\u003e3\u003c/span\u003e, older respondents (i.e., \u0026gt; 31-years old) report trying significantly more mass-marketed diets than younger respondents, while at the same time, younger respondents were significantly more likely to recommend diets that they were following (even if reporting fewer total dietary plans having been attempted), p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Female respondents were more likely to try more total diets, relative to their male counterparts, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. But at the same time, they were not any more likely to make recommendations for diets that they have followed, diets that they have not attempted or diets that they heard more negatives than positives about. Additionally, medical and nursing students reported trying the fewest mass-marketed diets, while undergraduate students reported trying significantly more diets than professors or medical and nursing students. Respondents that identified as being a professor indicated a significantly greater willingness to recommend diets that they had not tried, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\n \u003cdiv\u003e \u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 3\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eUtilization and recommendation of mass-marketed diets. \u003csup\u003e#\u003c/sup\u003edenotes significantly greater based on being professor or student, \u003csup\u003e$\u003c/sup\u003edenotes significantly greater based on age-range, \u003csup\u003e^\u003c/sup\u003edenotes significantly greater based on gender identification (ANOVA, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTried\u0026thinsp;\u0026lt;\u0026thinsp;2 Mass-Marketed Diets\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTried 2\u0026ndash;3 Mass-Marketed Diets\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTried\u0026thinsp;\u0026gt;\u0026thinsp;3 Mass-Marketed Diets\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eWill recommend diet that has not be used\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eWill only recommend diets followed\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eWill recommend diet with greater negatives\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAll respondents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72%\u003csup\u003e^\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41%\u003csup\u003e^\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27%\u003csup\u003e^\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e83%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;31-years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70%\u003csup\u003e$\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85%\u003csup\u003e$\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;31-years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55%\u003csup\u003e$\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProfessor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45%\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAll Students\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedical and Nursing Student\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40%\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUndergraduate Student\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69%\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u0026lt;\u0026lt;INSERT Table \u003cspan\u003e3\u003c/span\u003e ABOUT HERE\u0026gt;\u0026gt;\u003c/p\u003e\n \u003cp\u003eWhen recommending and following the various mass-marketed diet plans, Table \u003cspan\u003e3\u003c/span\u003e, there was a relationship between seeing diets as being something restrictive and number of plans that respondents had attempted (r\u0026thinsp;=\u0026thinsp;0.65). There was a significantly greater percentage of respondents that have attempted 2\u0026ndash;3 of the mass-marketed dietary plans than less than 1 or more than 3, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Moreover, respondents were 4-times as likely to recommend a diet plan that they tried relative to those that they have nor tried. Were 3.5-times more likely to recommend plans that they followed and heard more positive things than negative things rate than those plans that they had only heard positive things about. And were 5-times more likely to recommend plans that they followed than plans that they heard more negative things than positive things about or had no opinion about.\u003c/p\u003e\n \u003cp\u003eAs shown in Table \u003cspan\u003e4\u003c/span\u003e, there was overall a greater likeliness to try more exercise regimens than was seen in attempting to follow a mass-marketed dietary plan. We see a significantly higher percentage of professors reported trying fewer than 2 of the indicated exercise regimens, while were more likely to recommend exercise regimens that they both have never used and have used relative to a student responder, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. The undergraduate student responder indicated having attempted significantly more exercise regimens than either professors or medical and nursing students, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. There were few differences noted between subcategorization of respondents based on either age grouping or gender identifications. In which males were significantly more likely to try less than 2 exercise regimens listed and were significantly more likely to recommend exercise regimens that they have been using, while female respondents show a significantly higher likeliness to recommend exercise regimens that they have not personally attempted, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\n \u003cdiv\u003e \u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 4\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eUtilization and recommendation of mass-marketed exercise programs and other training regimens. \u003csup\u003e#\u003c/sup\u003edenotes significantly greater based on being professor or student, \u003csup\u003e$\u003c/sup\u003edenotes significantly greater based on age-range, \u003csup\u003e^\u003c/sup\u003edenotes significantly greater based on gender identification (ANOVA, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTried\u0026thinsp;\u0026lt;\u0026thinsp;2 exercise regimens\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTried 2\u0026ndash;4 exercise regimens\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTried\u0026thinsp;\u0026gt;\u0026thinsp;4 exercise regimens\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eWill recommend exercise regimens not used\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eWill recommend exercise regimens used\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eWill recommend exercise regimens with greater negatives\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAll respondents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29%\u003csup\u003e^\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49%\u003csup\u003e^\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15%\u003csup\u003e^\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93%\u003csup\u003e^\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;31-years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60%\u003csup\u003e$\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85%\u003csup\u003e$\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;31-years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProfessor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19%\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78%\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e97%\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAll Students\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65%\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedical and Nursing Student\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUndergraduate Student\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69%\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u0026lt;\u0026lt;INSERT Table \u003cspan\u003e4\u003c/span\u003e ABOUT HERE\u0026gt;\u0026gt;\u003c/p\u003e\n \u003cp\u003eBased on what exercise is being used and recommended, female respondents show a higher percentage of responses toward trying an endurance training regimen versus resistance training (65% versus 34%). Younger respondents (i.e., \u0026lt; 31-years old) appear to have a preference toward interval and circuit training methods (e.g., HIIT, Cross-fit, circuit training) while older respondents (i.e., \u0026gt; 31-years old) appear to have a preference toward group exercise and more traditional endurance exercise modalities (e.g., spin class, group exercise classes, long-duration training). There was very limited indication to having selected powerlifting, Olympic lifting, or plyometric training. Of the respondents that indicated having used CrossFit and HIIT training (35% of all respondents), they would not only recommend these training regimens but would also at 90% agreement recommend training through plyometrics, strongman, and Olympic lifting.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eWith the growing awareness of the impact that lifestyle choices have on noncommunicable chronic illness, there is a growing push among healthcare professionals and public health advocates to generate a holistic approach to health through the promotion of pro-health behaviors [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. The ability to present these pro-health behaviors through a holistic and unbiased approach to lifestyle interventions is the ideal that many healthcare professionals attempt to achieve [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. An approach that means needing to present information in an educational setting independent of one\u0026rsquo;s personal bias [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Even though there is an expansion on the inclusion of such topics within undergraduate and career specific courses with the added intention of making practitioners more informed on the role that diet and nutrition has on overall health [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e], educational approaches are often done without awareness of the accuracy or validity of the information or the extent that personal bias impacts the presentation of such information. Reliance on such biases in education not only perpetuate misconceptions about what body weight might mean about health but has the potential to impact the selection of information being transmitted and how that information gets transmitted (i.e., tone of voice, word choice) in the attempt to persuade one to follow the professional\u0026rsquo;s recommendation [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Something that has been noted across multiple healthcare disciplines not only with personal biases regarding body image, but also with the adherence to behaviors are considered socially acceptable behaviors based on gender, body morphology, or age of their patients [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAdditionally, it is important to acknowledge that the ability to challenge these biases are quite difficult, especially given the increasing reliance on social media for obtaining information as to what should be seen as \u003cem\u003eideal\u003c/em\u003e and should that ideal also be seen as \u003cem\u003ehealthy\u003c/em\u003e for both behaviors along with body weight [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. Something that has only become more difficult given the growing reliance on digital interactions that has the potential to distort reality [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan additionalcitationids=\"CR52\" citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. All of which leads to the question that we have endeavored to address. Where, when, and how does a future health professional develop some of these biases?\u003c/p\u003e \u003cp\u003eThe answers to which lie not only with what information is sought to provide rationales for making selections and then offering recommendations to others, but also with the influence that mentors and educators have on validating rationales and recommendations used for selection of pro-health behaviors [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan additionalcitationids=\"CR55 CR56\" citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]. Actions that reinforce personal heuristics which serve as foundations of the biases expressed. Where, just as with respondents here, individuals will be more likely than not to seek evidence to support their perspectives or recommend behaviors that they have either used or heard positive things about, without seeking out if scientific consensus supports their opinions. While at the same time discourage the use of diets and exercise that they have not attempted or that they have heard negative things about. An alarming pattern, given that faculty must actively combat the information and biases in perspective stemming from excessive reliance on unreliable sources (e.g., social media, Internet publication) that are overwhelmingly used to stay informed on diet and exercise. As it is readily acknowledged that it requires more effort to dispel misinformation, disinformation, and myths than it does to teach the correct concept [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e] or provide compelling rationales for options that are antithesis to popular or socially acceptable norms for behaviors [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]. Hampering this effort is the reliance on unreliable sources (i.e., social media or internet sources) that nearly 40% faculty members use to stay informed about diet and exercise coupled with limited exposure to primary and secondary source material (e.g., scientific journals, conference presentations) related to diet and exercise. Meaning that faculty may be at a disadvantage to counter misinformation and disinformation that students enter the classrooms have already learned [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e]. Faulty viewpoints that can influence and guide the development of opinions about the patients that they will treat in the future, and viewpoints that get reinforced through personal biases.\u003c/p\u003e \u003cp\u003eThe biases that are presented in the information selection falls along the lines of confirmation bias, even when respondents here indicate an openness to information. Biases that not only impact selection of information that only agrees with opinions already held, but also with the recommendations that are being offered to others and the subjective feelings that respondents have toward diet and exercise. A general trend that seems to agree with what has been previously reported on regarding subjective biases in recommendations to patients by healthcare professionals, or biases that have been noted in students across multiple disciplines within the health sciences [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIt is this latter point regarding subjective feelings that also directly impacts the likelihood that they have for others to seek them for their opinions or their willingness to offer advice regarding diet or exercise. Moreover, those that tended to voice negative words regarding diet (e.g., restrictive, punishing) or exercise (e.g., hard, tiring, punishment) or felt that exercise allowed them to eat whatever they wanted not only projected weight bias in their selection of appropriate body image for what is considered healthy but to also indicate a general agreement that they cannot influence someone else\u0026rsquo;s diet or exercise habits. A pattern of thought that is coupled with a feeling of being overwhelmed when trying to keep up with the information about diet and exercise trends.\u003c/p\u003e \u003cp\u003eMoreover, students who strive for the \u0026ldquo;perfect grade\u0026rdquo; that they believe is necessary to become a successful healthcare provider, may through repetition inherently engrave the biases of professors, mentors, and other faculty as being true, versus what can be deduced or inferred by the student actually thinks for themselves [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]. As educators may express all too often their opinions devoid of application of the scientific consensus (i.e., GMO-food is not safe to consume, organic food is healthier than non-organic, and the ability to have spot reduction of fat mass) that permeate many conversations and media postings about diet, exercise and health or expressing personal values about diets (e.g., something restrictive) or exercise (e.g., finding gyms and fitness centers intimidating). Opinions that might align with preconceived notions held by students, or challenge students to alter their ideals to align the perspectives offered by the faculty that whether implicit or overt serve as means to persuade and influence students and others to accept the faculty\u0026rsquo;s perspective as being correct. Encouraging future healthcare professionals to potentially spread biased opinions onto others.\u003c/p\u003e \u003cp\u003eYet, we know that openness to opposing ideas and ideals is significant in current and future healthcare [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e]. An important idea to remember as we have previously noted the importance of utilizing a collaborative holistic effort that includes the patient in the treatment choices and not the historical approach of coercion and deferral to the healthcare professional [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Unfortunately, we tend to see something antithesis to this ideal, a degree of close-mindedness with high rates of bias expressed in what would be recommended to individuals regarding diet or exercise as it pertains to health. Even if half of the group identified a multitude of exercise regimens and diets having been attempted, they are still more apt to recommend one that was attempted over those that were not.\u003c/p\u003e \u003cp\u003eAdditionally, the willingness to suggest something that worked for them when giving advice, which may or may not have been recommended by a healthcare provider, is further complicated as half of the respondents here stated only referencing resources that support their preferences when giving advice. Meaning that they not only will recommend what worked for them but will reinforce this opinion through cherry-picking of the information so as to not challenge that idea when giving advice. Issues given where information is being culled, i.e., social media, that is acknowledged as being less than valid and reliable. Sources of information (i.e., social media) where there is also a tension between cultivating a following and providing meaningful truthful information to listeners and viewers. Tension that all too often includes an inability to accept that their stipulations might not be supported by empirical evidence, compounded by the influence that social cues have on how information gets disseminated.\u003c/p\u003e \u003cp\u003eTensions that can be lessened should one review the context of information based on what is available in peer-reviewed scientific publications, yet respondents showed limited adherence to this idea while also being more likely than not to have difficulty in staying informed with current understanding being published in these reliable resources. Meaning that even though this group is a population that should use the scientific consensus to guide understanding, students and faculty alike are susceptible to popular beliefs for recommendations pertaining to diet, exercise, and health. Beliefs and tenets that are formed through the social influences that regulate much of our social interaction and behaviors that are meant to form a means of acceptance within our social cliques and not our scientific understandings. Social influences that are commonly determined by the similarities of likes, dislikes, and rationalizations offered; the expression of social values (i.e., traditional versus progressive influence); what gets culturally accepted amongst different ethnic subgroups that all persuade the biases across and within each group of our society; or what gets accepted based on generational and gender groups. Social influences that can impact the willingness to advise others regarding diet and exercise or how to discuss the pros and cons of diet and exercise when asked by others for their understanding and advice.\u003c/p\u003e \u003cp\u003eAnd then there is the issue of body image and weight biases. While we have come to an agreement that societally we must combat the historically-held view of a female body image that overtly stresses the need for being thin for both attractiveness as well as health [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e], a historically-held view that gets expressed here. Reliance on this point of view imparts unseen stresses on students to meet a socially acceptable body image for a healthcare professional, while at the same time causes distress as we have accepted the need to show a greater awareness of the social pressures presented about body images for females versus what is acknowledged as pressure presented onto males [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e]. Even with the extraordinary level of awareness of social pressures on females to meet a selected body image and some growing awareness of the pressures faced by males [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan additionalcitationids=\"CR66\" citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e], we still see a selection of a desirable body image in lieu of one that might actually be the healthy body image. A possible expression of weight bias and body image bias occurring, even within a population that expresses an awareness that a difference exists between the two labels (i.e., ideal and healthy).\u003c/p\u003e \u003cp\u003eYet, we also see an equal attention to concerns of weight issues that are actively expressed by males and females, meaning that studying to enter healthcare as a profession, or function as an educator in this career pathway might allow for changing perception about social pressures and concerns that males also experience possible weight biases. Even if such thinking is at odds with historical social opinions about the overall social pressures and discussions of body weight/body image that too often result in hypersensitivity around females and hyposensitivity around males. Where social influences might impact biases around body weight along with personal experiences of bullying or being subjected to demeaning comments about their personal body image, and the implicit sense of perfection of body image as portrayed in media or an overtly imposed idea of body image and fitness related to athletic endeavors [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan additionalcitationids=\"CR67 CR68 CR69\" citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThis connection between what the majority perceives to be \u0026ldquo;healthy\u0026rdquo; is interesting and may reflect some degree of body image and weight bias, influenced by several social factors (i.e., cultural norms, generational societal norms, social media, popular opinions, internalized self-body image), being expressed by our respondents [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan additionalcitationids=\"CR50\" citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan additionalcitationids=\"CR65\" citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e]. The impact that social norms have on cultural and generational differences on these accepted norms. As we must stipulate that social norms about \u003cem\u003eideal\u003c/em\u003e and \u003cem\u003ehealthy\u003c/em\u003e body images are not only inconsistent within any society but are also constantly changing from generation to generation. Variability and inconsistency in acceptable norms mean that what is acceptable and modeled is also going to change, something that is seen here between generations (i.e., millennials versus Generation-X) more than what we see between social classifications of genders or race.\u003c/p\u003e \u003cp\u003eTo alleviate much of the social and cultural pressures that are evident in body image issues and biases there has been a recent push toward being more accepting of variability of weight and body images [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e]. An idea commonly referred to as body positivity, coupled with a growing awareness that being healthy is not directly linked with one\u0026rsquo;s calculated body mass index (BMI) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e]. Important perspectives given how many have an internalized ideal that weight and body image is a reflection of not only self-worth but also from who one might seek advice from in order to achieve health and fitness via diet and exercise, or how we might offer advice to others that might see us as presenting that idealized image of being healthy or fit [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhat is interesting is that while there is awareness for cultural and societal pressures on the appropriate body image to project health, there is a disconnect between self-rating of body image and determination of projecting a body image that would elicit a desire from others to seek advice for improving health. With nearly 60% of respondents indicating that they had a healthy body image that did not match the standard for healthy body image (see Figs.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), with 25% of all respondents indicated having a body image that would lead others to ask advice from, even if they did not indicate having a \u003cem\u003ehealthy\u003c/em\u003e body image. Within this disconnect, there was a higher percentage fitting this mismatch within older respondents (i.e., older Generation-Y and Generation-X respondents) and might be an indication of expertise regarding health due to academic and professional background more than any insinuation about what their body image might represent. Yet, it is the differences between generations seen here that deserve more research to evaluate changing ideology across generations.\u003c/p\u003e \u003cp\u003eWe also noted that approximately two-thirds of all respondents indicated they become more conscious about diet and exercise in front of those who express concerns of being overweight. A valuable insight as we know that both patients and practitioners are apt to pass judgements on each other as being \u003cem\u003eunhealthy\u003c/em\u003e simply due to perceived weight issues without knowing personal beliefs, actions, and level of personal care [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e]. Moreover, given that we did not ask about directionality of concern (e.g., change of topic or word choice) it might serve as a reflection of body positivity to make them feel more comfortable with their provider and be more open to holistic care plans by minimizing personal biases [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e]. Biases that can be corrected prior to work as a healthcare professional by having an educational experience that minimizes the projection of biases by faculty.\u003c/p\u003e \u003cp\u003eUnfortunately, both health science students and faculty are not only more likely to compare themselves with their peers but will also compare themselves to what they see through media feeds. A comparison with the latter is known to have negative impacts on the internalized sense of one\u0026rsquo;s body image and heath, along with projection of ideals to others based on these internalized feelings [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e]. A negative internalization that has recently been on the rise leading to higher incidence of mental health issues (e.g., eating disorders or body dysmorphia) across the population associated with the transition to a digital world of interactions during and following the SARS-Covid 19 pandemic coupled with surges in use of digital and social media [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. Where even with awareness to the detrimental effects of these comparisons, health science students and their faculty indicate that they tend to listen to those that project an ideal of being \u003cem\u003efit\u003c/em\u003e and \u003cem\u003ehealthy\u003c/em\u003e for how to incorporate diet and exercise into their lifestyle. An opinion that aligned with what we see broadcasted across media platforms (i.e., traditional broadcast, Internet, social media) by self-anointed influencers who hold themselves as the standard of being \u003cem\u003efit\u003c/em\u003e and \u003cem\u003ehealthy\u003c/em\u003e, advertising their expertise and habits to the general public.\u003c/p\u003e \u003cp\u003eWhich can be dangerous as the projection of expertise from these influencers may not come with the appropriate academic or clinical understanding of the physiological complexity of health or how body composition is established, modified, or maintained over time [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Where acceptance for what is best can be exaggerated, coming from the praise and compliments regularly seen on social media posts from those that we ascribe expertise to, simply due to their body image which perpetuates the misguided notion that body image portrayed equates to a level of health or fitness [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. A connection that subsequently causes many to undertake and promote the habits espoused by these individuals in the hope of achieving and receiving similar attention that further adds to existing social pressures for achieving a body image that mirrors what becomes popularly accepted. A point of view that can negatively affect the authenticity of advice offered and reflects an internalized bias regarding weight issues that may be expressed by others [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e]. Countering this narrative, we do see nursing and medical students overtly indicate that they are more likely to see other healthcare providers as providing the greatest level of expertise for being healthy. An opinion which may reflect an implicit bias (whether warranted or not) that healthcare professionals, or those that are studying to be a healthcare professional, are \u003cem\u003ehealthy\u003c/em\u003e or \u003cem\u003efit\u003c/em\u003e, or attempt to undertake behaviors to improve overall fitness simply due to their profession [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Even if there is a general opinion that there is limited influence that respondents had on changing one\u0026rsquo;s behavior to improve body. A disconnect that might reflect implicit weight bias among respondents.\u003c/p\u003e \u003cp\u003eAlong these lines, we stipulate that it is important to acknowledge that those we socially deem to be \u003cem\u003eideal\u003c/em\u003e for displaying a body image of \u003cem\u003efit\u003c/em\u003e, or \u003cem\u003ehealth\u003c/em\u003e, may experience more stress than the average person to meet that \u003cem\u003eideal\u003c/em\u003e. A pattern of thought that can be transferred to healthcare professionals that are expected to project a body image of health, where they too must abide by social norms for this \u003cem\u003eideal\u003c/em\u003e or provide exquisite rationale for why they might differ from that ideal. Simply put, the weight and body image bias projected by healthcare professionals to their patients may stem from weight bias that has been projected upon the healthcare professional throughout their education and training. And while respondents here have indicated understanding that body mass index (BMI) does not indicate overall health for a person, the patients that we classify as \u0026ldquo;overweight\u0026rdquo; or \u0026ldquo;obese\u0026rdquo; based on BMI may not; and can internalize the labels and with thoughts of \u0026ldquo;What makes me appear \u003cem\u003eunhealthy\u003c/em\u003e?\u0026rdquo; or \u0026ldquo;Am I too \u003cem\u003eoverfat\u003c/em\u003e?\u0026rdquo; impacting psyche and mental well-being [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA situation where updated curriculum and course materials may be of benefit [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e]. While efforts have been made toward increased inclusion of underrepresented groups (i.e., LGBTQIA+, non-Europeans, gender) in health science textbooks and instruction, there is still a struggle for issues of weight. As such there seems to be limited updating to the consequences of using a metric like BMI, or other outdated ideals of fitness which unfortunately prompts incorrect attributions onto a person that may adversely impact treatment and subsequently their overall health, physical and mental [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs such, we would highly recommend updating curriculum and resources meant to educate health science students to focus on facts and scientific consensus regarding health and fitness, without biases from faculty that focuses on the complex interaction of modifiable and non-modifiable factors while addressing fallacy of familiar opinions that influence weight bias in the care for patients that tend to lead to poor resolutions [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan additionalcitationids=\"CR19 CR20 CR21 CR22\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e]. Without such changes, the validity and accuracy of the practices performed by health professionals become compromised from the biases for what can be deemed \u003cem\u003ehealthy\u003c/em\u003e versus \u003cem\u003eunhealthy\u003c/em\u003e based on how the patient\u0026rsquo;s weight aligns with a preconceived notion for what a \u003cem\u003ehealthy\u003c/em\u003e body looks like [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Biases seen here and throughout the general population are susceptible to group thought because of the undue influence that social media influencers seem to have on what is deemed as \u003cem\u003ehealthy\u003c/em\u003e by current social standards [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe projection of such attitudes within the education of healthcare professionals can lead to the modeling of biases [\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e], yet if future healthcare providers can be provided information in an unbiased manner, asked to critically evaluate information based on scientific veracity then bias of care can be minimized [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e]. Allowing for treatment without the incorporation of judgment around ideal weight and allow for the holistic approach to care that incorporates the ideals of self-motivation and self-monitoring over the authoritarian coercive care that is commonly used towards those that are seen as being \u003cem\u003eunhealthy\u003c/em\u003e simply because of body weight [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile we have found many interesting points from the responses obtained there are some limitations to this study that need to be indicated. The major limitation that needs to be noted is the limited population (N\u0026thinsp;=\u0026thinsp;344), that even though large enough to have statistical power may not be large enough to offer definitive conclusions. There is also a degree of population of convenience, based on the means of recruitment may not include an open invitation to anyone that might teach a health science course or be enrolled in a health science program.. The major limitation that needs to be noted is that the population we are reporting is limited (N\u0026thinsp;=\u0026thinsp;344), even if large it is enough to offer us the population necessary to have power in statistical analysis. There is also a degree of population of convenience being surveyed here, based on how we recruited there was no way to ensure an open invitation to any person that might teach health science students or were enrolled as a health science student at any college or university. There are many factors that impact healthy behaviors and while our survey looked at many of these components it eliminated other factors that might impact responses analyzed here. We also did not examine backgrounds of the respondents to understand what social stresses, or if cultural and generational emphasis influenced opinions expressed here. To address these limitations, it is the intention to repeat this survey with a larger population of respondents, integrate questions to examine social stresses and cues that might impact view of body image and preference towards \u003cem\u003ehealthy\u003c/em\u003e and \u003cem\u003eideal\u003c/em\u003e body image, and understanding of body composition as it relates to health. We would also encourage other researchers to begin examining the role that biases have in how we present body image, health, and lifestyles throughout the educational system. As the development or correction of bias may be pivotal in the holistic approach to treatment of lifestyle disease.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThere is evidence of weight bias presented by both health science students and faculty, with a bias appearing to parallel what is seen in the general population for preferring thinness as a reflection for being healthy. An opinion that is reflected even with greater scientific awareness of the faulty connection of body weight, or BMI, being an indication of health, indicating that personal and unscientific opinions being offered by faculty members may ultimately impact student awareness and application of evolving understanding. A conclusion that helps us to better understand how biases projected by educators impact how ideals about health and lifestyle that allows for healthiness is built by future healthcare professionals three ways. First, faculty see themselves as being a person that others look to for information on diet and exercise regardless of their self-described body image being deemed subjectively as being healthy. Second, everyone feels overwhelmed keeping informed given the glut of information pertaining to diet, exercise and healthy living bombarding anyone on a daily basis and are overly reliant on social media to stay informed. Third, a degree of blindness toward bias is noted leading to reliance on personal opinions and confirmation bias when making recommendations regarding diet or exercise that can be used to improve one\u0026rsquo;s health. From these points, we can surmise that bias development in future healthcare professionals arise from a combination of preconceived notions that are reinforced by modeling and educational tendencies to emphasize personal beliefs by faculty. Biases that without modification or corrections may have a negative impact on the holistic approach to care that has become a focus of patient care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo author has a conflict of interest in publication of this manuscript or conclusions being offered\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eResponsibilities:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the formatting and writing of the survey, distribution of the survey, and the writing or editing of this manuscript.\u003c/p\u003e\n\u003cp\u003eJEC was also responsible for coding and data analysis of responses provided from the survey.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is not agency or organization funding this study or publication of findings here.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAcknowledgement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors would like to thank all respondents for their time in completing the survey.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cbr\u003e \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBooth, F.W., et al., \u003cem\u003eWaging war on modern chronic diseases: primary prevention through exercise biology.\u003c/em\u003e J Appl Physiol, 2000. \u003cstrong\u003e88\u003c/strong\u003e(2): p. 774-87.\u003c/li\u003e\n\u003cli\u003eBooth, F.W. and M.J. 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Services, Editor. 2017, Kaiser Permanente Center for Health Research, Portland OR: Portland, OR.\u003c/li\u003e\n\u003cli\u003eBrown, S.J., S. White, and N. Power, \u003cem\u003eIntroductory anatomy and physiology in an undergraduate nursing curriculum.\u003c/em\u003e Adv Physiol Educ, 2017. \u003cstrong\u003e41\u003c/strong\u003e(1): p. 56-61DOI: 10.1152/advan.00112.2016.\u003c/li\u003e\n\u003cli\u003eCohen, R., T. Newton-John, and A. Slater, \u003cem\u003eThe case for body positivity on social media: Perspectives on current advances and future directions.\u003c/em\u003e Journal of Health Psychology, 2021. \u003cstrong\u003e26\u003c/strong\u003e(13): p. 2365-2373DOI: 10.1177/1359105320912450.\u003c/li\u003e\n\u003cli\u003eBindl, U.K., et al., \u003cem\u003eFuel of the self-starter: How mood relates to proactive goal regulation.\u003c/em\u003e Journal of Applied Psychology, 2012. \u003cstrong\u003e97\u003c/strong\u003e(1): p. 134-150DOI: 10.1037/a0024368.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"sport-sciences-for-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ssfh","sideBox":"Learn more about [Sport Sciences for Health](http://link.springer.com/journal/11332)","snPcode":"11332","submissionUrl":"https://submission.nature.com/new-submission/11332/3","title":"Sport Sciences for Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Health, Confirmation Bias, Weight Bias, Education, Students","lastPublishedDoi":"10.21203/rs.3.rs-5467293/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5467293/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eBias is a recognized to inhibit a holistic model of healthcare. Yet, little has been investigated into how bias in the educational process influences the development of bias in healthcare professionals.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e344 students and professors (152 M/172 F/ 20 other) completed an electronic survey regrading ideals of diet, exercise, health, body weight, and how one obtains information for developing or modeling healthy behaviors. Responses were analyzed based on group averages,\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eSocial media appears to be the most cited source for information on lifestyle interventions. Even with awareness of social pressures to be thin, \u0026ldquo;thinnest\u0026rdquo; body was deemed to be healthiest. A greater confirmation bias was expressed in older respondents regarding advice to overweight individuals, with younger respondents being more conscious of their approach.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eFor students, biases appear to develop through combination of preconceived ideals reinforced by educators. Recommendations appear to be based on personal beliefs and projection of biases by educators and students based on personal anecdotes or over-reliance on social media for modeling of appropriate healthy behaviors and attitudes.\u003c/p\u003e","manuscriptTitle":"Biases toward weight, diet, and exercise expressed by health science students and their professors","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-17 13:11:09","doi":"10.21203/rs.3.rs-5467293/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-09T02:14:53+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-09T02:08:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"302590938149444305615186201331705130545","date":"2025-02-18T01:22:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-02-15T18:55:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"327037740217271371298784778765948621050","date":"2025-02-05T15:35:02+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-02-05T05:22:22+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-11-18T02:18:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-11-18T02:17:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"Sport Sciences for Health","date":"2024-11-16T19:10:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"sport-sciences-for-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ssfh","sideBox":"Learn more about [Sport Sciences for Health](http://link.springer.com/journal/11332)","snPcode":"11332","submissionUrl":"https://submission.nature.com/new-submission/11332/3","title":"Sport Sciences for Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"fe7b2f3e-e7ff-4b22-a372-cfccb38dc53e","owner":[],"postedDate":"December 17th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-01T07:25:10+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-17 13:11:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5467293","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5467293","identity":"rs-5467293","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}