Practicing weight-inclusive healthcare in a weight-centric field: an examination of the barriers faced by weight-inclusive healthcare practitioners in the U.S.

Abstract

ABSTRACT The provision of stigmatizing, weight-centric healthcare negatively affects health in many ways, including the stress generated during discriminatory and microaggressive provider-patient interactions, the barriers to healthcare access it creates, and the way it encourages healthcare avoidance, facilitating the reproduction of widespread health disparities. As the harms of weight-centric healthcare have been increasingly exposed across both scholarly publications and lay media in recent years, a greater number of healthcare practitioners have begun adopting a weight-inclusive practice paradigm in their work with patients and clients. Yet, given the constraining nature of social structures, healthcare practitioners committed to providing weight-inclusive care likely face barriers they must contend with as they transition toward and carry out weight-inclusive care in their work. Currently, little is known about the experiences of weight-inclusive healthcare practitioners, the barriers they face in adopting or enacting a weight-inclusive care, and the ways they navigate those barriers. The present study explores these questions via a thematic analysis of 53 semi-structured, in-depth interviews with self-identified weight-inclusive healthcare practitioners (36 dietitians/nutritionists, 13 mental health therapists, 2 physical therapists, 1 fitness coach, and 1 physician’s assistant) recruited through the Association for Size Diversity and Health’s Health at Every Size professional listing and snowball sampling. The results of this study indicate several barriers to adopting and enacting weight-inclusive healthcare in the U.S., including weight-centric healthcare training, weight-centric workplaces, and weight-centric insurance systems, which require time, money, and energy to navigate. Suggestions for how these barriers can be mitigated are discussed.