Stigmatizing weight experiences in health care: Associations with BMI and eating behaviours.

Jocelyn E Remmert,Meghan L Butryn,Alexandra D Convertino,Savannah R Roberts,Kathryn M Godfrey

doi:10.1002/osp4.379

Abstract

SummaryIntroductionIndividuals with overweight or obesity often experience stigmatizing weight‐related interactions in health care, though how these experiences are associated with body mass index (BMI) and eating behaviour is unknown. This study had three aims: (a) characterize types and frequency of stigmatizing health care experiences, (b) assess relationships among BMI, eating behaviour, and stigmatizing experiences, and (c) examine whether internalized weight stigma mediates the relationship between stigmatizing experiences, weight, and eating behaviour.MethodsAdults (N = 85) enrolled in behavioural weight loss completed measures of stigmatizing health care experiences, weight bias internalization, eating behaviours, and BMI. Cross‐sectional correlational and mediational analyses were conducted.ResultsThe majority (70.6%) of participants reported at least one stigmatizing health care experience in the past year. Greater amounts of stigmatizing experiences were associated with higher BMI (r = 0.32, P < .01) and greater uncontrolled (r = 0.22, P = .04) and emotional eating (r = 0.28, P < .01). Internalized weight stigma significantly mediated the relationship between stigmatizing experiences and maladaptive eating.ConclusionExperiences of health care weight stigma were associated with eating behaviour and BMI. Participants with a higher BMI or greater maladaptive eating behaviours may be more susceptible to stigmatizing experiences. Reducing internalized weight stigma and health care provider stigma may improve patient health outcomes.

Highlights

Given the high prevalence and negative health consequences of obesity, professional guidelines recommend that medical providers discuss weight, give advice to lose weight, and offer behavioural interventions to support behaviour change.[1]
When interacting with health care providers, this can take the form of explicit, derogatory comments,[8] insensitive language,[9] or more subtle interactions that a patient may perceive as stigmatizing, such as a provider attributing medical problems to a patient's weight when the patient does not perceive there to be a link between weight and the medical problem.[10]
This study examined the relationship between stigmatizing experiences in health care and weight and eating behaviour

Summary

Introduction

Given the high prevalence and negative health consequences of obesity, professional guidelines recommend that medical providers (eg, physicians and nurses) discuss weight, give advice to lose weight, and offer behavioural interventions to support behaviour change.[1]. Patients report receiving overly simplistic recommendations for weight loss from providers, which they perceive to be insensitive and humiliating (eg, “eat less, move more” as the only recommendation).[10,11] Negative weight‐related experiences in health care (ie, all providers, staff, equipment, and facilities) are common and have measurable health consequences for individuals with overweight or obesity, including reduced perception of provider empathy,[12] reduced success in weight loss programmes,[13] and missing or delaying medical appointments.[2,14]

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