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Background: Healthcare in the U.S. is laden with weight stigma, resulting in healthcare avoidance, underutilization, and increased anxiety when accessing services. This study seeks to identify potential solutions to weight stigma experienced in healthcare.
Methods: This parallel mixed methods, cross sectional survey study was conducted via online survey. Data were collected online between January 15, 2021 and February 1, 2021. Participants responded to the Body Appreciation Scale-2 (Tylka & Wood-Barcalow, 2015), the Weight Self-Stigma Questionnaire (WSSQ; Lillis et al, 2010), the Financial Strain Index (FSI) to measure socioeconomic status (SES), and a list of five possible solutions healthcare providers could implement to “make them feel more comfortable” seeking healthcare We ran a series of tests for statistical assumptions, descriptive statistics, and multivariate logistic regression analyses. Participants were asked one open-ended question: “What other ideas do you have for solutions healthcare providers could implement that would make you feel more comfortable receiving healthcare services?” Responses were analyzed in Excel using content analysis and thematic coding.
Results: The sample included 384 cisgender women. Most of the sample was White (n = 260, 67.7%) with 27.1% Black (n = 104). The mean age of the sample was 33.18 (SD = 7.43). Seventy-four percent of participants (n = 283) reported feeling uncomfortable receiving healthcare services and 5.5% (n = 21) said none of the options listed would help. Participants most-highly endorsed providers posting “a sign above the scale making it clear that weight does not equal or determine health” (48.2%; n = 185). 34.9% (n = 134) indicated that they would feel more comfortable receiving healthcare if weighing was optional, 35.4% (n = 136) if healthcare providers did not use the BMI, 27.6% if healthcare providers used kilograms instead of pounds on the scale, and 31% (n = 119) if healthcare providers had furniture that comfortably fit their body size. The WSSQ fear of enacted stigma subscale was positively related (p < .05) to all five proposed solutions, and body appreciation was negatively related (p < .05) to the “discontinuation of BMI use” proposed solution.
Several themes were identified in the answers to the open-ended questions. 74.5% referenced mental health and emotions, 70.8% referred to provider presence and communication, while 53.8% mentioned structural issues. 50.0% discussed the provider’s view of the patient, while 40.6% referred to interactions during the appointment and 31.1% talked about a view of health.
Conclusions & Implications. Implicit and explicit weight-related stigma play a negative role in medical care and create barriers to access. Changes in the healthcare environment and in provider bias can mitigate some of these barriers and improve patient outcomes. Decreasing a focus on body size by making weighing optional or posting a sign above the scale that weight does not determine health will increase comfort for those who have a higher fear of enacted stigma, while those with high weight stigma self-devaluation found no positive relationship with any of the possible solutions suggested in this study.