"It Wouldn't be like a Default Diagnosis": Black Women's Reflections on Integrating Weight-Neutral Approaches into Healthcare

Background: Efforts to improve health outcomes among Black women have typically encouraged weight control as a central component. However, as recent studies have highlighted the relative ineffectiveness of intentional weight loss in improving health outcomes long-term, there is a need to consider alternative, non-weight-loss-oriented approaches. Interventions developed from a weight-neutral perspective (i.e., an approach to health that de-emphasizes weight as a focal point of intervention and instead encourages health promoting behaviors for individuals across the weight spectrum) have been associated with positive physical and mental health outcomes. However, given the lack of representation in supporting literature, findings can not be assumed to generalize to Black women. This significant knowledge gap provides social worker researchers with an opportunity to provide leadership in exploring weight-neutral approaches as a potential foundation from which to base large-and small-scale health promotion and chronic disease prevention efforts for Black women, starting with a foundational understanding of the acceptability of such approaches to members of this population. To this end, the present study sought to explore Black women’s perspectives on integrating weight-neutral approaches in relation to healthcare, including perceptions of strengths and limitations of weight-neutral perspectives on body size, diet, and exercise.

Methods: Participants for this study included 17 Black women, aged 27-77 (median age, 42) residing in the greater Baltimore region. Data were collected using semi-structured interviews, supplemented with collaborative mind mapping activities. Interviews explored participants beliefs about health, healthcare experiences, thoughts on Black women’s health, and perceptions of weight-neutral approaches to body size, diet, and exercise. Data were inductively analyzed using methods consistent with constant comparative analysis.

Findings: Participants' insights were organized into three key themes. “The care for us is not the level of care we should be getting,” reflects participants’ experiences of being dismissed or mistreated in healthcare settings. Participants attributed their experiences of mistreatment to the varied intersections of racism, sexism, classism, and weight stigma. “It wouldn't be kind of like a default diagnosis,” captures insights suggesting that weight-neutral approaches to health could promote patient autonomy and ensure thorough, patient-centered care. “We can’t act like we don’t need a metric,” highlights concern about weight-neutral care approaches. Specifically, participants were unsure if weight-neutral approaches could provide the needed guidance to guide healthful decision making.

Conclusion/Implications: Findings from this study enhance our understanding of the acceptability of weight-neutral perspectives among Black women and provide preliminary support for integrating such perspectives into healthcare. Independent of particular interventions, social workers across varied domains of practice can lead by example and take proactive steps to integrate desired components of weight-neutral perspectives into practice. For instance, social workers can support specific advocacy efforts, such as movements to end the use of BMI in and beyond healthcare settings. Social work researchers can continue to develop the knowledge base on Black women and weight-neutral approaches to care, and social workers supporting those managing chronic health conditions can refer patients to weight-neutral resources and providers.