"Forget It. I'm Not Going to See Another Provider" the Intersection of Weight Stigma and Healthcare Access for Black Women

Background:
Black women face compounded discrimination in healthcare settings due to the intersections of race, gender, and body size. Despite experiencing higher “obesity” rates, Black women remain underrepresented in weight stigma research. Weight bias in healthcare contributes to inadequate care, misdiagnosis, and avoidance of services, particularly for Black women. Stereotypes rooted in racism and fatphobia undermine trust and patient-provider communication. This study explores how weight stigma affects healthcare access among Black women, highlighting the role of intersectionality in shaping these experiences and outcomes.

Methods:
This study employed a qualitative design rooted in grounded theory to explore the lived experiences of Black women encountering weight stigma in healthcare settings. Participants were recruited using purposive and snowball sampling techniques. In-depth interviews were conducted with 21 Black women over the age of 35, all of whom self-identified as medically “obese” and low-income. Interviews were held via Zoom and phone, audio-recorded, and transcribed verbatim. Transcripts were double-coded using NVivo14, and data were examined through inductive thematic analysis to uncover recurring themes and patterns.

Results: Five themes emerged from the analysis: 1) avoidance and delay of care, 2) misdiagnosis and weight-centered care, 3) discrimination, bias and denial of care 4) psychological impact and 5) preferences for inclusive care. Participants reported that weight stigma significantly influenced their health-seeking behavior. Participants reported avoiding care, often due to cost, shame, or fear of judgment. Many described skipping appointments, postponing care, or preferring self-treatment over interactions with providers who dismissed their concerns. Several women highlighted that being misdiagnosed or having symptoms reduced to weight alone delayed necessary treatment. Stigma was also institutional: inadequate clinical equipment and restrictive eligibility criteria for services contributed to feelings of exclusion. Participants shared experiences of bias and disrespect, especially during pregnancy or when seeking emergency care. Preferred care included culturally responsive providers, inclusive facilities, and access to services regardless of weight or insurance status.

Conclusion: Weight stigma undermines equitable healthcare access for Black women, amplifying existing racial and socioeconomic disparities. Recommendations from participants emphasized the need for inclusive care practices, culturally competent providers, accessible equipment, and expanded insurance coverage. Structural changes such as anti-racism and weight sensitivity training, hiring more Black providers, and community-based outreach were viewed as vital to improving trust and access. This study calls for intersectional, policy-driven responses that challenge weight-centered models of care and affirm the dignity and health needs of Black women.