Weight Stigma As a Barrier to Healthcare Access Among Transgender and Gender Diverse Adults

Background: Transgender and gender diverse (trans) people encounter barriers to medical care due to gender-identity related discrimination, which likely contributes to the health inequities they face. In the general population, weight stigma is a barrier to healthcare access and utilization. However, the role that weight stigma plays in trans peoples’ experiences seeking medical care and how this varies within the trans population is not yet known. This study addresses this gap in scholarship by describing the prevalence of experiencing difficulties accessing medical care and being treated poorly when seeking medical care due to weight stigma in a statewide sample of trans people. Additional analyses explored whether weight stigma experiences differed by identity (race/ethnicity, disability, sexuality, insurance type, gender) within this sample.

Methods: Cross-sectional online surveys were administered to trans people aged 16 and older in Colorado. Participants were recruited via flyers, social media, and emails distributed by LGBTQ+ organizations. The sample (N=388) was primarily nonbinary (46%), plurisexual (e.g., bisexual, queer; 60%), and white (60%). Mean age of the sample was 29.8 (SD=8.0). Bivariate analyses (chi-square, fisher’s exact tests) and logistic regression models identified differences in perceived weight stigma as a barrier to medical care (both general healthcare and trans-specific care) across gender, race/ethnicity, sexuality, disability status, sex, and type of health insurance.

Results: Fifty-seven percent of the sample reported difficulties accessing general medical care and trans-specific care (59%) due to weight stigma. Nearly two-thirds of the sample reported being treated poorly seeking general medical care (61%) and 54% reported being treated poorly when seeking trans-related care due to weight stigma. Chi-square and fisher’s exact tests illustrated significant differences in experiencing weight stigma in medical care by race/ethnicity, gender, sex (i.e., endosex and intersex), disability, and health insurance. No significant differences were found across sexualities. Logistic regressions indicated that when compared to white respondents, Black respondents had greater odds of being treated poorly while seeking general medical care (p<.001, OR=6.92, 95% CI [2.47, 19.43]) and trans-related care (p<.01, OR=3.71 [1.61, 8.54]) as well as greater odds of encountering difficulties accessing general medical care (p<.001, OR=10.15, [3.35, 30.73]) and trans-related care (p<.01, OR=5.61, [2.10, 14.98]. When compared to nonbinary respondents, transfemme participants experienced greater odds of being treated poorly when seeking general care (p<.05, OR=2.56, [1.12, 5.87]) and trans-related care (p<.05, OR=2.70, [1.19, 6.12]).

Implications: These findings suggest that weight stigma in medical care contributes to the barriers that trans people face seeking medical care, and that it likely has a greater impact on specific groups within the trans population (i.e., Black, Native American, transfemme, intersex). Social work research and policy advocacy must take an intersectional approach to reducing the barriers trans populations face accessing medical care, recognizing the need to fiercely advocate for those who experience the greatest barriers to getting their health needs met in the healthcare system.