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. 2024 Nov 16;58(12):789-798.
doi: 10.1093/abm/kaae044.

Women's Relationships With Healthcare and Providers: The Role of Weight Stigma in Healthcare and Weight Bias Internalization

Karen E Wetzel  1 , Mary S Himmelstein  1
Affiliations

Women's Relationships With Healthcare and Providers: The Role of Weight Stigma in Healthcare and Weight Bias Internalization

Karen E Wetzel et al. Ann Behav Med. .

Abstract

Background: Weight stigma (devaluation due to body weight) in healthcare is common and influences one's engagement in healthcare, health behaviors, and relationship with providers. Positive patient-provider relationships (PPR) are important for one's healthcare engagement and long-term health.

Purpose: To date, no research has yet investigated whether weight bias internalization (self-stigma due to weight; WBI) moderates the effect of weight stigma on the PPR. We predict that weight stigma in healthcare is negatively associated with (i) trust in physicians, (ii) physician empathy, (iii) autonomy and competence when interacting with physicians, and (iv) perceived physician expertise. We also predict that those with high levels of WBI would have the strongest relationship between experiences of weight stigma and PPR outcomes.

Methods: We recruited women (N = 1,114) to complete a survey about weight stigma in healthcare, WBI and the previously cited PPR outcomes.

Results: Weight stigma in healthcare and WBI were associated with each of the PPR outcomes when controlling for age, BMI, education, income, race, and ethnicity. The only exception was that WBI was not associated with trust in physicians. The hypothesis that WBI would moderate the effect of weight stigma in healthcare on PPR outcomes was generally not supported.

Conclusions: Overall, this research highlights how weight stigma in healthcare as well as one's own internalization negatively impact PPRs, especially how autonomous and competent one feels with their provider which are essential for one to take an active role in their health and healthcare.

Keywords: Healthcare; Internalization; Patient–provider relationship; Weight stigma.

Plain language summary

Being treated differently because of your weight is common in healthcare. Being treated poorly because of one’s weight when interacting with physicians can influence whether they make appointments with their doctors, how they eat, and how they interact with doctors in the future. This is important because the relationship one has with their doctor impacts their health. We expected that negative experiences with doctors about weight would impact whether people trust doctors, think their doctor is empathetic, think their doctor is an expert, and think they can be themselves around their doctor. We also expected this to be impacted by how people feel about their own body weight. 1,114 women completed a questionnaire about all these topics. Negative experiences with doctors about weight and thinking poorly of their own weight were associated with each of the expected outcomes. The only exception is that the way one felt about their own body was not associated with trusting doctors. Also, the way people felt about their own weight did not impact the effect that negative experiences had on these outcomes. Overall, this study shows how important feelings and conversations about weight are when interacting with one’s doctor.

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