Patient Perceptions of Weight Stigma Experiences in Healthcare: A Qualitative Analysis

IF 3 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES Health Expectations Pub Date : 2024-09-02 DOI:10.1111/hex.70013

Kathleen M. Robinson, Kimberley A. Robinson, Aaron M. Scherer, Melissa Lehan Mackin

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Abstract

Background

Weight stigma is the social devaluation and denigration of individuals because of their excess body weight, resulting in poorer physical and mental health and healthcare avoidance. Attribution Theory and Goffman's theory of spoiled identity provided a general overarching framework for understanding weight stigma experiences.

Objective

Our purpose was to explore weight stigma experiences from a broad range of perspectives emphasizing identities typically excluded in the weight stigma literature.

Design

We conducted a qualitative descriptive study with data drawn from 73 substantive narrative comments from participants who responded to a larger survey.

Results

Analysis developed five themes: Working on weight, Not being overweight, Lack of help and empathy, Exposure and embarrassment and Positive experiences. Individuals who would be clinically assessed as overweight, especially men, often did not identify with having a weight problem and found the framing of personal responsibility for weight empowering. Participants with larger body sizes more often attributed embarrassment and shame about weight to treatment in the clinical setting. Older participants were more likely to have positive experiences.

Conclusions

The findings suggest ongoing tension between the framing of weight as a personal responsibility as opposed to a multifactorial condition with many uncontrollable aspects. Gender, age and body size shaped respondent perspectives, with some young male respondents finding empowerment through perceived personal control of weight. The healthcare system perpetuates weight stigma through lack of adequate equipment and excessively weight-centric medical counselling. Recommending a healthy lifestyle to patients without support or personalized medical assessment may perpetuate weight stigma and associated detrimental health outcomes.

Patient or Public Contribution

Patients with obesity and overweight were integral to this study, providing comments for our qualitative analyses.

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病人对医疗保健中体重污名化经历的看法：定性分析。

背景：体重烙印是指因体重超标而受到社会贬低和诋毁，从而导致身心健康状况不佳和逃避医疗保健。归因理论和戈夫曼的溺爱认同理论为理解体重鄙视经历提供了一个总体框架：我们的目的是从广泛的角度探讨体重烙印经历，强调体重烙印文献中通常排除的身份：我们进行了一项定性描述性研究，数据来自 73 份实质性叙述性评论，这些评论来自对一项大型调查做出回应的参与者：分析得出了五个主题：努力减轻体重、没有超重、缺乏帮助和同情、暴露和尴尬以及积极的经历。在临床上被评估为超重的人，尤其是男性，往往不认为自己有体重问题，并认为对体重承担个人责任的框架能增强他们的能力。体型较大的参与者更常将体重带来的尴尬和羞耻归因于临床环境中的治疗。年龄较大的参与者更有可能获得积极的体验：研究结果表明，将体重归咎于个人责任与将其归咎于具有许多不可控因素的多因素状况之间一直存在着矛盾。性别、年龄和体型决定了受访者的观点，一些年轻男性受访者认为个人控制体重可以增强能力。医疗保健系统由于缺乏足够的设备和过度以体重为中心的医疗咨询，导致体重污名化现象长期存在。在没有支持或个性化医疗评估的情况下，向患者推荐健康的生活方式可能会使体重污名化和相关的有害健康结果永久化：肥胖和超重患者是本研究不可或缺的一部分，他们为我们的定性分析提供了意见。

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来源期刊

Health Expectations 医学-公共卫生、环境卫生与职业卫生

CiteScore

5.20

自引率

9.40%

发文量

251

审稿时长

>12 weeks

期刊介绍： Health Expectations promotes critical thinking and informed debate about all aspects of patient and public involvement and engagement (PPIE) in health and social care, health policy and health services research including: • Person-centred care and quality improvement • Patients'' participation in decisions about disease prevention and management • Public perceptions of health services • Citizen involvement in health care policy making and priority-setting • Methods for monitoring and evaluating participation • Empowerment and consumerism • Patients'' role in safety and quality • Patient and public role in health services research • Co-production (researchers working with patients and the public) of research, health care and policy Health Expectations is a quarterly, peer-reviewed journal publishing original research, review articles and critical commentaries. It includes papers which clarify concepts, develop theories, and critically analyse and evaluate specific policies and practices. The Journal provides an inter-disciplinary and international forum in which researchers (including PPIE researchers) from a range of backgrounds and expertise can present their work to other researchers, policy-makers, health care professionals, managers, patients and consumer advocates.