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

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.

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.

Weight stigma is uniquely tied to maladaptive eating across different racial, ethnic, and gender groups.

Weight stigma, racism, and sexism (social devaluation due to body weight, race or ethnicity, and sex or gender), have been linked to increased maladaptive eating behaviors; however, no research has investigated the unique associations between different forms of stigma and eating concurrently. We analyzed within-group (by race/ethnicity and sex) effects of different forms of stigma on maladaptive eating behaviors to test whether there is some unique relationship between weight stigma and maladaptive eating across identities. Additionally, we explored differences by racial/ethnic group and sex, as well as BMI category, in levels of reported weight stigma, racism, sexism, and maladaptive eating. Participants (N = 1051) were recruited so that there were approximately even numbers of participants identifying as Black (33.3%), Hispanic or Latino (32.8%), and White (33.9%). Overall, participants reported similar amounts of weight stigma by race/ethnicity and sex, but different levels of racism and sexism. Weight stigma, but not racism or sexism consistently predicted binge eating and eating to cope across groups, controlling for education, income, BMI, and age. Restricted dieting, however, was only predicted by weight stigma for Hispanic/Latino and Black men. These findings suggest that weight stigma is a unique predictor of maladaptive eating, even when considering the effects of racism and sexism. This study provides evidence of a more focused model of weight stigma and eating outcomes, rather than a more general model of the effect of stigma on eating outcomes due to overall stress. Future research should investigate when and why weight stigma drives restricted dieting, since this relationship seems strongest in men, going against many common inclinations about weight stigma.

Constant vigilance: The impact of weight stigma, vigilance, and internalization on maladaptive eating behaviors.

OBJECTIVE: Weight stigma (social devaluation because of weight) and weight bias internalization (self-stigma due to weight) have been independently implicated in maladaptive eating, which ultimately contributes to poor cardiometabolic health. Additionally, vigilance (being on the lookout for social devaluation) is connected to stress, poor sleep, and depression. Most research considers these factors separately but establishing how these variables interact with one another is essential to understanding their cumulative impact on health behaviors. METHOD: Using a diverse national panel of adults in the United States (N = 1,051), this study tested several statistical moderated mediations in which weight stigma was both directly associated with maladaptive eating and indirectly associated with maladaptive eating via vigilance. We simultaneously examined whether the relationship between weight stigma and vigilance was moderated by self-stigma. RESULTS: Results indicated that experiencing weight stigma was directly related to each of the maladaptive eating behaviors (eating to cope, restrictive dieting frequency, and binge eating). Weight stigma was also indirectly related to each eating behavior through vigilance; this indirect relationship was stronger among those with high levels of weight bias internalization, compared to those with low levels of weight bias internalization. Race moderated the relationship between weight stigma and vigilance, such that participants identifying as Black had a stronger relationship between them. CONCLUSIONS: These results provide support for a theoretical model which explains how weight stigma, self-stigma, and vigilance interact with one another to produce negative health behaviors and highlight the importance of further investigation of vigilance in the context of weight stigma. (PsycInfo Database Record (c) 2023 APA, all rights reserved).