Background

Weight based stigma and discrimination is prevalent in numerous contexts, including healthcare. This stigma and discrimination may contribute to lower-quality interpersonal communication between individuals with higher BMIs and their health care providers, as well as feelings of disrespect and humiliation among patients. These experiences may lead to patients with obesity being less likely to have a primary care doctor they are comfortable with and more likely to avoid follow-up care and “doctor-shop.”

Methods

Survey data were collected among 2,799 individuals with obesity recruited from 5 sites of the Learning Health Systems Network (LHSNet), a PCORI-funded Clinical Data Research Network. Respondents were identified through medical records and completed data collection via an anonymous mailed survey. Individuals self-reported their height and weight to calculate BMI, poor communication or embarrassment while seeking healthcare, and utilization of healthcare services.

Results

In multivariate regression models adjusted for number of comorbidities, race, sex, and age, greater BMI was associated with greater perceived stigma (b=.03, p<.001), less respect while receiving healthcare (b=-.003, p<.001), less patient-centered communication in healthcare (b=-.01, p<.001), and having tried to find a new primary care provider (b=.03, p<.001) or delayed needed care in the past 12 months (b=.06, p<.001). In a series of path models, perceived stigma, less patient-centered communication, and less provider respect fully mediated the association between BMI and having tried to switch primary care providers.Perceived stigma, less patient-centered communication, and less provider respect each partially mediated the association between BMI and having delayed needed care.

Conclusions

Among patients with obesity, negative weight-based interactions with healthcare providers appear to severely interfere with individuals of higher BMIs utilizing needed healthcare and receiving consistent healthcare.