Unpacking the Impact of Weight Bias on the Provision of Healthcare for Individuals with Obesity in the UK

Abstract

Background: Weight stigma, defined as discriminatory attitudes and behaviours directed towards individuals due to their weight or size, represents a pervasive societal phenomenon with profound implications for public health. Despite efforts to promote size acceptance, anti-fat biases persist across institutional and interpersonal settings, contributing to adverse psychological and physical health ramifications for affected individuals. Objective: This study aimed to synthesise findings from a qualitative secondary analysis of the literature to construct an overarching conceptual model elucidating the cyclical, self-perpetuating nature through which weight stigma operates to exacerbate weight gain and obesity. Methods: A thorough review and synthesis of peer-reviewed studies examining weight stigma's manifestations, theoretical mechanisms of impact, psychological and physiological consequences, and intervention considerations was conducted. Findings were theoretically framed using the Weight-Based Social Identity Threat Model. Results: The analysis identified vital themes illustrating how weight stigma becomes internalised by targets, contributing to physiological stress responses and motivating unhealthy coping behaviours paradoxically linked to further weight gain. This self-perpetuating cycle is driven by weight stigma inducing psychological identity threat, triggering maladaptive coping efforts that enable additional weight gain and reinforce subsequent stigma exposure. Healthcare professionals emerged as perpetrators of weight bias, potentially compromising care quality. Intervention opportunities included provider training, promoting supportive environments, and policy-level initiatives challenging discriminatory practices. Conclusions: Findings underscore weight stigma as a self-reinforcing public health issue warranting prioritisation of comprehensive, multi-level interventions. Disrupting this vicious cycle through interventions targeting individual, institutional, and societal levels is imperative for improving health outcomes, reducing disparities, and promoting more significant equity for individuals across the weight spectrum. Implementing coordinated efforts to mitigate weight stigma's perpetuation demands a reframing of obesity discourse and healthcare practices.