Mitigating Weight Bias in the Clinical Setting: A New Approach to Care

Psychosocial distress in people with overweight and obesity: the role of weight stigma and social support

We aimed to assess the role of weight stigma and social support in depression, anxiety, and loneliness controlling for sociodemographic and clinical variables. A total of 189 adults with overweight/obesity were included. Participants were recruited from outpatient clinics by general practitioners which covered all regions of Slovakia. Correlation analyses and multiple linear regression were used to analyze the data. Participants experienced weight-related teasing (40.4%), unfair treatment (18.0%), and discrimination (14.1%). We found an association between lower age, female sex and psychological distress. No role of obesity indicators in psychosocial distress was identified, except for a small association between body mass index and depression in correlation analyses. Significant associations between experienced weight stigma/self-stigmatization and psychosocial distress weakened when variables related to the social support system were added to the linear regression. Poor social support was strongly associated with depression, anxiety, and loneliness. The explained variance in the final regression models was 42, 44, and 54%, respectively. Weight stigma negatively affects mental health and a sense of belonging while it seems to be a more significant contributor to psychosocial distress compared to obesity per se. Interventions targeting weight-related self-stigmatization and social relationships may mitigate the negative impact of weight stigma on psychosocial well-being.

Fear of Childbirth Among Pregnant People Facing Anti-Fat Bias

Explicit and implicit anti-fat biases are widespread among healthcare providers, leading to significant negative consequences for pregnant people, including poorer health outcomes. Fear of childbirth (FOC) can affect the length of labor, increase the risk of cesarean delivery, and negatively influence a new parent's perception of infant bonding. This study investigated the impact of perceived anti-fat bias on FOC among pregnant people. Data were gathered from 329 pregnant people recruited from three large academic prenatal centers in the United States and via social media. Participants completed a survey that included validated instruments measuring perceptions of anti-fat bias and FOC. Participants perceiving anti-fat bias reported higher FOC. Black participants perceiving anti-fat bias reported higher FOC. These findings suggest that perceived anti-fat bias from providers is associated with FOC for pregnant people, particularly those who identify as Black. Interventions to educate providers on these important concepts could help improve pregnant people's experience within the healthcare system.

Weight-based disparities in perinatal care: quantitative findings of respect, autonomy, mistreatment, and body mass index in a national Canadian survey

BACKGROUND

Qualitative studies document episodes of weight-related disrespectful care, particularly for people with high body mass index (BMI ≥ 30) and reveal implicit and explicit biases in health care providers. No large quantitative studies document the pervasiveness of weight stigma or if experiences change with increasing BMI.

METHODS

The multi-stakeholder RESPCCT study team designed and distributed a cross-sectional survey on the experiences of perinatal services in all provinces and territories in Canada. From July 2020 to August 2021, participants who had a pregnancy within ten years responded to closed and open-ended questions. Chi square analysis assessed differences in mean scores derived from three patient-reported experience measures of autonomy (MADM), respect (MOR), and mistreatment (MIST). Controlling for socio-demographic factors, multivariate logistic regression analysis explored relationships between different BMI categories and respectful care.

RESULTS

Of 4,815 Canadians who participated, 3,280 with a BMI of ≥ 18.5 completed all the questions. Pre-pregnancy BMI was significantly associated with race/ethnicity, income sufficiency, and education but not with age. Individuals with higher BMIs were more likely to experience income insufficiency, have lower levels of education, and more frequently self-identified as Indigenous or White. Those with BMI ≥ 35 exhibited notably higher odds of reduced autonomy (MADM) scores, with an unadjusted odds ratio of 1.62 and an adjusted odds ratio of 1.45 compared to individuals with a normal weight. Individuals with BMIs of 25-25.9, 30-34.9, and ≥ 35 exhibited odds of falling into the lower tercile of respect (MOR) scores of 1.34, 1.51, and 2.04, respectively (p < .01). The odds of reporting higher rates of mistreatment (top 33% MIST scores) increased as BMI increased.

CONCLUSIONS

While socio-demographic factors like race and income play significant roles in influencing perinatal care experiences, BMI remains a critical determinant even after accounting for these variables. This study reveals pronounced disparities in the provision of respectful perinatal care to pregnant individuals with higher BMIs in Canada. Data suggest that those with higher BMIs face disrespect, discrimination, and mistreatment. Identification of implicit and explicit weight bias may give providers insight enabling them to provide more respectful care.

Weight Bias Among Certified Nurse-Midwives and Certified Midwives: Findings From a National Sample

INTRODUCTION

Weight bias toward individuals with higher body weights permeates health care settings in the United States and has been associated with poor weight-related communication and quality of care as well as adverse health outcomes. However, there has been limited quantitative investigation into weight bias among perinatal care providers. Certified nurse-midwives (CNMs)/certified midwives (CMs) attend approximately 11% of all births in the United States. The aims of this study were to measure the direction and extent of weight bias among CNMs/CMs and compare their levels of weight bias to the US public and other health professionals.

METHODS

Through direct postcard distribution, social media accounts, professional networks, and email listservs, American Midwifery Certification Board (AMCB)-certified midwives were solicited to complete an online survey of their implicit weight bias using the Implicit Association Test and their explicit weight bias using the Antifat Attitudes Questionnaire, Fat Phobia Scale, and Preference for Thin People measure.

RESULTS

A total of 2257 midwives participated in the survey, yielding a completion rate of 17.7%. Participants were mostly White and female, with a median age of 46 years and 11 years since AMCB certification. More than 70% of midwives have some level of implicit weight bias, although to a lesser extent compared with previously published findings among the US public (P < .01) and other health professionals (P < .01). In a subsample comparison of female midwives to female physicians, implicit weight bias levels were similar (P > .05). Midwives also express explicit weight bias, but at lower levels than the US public and other health professionals (P < .05).

DISCUSSION

This study provides the first quantitative research documenting weight bias among a national US sample of perinatal care providers. Findings can inform educational efforts to mitigate weight bias in the perinatal care setting and decrease harm.

Clinicians Address Gestational Weight Gain and Nutrition Using the International Federation of Gynecology and Obstetrics (FIGO) Nutrition Checklist

The negative effects of excessive gestational weight gain (GWG) and obesity during pregnancy are well documented in the literature. However, lack of time, education, comfort, and confidence among health care providers often make it difficult to provide proper nutrition and weight gain guidance for pregnant persons. In response, the International Federation of Gynecology and Obstetrics (FIGO) has developed a nutrition checklist that can standardize recommendations for GWG, facilitate discussions with pregnant persons, and aid providers with nutrition education. The checklist is an innovative tool that can help reduce complications associated with excessive GWG. This article discusses the benefits of FIGO Nutrition Checklist and its implementation at a midwifery clinic that primarily serves Native American women. By using this quick, simple, guided, time-efficient tool, clinics can be successful in facilitating important conversations and education about nutrition and GWG during pregnancy.