A model of weight‐based stigma in health care and utilization outcomes: Evidence from the learning health systems network
Open accessAbstract
Objective: Obesity is stigmatized and people with obesity report experiencing stigmatizing situations when seeking health care. The implications of these experiences are not well understood. This study tests an indirect effects model of negative care experiences as an intermediate variable between obesity and care avoidance/utilization and switching primary care doctors. Methods: A survey was completed by 2380 primary care patients in the Learning Health Systems Network (LHSNet) Clinical Data Research Network with a BMI >25 kg/m 2. Measures included scales assessing stigmatizing situations, perceived patient‐centered communication, perceived respect, having delayed needed care, and having looked for a new primary doctor in the past 12 months. Sequential and serial indirect effects of care experiences and respect in the association between BMI and care utilization outcomes was modeled. Results: The hypothesized model was supported by findings. The associations between BMI and delaying needed care (OR = 1.06, p < 0.001) and attempting to switch primary doctors (OR = 1.02, p = 0.04) was mediated by both stigmatizing situations experienced in a health care context and lower patient‐centered communication. Lower perceived respect mediated the association between care experiences and utilization outcomes. Conclusions: People with higher BMIs may avoid care or switch doctors as a result of stigmatizing experiences and poor communication with doctors. These outcomes may contribute to morbidity in people with obesity if they delay or avoid care for health concerns when symptoms first present.
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Weight stigma and body shame also obstruct use of health care, especially for people with higher body weight, prediabetes, or type 2 diabetes.
“Weight stigma and body shame are also barriers to health care utilization (Mensinger et al., 2018; Phelan et al., 2022; Prunty et al., 2023), particularly among those with higher body weight (Curran et al., 2024), prediabetes (Salvia et al., 2023), and T2D (Himmelstein & Puhl, 2021; Svenningsson et al., 2011).”
From A Randomized Controlled Trial of an Acceptance and Commitment Therapy-Informed Diabetes Prevention Program Reduces Body Shame and Distress. (2025) · cites this paper as Phelan et al., 2022
The Discussion reports that, among patients with BMI above 24.9, stigmatizing health care experiences were associated with delaying needed care and seeking a new doctor. It mentions embarrassment about not losing weight as a possible explanation, but does not establish body shame as a separate barrier. The prediabetes and type 2 diabetes qualifications are attached to other citations in the citing sentence, not to Phelan et al. (LLM, conf=0.82)
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Intersectionality in Weight Stigma Research: A Systematic Review of Empirical Evidence
Inusah, A. S., Shang, M., Li, X., & Qiao, S. (2026) · Current Obesity Reports · doi:10.1007/s13679-026-00715-6 · Cited by 6 · see citing works
Lipsett, M., & Berkman, E. (2025) · Health Psychology · doi:10.1037/hea0001434 · Cited by 3 · see citing works
“Weight stigma and body shame are also barriers to health care utilization (Mensinger et al., 2018; Phelan et al., 2022; Prunty et al., 2023), particularly among those with higher body weight (Curran et al., 2024), prediabetes (Salvia et al., 2023), and T2D (Himmelstein & Puhl, 2021; Svenningsson et…”
Nutter, S., Waugh, R., McEachran, E., Toor, A., Shelley, J., Alberga, A. S., Forhan, M. A., Kirk, S., Nagpal, T. S., Patton, I. T., et al. (2025) · International Journal for Equity in Health · doi:10.1186/s12939-025-02606-z · Cited by 3 · see citing works
“Within healthcare settings, weight stigma negatively impacts clinical decision making [17], and higher-weight patients report decreased patient-centered communication and stigmatizing experiences, both of which are associated with healthcare avoidance and doctor shopping [18, 19].”
Dennison, T., Nutter, S., & Chauhan, N. (2025) · BMC Pediatrics · doi:10.1186/s12887-025-05995-w · Cited by 3 · see citing works
“These attitudes can negatively impact healthcare encounters via negative judgment of patients, poorer patient-centered communication, less time spent with patients, and fewer offered treat-ment options [2–4], which can increase patient avoidance of healthcare and doctor shopping [5].”
Tolvanen, L., Mossberg, K., Standen, E. C., Grace, L. M., Lebow, J. R., Phelan, S. M., Andersson, D. P., & Koball, A. M. (2025) · Obesity Science & Practice · doi:10.1002/osp4.70087 · Cited by 2 · see citing works
“More generally, the literature indicates that experiencing weight stigma in primary care is associated with reduced trust in one's provider, attempting to transfer to a new PCP, and delaying needed care [46, 48], which underscores the importance of providing stigma‐ free care.”
Self-citationKane, R. M., Williams, S. B., Reynolds, K. L., Kincanon, A., Hager, M. R., McDougall, C., Purnell, J. Q., & Carney, P. A. (2025) · PLoS ONE · doi:10.1371/journal.pone.0314269 · Cited by 3 · see citing works
Jones, S. C., Nutter, S., & Saunders, J. F. (2024) · BMC Family Practice · doi:10.1186/s12875-024-02580-5 · Cited by 3 · see citing works
“One potential barrier to patient centered care for individuals with Cushing’s is weight stigma (i.e., stereotypes and negative attitudes about people with higher weights), which is prevalent in healthcare, [13, 14] and is associated with consequences for healthcare utilization [15, 16].”
BackgroundSalas, X. R., & Esquivias, H. P. (2024) · Salud Mental · doi:10.17711/sm.0185-3325.2024.019 · Cited by 3 · see citing works
“Individuals living with obesity who have experienced weight bias and stigma from healthcare professionals may delay or avoid healthcare services for fear of being blamed and shamed for their weight (Alberga et al., 2019; Phelan et al., 2022).”
Weight stigma in Latin America and the Caribbean: regional evidence and a call to action by ABESO
Viola, L. F., Valério, C. M., Salas, X. R., Saiful, S., Trujilho, T. D. G., Lamounier, R. N., Hohl, A., Halpern, B., & Trujilho, F. R. (2026) · The Lancet Regional Health - Americas · doi:10.1016/j.lana.2026.101409 · Cited by 1 · see citing works
“35 WS experiences also commonly occur in public environments, such as fitness centers, furthering social exclusion.”
Weight discrimination and up-to-date breast and cervical cancer screening in US women.
Gerend, M. A., Wilkinson, L. J., Pendleton, C., Sutin, A. R., & Shepherd, J. E. (2025) · Preventive Medicine · doi:10.1016/j.ypmed.2025.108470 · Cited by 2 · see citing works
Robinson, K. M., Scherer, A. M., Zorn, A. N., Mengeling, M. A., & Laroche, H. H. (2025) · Obesity Science & Practice · doi:10.1002/osp4.70095 · Cited by 3 · see citing works
Ruck, J., Krauthausen, M., Tiedemann, E., Koch, M. J., & Simmenroth, A. (2025) · Frontiers in Education · doi:10.3389/feduc.2025.1565119 · Cited by 2 · see citing works
Wilson, O. W. A., Nutter, S., Russell‐Mayhew, S., Ellard, J. H. T., Alberga, A. S., & MacInnis, C. C. (2023) · Journal of Communications In Healthcare · doi:10.1080/17538068.2023.2297122 · Cited by 3 · see citing works
“Patient experiences of patronizing and/ or disrespectful treatment by healthcare professionals due to weight results in low trust in providers, lower perceived respect, doctor shopping, and delaying or avoiding future healthcare [11,12].”
Shaw, S. C. K., Hennessy, L., & Meadows, A. (2026) · PLoS ONE · doi:10.1371/journal.pone.0340598 · Cited by 2 · see citing works
“Unsurprisingly, higher-weight people report stigma among healthcare professionals as a barrier to healthcare [24–26], resulting in future healthcare avoidance [27,28].”
Bell, D. L. (2025) · Nutrition in Clinical Practice · doi:10.1002/ncp.70036 · Cited by 1 · see citing works
“47 Implementation and sustainability infrastructure An organization's inner workings and characteristics are vital to workflow within an implementation setting, fostering program delivery and sustainability for the future.”
Kearney, L. N., Jenkinson, B., Robins, A., Callaway, L. K., van den Heuvel, J., Roussin, M., & Hill, B. (2025) · Sexual & Reproductive Healthcare · doi:10.1016/j.srhc.2025.101145 · Cited by 2 · see citing works
Blending Pendagogy and Technology: How Digital Tools Enhance Teaching and Learning Outcomes
Sari, W. P., Putra, F. N., & Razak, F. (2025) · Journal of Educational Teaching and Trends · doi:10.64840/jett.v1i1.22 · Cited by 1
“…a Pedagogical-Technological Integration Framework (PTIF) that identifies optimal pairings of digital tools and teaching strategies across six learning domains: conceptual understanding, skill acquisition, metacognition, collaboration, creativity, and assessment (Martin, 2021; Phelan, 2022).”
Does size matter? Weight bias, stigma, and medical radiation technology practice in Canada
Smith, S. C., Smoke, M., Farrell, T. J., Reis, V., & Brydon, M. (2025) · Journal of medical imaging and radiation sciences · doi:10.1016/j.jmir.2025.101886 · Cited by 1 · see citing works
Mathews, N., Joseph, J., Joseph, M. E., Muñoz, E. G., & Lee, L. T. (2024) · Journal of Radiology Nursing · doi:10.1016/j.jradnu.2024.09.007 · Cited by 1 · see citing works
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“28 The association between perceived stigma and liver fibrosis or cirrhosis may also indicate that disease severity amplifies stigmatisation, either through visible symptoms or increased interactions with health services.”
An Interprofessional Workshop Aimed at Addressing Weight Stigma at the Micro, Mezzo, and Macro-Level
Beaudoin, J., Vyas, D., Fischer-Shemer, N., & Yalamanchili, J. (2026) · Journal of Interprofessional Education & Practice · doi:10.1016/j.xjep.2026.100854
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“Thus, when naming departments or clinics, it may be beneficial to consider names that reduce stigma, are accessible, avoid patient discomfort Adv Ther (2026) 43:4218–4231 and self-consciousness, and do not cause psychological hesitance [29].”
Navigating radiography as a larger-bodied patient: a qualitative exploration
Manning, F., Heales, C., Ulett, P., & Hancock, A. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1803012
Sheynblyum, M., & Pearl, R. L. (2026) · Journal of Health Psychology · doi:10.1177/13591053251408886
“Individuals who experience weight stigma, especially in healthcare, tend to avoid doctor’s visits (Agénor et al., 2022; Hughes et al., 2019; Phelan et al., 2021).”
International Trends in Endometriosis Delay to Diagnosis Data
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“6 The higher delay and avoidance of care in these individuals was also related to fear of discrimination or fear of being judged due to their weight.”
Self-citation
- Authors
- Phelan, S. M., Bauer, K. W., Bradley, D., Bradley, S. M., Haller, I. V., Mundi, M. S., Finney Rutten, L. J., Schroeder, D. R., Fischer, K., & Croghan, I.
- Affiliations
- Mayo Clinic (US)
- University of Michigan (US)
- The Ohio State University Wexner Medical Center (US)
- Minneapolis Heart Institute Foundation (US)
- Essentia Health (US)
- Department of Quantitative Health Sciences Mayo Clinic Rochester Minnesota USA
- Corresponding author
- Phelan, Sean M.
- ORCID
- Venue
- Obesity Science & Practice
- Publisher
- Wiley
- Published
- 2021-08-27
- Volume
- 8
- Issue
- 2
- Pages
- 139-146
- ISSN
- 2055-2238 (ISSN-L)
- PMC
- PMC8976541
- OpenAlex
- W3195633303
- Cited by
- 57
- References
- 53
- Citations by year
- 2026: 11 · 2025: 19 · 2024: 16 · 2023: 6 · 2022: 3 · 2021: 2
- FWCI
- 10.53
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Obesity Science & Practice (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Patient-Centered Outcomes Research Institute (CDRN‐1501‐26638)
- Topics
- Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- obesity, weight stigma, health care utilization, care avoidance, patient-centered communication, perceived respect, delayed care, primary care patients, body mass index
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