Mechanisms underlying weight status and healthcare avoidance in women: A study of weight stigma, body-related shame and guilt, and healthcare stress
Abstract
Studies show that women with high BMI are less likely than thinner women to seek healthcare. We aimed to determine the mechanisms linking women's weight status to their healthcare avoidance. Women (N = 313) were surveyed from a U.S. health-panel database. We tested a theory-driven model containing multiple stigma and body-related constructs linking BMI to healthcare avoidance. The model had a good fit to the data. Higher BMI was related to greater experienced and internalized weight stigma, which were linked to greater body-related shame. Internalized weight stigma was also related to greater body-related guilt, which was associated with higher body-related shame. Body-related shame was associated with healthcare stress which ultimately contributed to healthcare avoidance. We discuss recommendations for a Weight Inclusive Approach to healthcare and the importance of enhancing education for health professionals in weight bias in order to increase appropriate use of preventive healthcare in higher weight women.
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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 Mensinger et al., 2018
Associations between internalized weight bias and at least one measure of body shame suggest a need for measurements that adequately distinguish these constructs.
“The associations between internalized weight bias and at least one measure of body shame (Mensinger et al., 2018) suggest a need for measurements that adequately distinguish these constructs.”
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 Mensinger et al., 2018
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- Authors
- Mensinger, J. L., Tylka, T. L., & Calamari, M. E.
- Affiliations
- Drexel University (US)
- The Ohio State University (US)
- Corresponding author
- Mensinger, Janell L.
- Venue
- Body Image
- Publisher
- Elsevier BV
- Published
- 2018-06
- Volume
- 25
- Pages
- 139-147
- ISSN
- 1740-1445 (ISSN-L)
- OpenAlex
- W2793546505
- Cited by
- 283
- References
- 99
- Citations by year
- 2026: 28 · 2025: 30 · 2024: 58 · 2023: 47 · 2022: 32 · 2021: 57 · 2020: 14 · 2019: 12 · 2018: 5
- FWCI
- 43.68
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Body Image (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- weight stigma, body shame, healthcare avoidance, weight status, body mass index, women, self-stigma, weight-inclusive care
- MeSH terms
- Adult, Aged, Aged, 80 and over, Body Image, Body Weight, Cross-Sectional Studies, Defense Mechanisms, Female, Guilt, Humans, Middle Aged, Patient Acceptance of Health Care, Shame, Stress, Psychological, Social Stigma
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