Weight stigma in maternity care: women’s experiences and care providers’ attitudes

“Power analyses indicated that 159 participants were required to have an 80% chance of detecting medium effect sizes [31], thus the analyses were collapsed across medical and midwifery pre-service care providers to maximise power.”

“Healthcare providers respond differentially to patients on the basis of their body size [9].”

“In their systematic review, Gorber, Tremblay, Moher and Gorber [42] found that participants within all weight categories tend to overestimate height and underestimate weight and BMI in self-report, and there is some evidence to suggest that those who are obese under-estimate weight and over-estimate height by greater…”

“There is a demonstrated detrimental impact of negative weight-related health treatment, and weight stigma more broadly, on psychosocial wellbeing [3,4,33] and health behaviours [5,7].”

“Weight stigma is the fourth most common form of discrimination in the United States, and studies from Australia, Europe and North America document its presence across a range of professional settings [2].”

“In light of evidence that higher BMI is associated with more negative treatment in general healthcare settings [11,29], it was expected that women with a higher prepregnancy BMI would perceive less positive and more negative treatment from maternity care providers.”

“Possible incidences of negative treatment are of concern in light of the potential harmful consequences of weight stigma for larger women’s psychosocial wellbeing and health [3,8,33].”

“, [46,47], yet a lack of information about experienced stigma among this group.”

“People who report experiencing weight stigma in healthcare settings are more likely to delay medical appointments and preventive healthcare procedures [8].”

“Such findings concur with those of Hebl and Xu [11], who found that general physicians perceived poorer self-management and health among patients with a higher BMI.”

“Possible incidences of negative treatment are of concern in light of the potential harmful consequences of weight stigma for larger women’s psychosocial wellbeing and health [3,8,33].”

“There is a demonstrated detrimental impact of negative weight-related health treatment, and weight stigma more broadly, on psychosocial wellbeing [3,4,33] and health behaviours [5,7].”

“These include poor psychological functioning [3], body dissatisfaction [4], increased episodes of binge-eating [5,6] and exercise avoidance [7], even after controlling for the direct effect of actual body size.”

“In their systematic review, Gorber, Tremblay, Moher and Gorber [42] found that participants within all weight categories tend to overestimate height and underestimate weight and BMI in self-report, and there is some evidence to suggest that those who are obese under-estimate weight and over-estimate height by greater…”

“Greater frustration with the management of obese pregnant patients [32], lower perceived confidence and knowledge regarding obesity [48], and perceptions of higher risks [34] may all contribute to weight stigma among maternity care providers.”

“Prolonged exposure to a workplace culture which condones weight stigmatising attitudes, as has been described in qualitative research [41], may inflate weight-based prejudice among health care providers.”

“Previous qualitative research suggests that overweight and obese women report experiencing sub-optimal treatment in maternity care settings, and attribute this to their larger body size and weight [23,24].”

“Greater frustration with the management of obese pregnant patients [32], lower perceived confidence and knowledge regarding obesity [48], and perceptions of higher risks [34] may all contribute to weight stigma among maternity care providers.”

“Furthermore, we relied on a student sample, and studies have found that healthcare professionals and students with fewer years of working experience display a lower degree of weight-based prejudice than those with more working experience [39,40].”

“Importantly, there is no evidence to suggest that overweight and obese patients have poorer self-management behaviours and abilities [37,38].”

“[21] found that midwives often felt uncomfortable raising weight-related issues with women, but that women attending a clinic with specialist midwives (with additional training and experience working with pregnant women with a higher BMI) benefited from clear, non-judgmental advice and support about issues related to…”

“Importantly, there is no evidence to suggest that overweight and obese patients have poorer self-management behaviours and abilities [37,38].”

“Such findings should be taken seriously, given the increased vulnerabilities to anxiety, depression and a range of other pressures for women during pregnancy and the postpartum period [18,45].”

“This result was consistent with evidence from outside the maternity care setting which has shown that healthcare providers have less positive attitudes towards caring for higher-weight than normal-weight patients [11,35].”

“Three recent qualitative studies found stigmatising attitudes among maternity care providers, including high levels of discomfort, intolerance, and feelings of repulsion in caring for obese pregnant women [19,20], as well as the assumption that obese women lacked necessary skills, awareness, or motivation to manage th…”

“A burgeoning literature is concerned with risks associated with obesity in pregnancy [12,13].”

“Furthermore, we relied on a student sample, and studies have found that healthcare professionals and students with fewer years of working experience display a lower degree of weight-based prejudice than those with more working experience [39,40].”

“Women with a higher BMI are more prone to lower selfesteem and greater depressive symptoms [36], and it is possible that pre-existing differences between groups in mental health may bias women’s perceptions of care and treatment.”

“Women report feeling embarrassed, isolated, receiving insufficient and/or inconsistent information about appropriate engagement in health behaviours in pregnancy, and desiring greater support from health professionals throughout the perinatal period [21,25].”

“A recent Australian large-scale survey explicitly investigating women’s experiences of discrimination in maternity care found an association between obesity in pregnancy and perceived discrimination [26].”

“Greater frustration with the management of obese pregnant patients [32], lower perceived confidence and knowledge regarding obesity [48], and perceptions of higher risks [34] may all contribute to weight stigma among maternity care providers.”

“Hildingsson and Thomas [27] hypothesised that this may be due to midwives’ reluctance to raise weight issues throughout pregnancy care, leading to a generally positive experience among higher-BMI women who desire the focus in their maternity care to be placed on their pregnancies and births, and not their weight.”

“, [46,47], yet a lack of information about experienced stigma among this group.”

“Those conversations may be compromised by ingrained weight stigma among health professionals, which training programmes need to overcome.(117) Midwives may lack the confidence to raise the issue of obesity and fear a hostile response from women that they are trying to form a professional bond with(112,117) and, with h…”

“Australian studies have also documented associations between weight stigma and lower engagement with healthcare providers [33], and reported weight stigma across different medical disciplines [34,35].”