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BMC Pregnancy and Childbirth

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Open Access 01-12-2020 | Obesity | Research article

Pregnant and postpartum women’s experiences of weight stigma in healthcare

Authors: Angela C. Incollingo Rodriguez, Stephanie M. Smieszek, Kathryn E. Nippert, A. Janet Tomiyama

Published in: BMC Pregnancy and Childbirth | Issue 1/2020

Abstract

Background

Weight stigma is a societal phenomenon that is very prevalent in healthcare, precipitating poor patient-provider relationships, discontinuity of care, and delayed cancer screening. Little research, though, has investigated weight stigma in prenatal and postpartum healthcare. To address this gap, this study examined the prevalence and frequency of weight-stigmatizing experiences in prenatal and postpartum healthcare.

Methods

501 pregnant and postpartum women responded to an online survey where they reported whether they had experienced weight stigma in prenatal or postpartum healthcare and, if so, how frequently. Participants also responded to questions about how providers had treated them regarding their weight and their reactions to these experiences. A subset of participants (n = 80) also provided examples of their experiences, and these were subjected to a thematic analysis and coded for overarching themes.

Results

Nearly 1 in 5 women (n = 92) reported experiencing weight stigma in healthcare settings. Percentages differed by BMI, with 28.4% of participants with pre-pregnancy obesity endorsing healthcare providers as a source of weight stigma. Experiences occurred between “less than once a month” and “a few times a month.” Obstetricians were the most commonly-reported source (33.8%), followed by nurses (11.3%). Participants reported feeling judged, shamed, and guilty because of their weight during healthcare visits. Additionally, 37 participants (7.7%) reported having changed providers because of treatment regarding their weight. Many also reported that they expected to feel or had felt uncomfortable seeking help with breastfeeding from a healthcare professional. Finally, thematic analysis of the open-ended examples identified four key themes: (1) negative attitudes and unkind or disrespectful treatment from providers; (2) evaluative comments about their weight; (3) healthcare providers focusing on their high-risk status and potential negative consequences (often when birth outcomes were ultimately healthy); and (4) inappropriate or demeaning comments.

Conclusions

Weight stigma may be a common experience in pregnancy and postpartum healthcare. Providers need additional training to avoid stigmatizing their patients and inadvertently undermining patient-provider relationships, quality of care, and health outcomes.

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Puhl RM, Brownell KD. Bias, discrimination, and obesity. Obes res [Internet]. 2001/12/18. 2001;9(12):788–805. Available from. http://www.ncbi.nlm.nih.gov/pubmed/11743063.

Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griffin JM, van Ryn M. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev [Internet]. 2015 Apr 1 [cited 2019 Sep 11];16(4):319–26. Available from: http://doi.wiley.com/10.1111/obr.12266.

Dixon JB. The effect of obesity on health outcomes. Mol cell Endocrinol [Internet]. 2009/07/25. 2010;316(2):104–8. Available from. http://www.ncbi.nlm.nih.gov/pubmed/19628019.

Puhl RM, Heuer CA. The stigma of obesity: a review and update. Obesity [Internet]. 2009/01/24. 2009;17(5):941–64. Available from. http://www.ncbi.nlm.nih.gov/pubmed/19165161.

Tomiyama AJ, Finch LE, Incollingo Belsky AC, Buss J, Finley C, Schwartz MB, et al. Weight bias in 2001 versus 2013: Contradictory attitudes among obesity researchers and health professionals. Obesity [Internet]. 2015 Jan [cited 2016 Oct 20];23(1):46–53. Available from: http://doi.wiley.com/10.1002/oby.20910.

Phelan SM, Dovidio JF, Puhl RM, Burgess DJ, Nelson DB, Yeazel MW, et al. Implicit and explicit weight bias in a national sample of 4,732 medical students: The medical student CHANGES study. Obesity [Internet]. 2014 Apr [cited 2016 Oct 20];22(4):1201–8. Available from: http://doi.wiley.com/10.1002/oby.20687.

Papadopoulos S, Brennan L. Correlates of weight stigma in adults with overweight and obesity: A systematic literature review. Obesity [Internet]. 2015 [cited 2015 Sep 10];23(9):1743–60. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26260279.

Gudzune KA, Bleich SN, Richards TM, Weiner JP, Hodges K, Clark JM. Doctor shopping by overweight and obese patients is associated with increased healthcare utilization. Obesity (Silver Spring). 2013 Jul;21(7):1328–34.CrossRef

Ferrante JM, Seaman K, Bator A, Ohman-Strickland P, Gundersen D, Clemow L, et al. Impact of perceived weight stigma among underserved women on doctor-patient relationships. Obes Sci Pract [Internet]. 2016 Jun [cited 2016 Nov 21];2(2):128–35. Available from: http://doi.wiley.com/10.1002/osp4.40.

10.

Amy NK, Aalborg A, Lyons P, Keranen L. Barriers to routine gynecological cancer screening for White and African-American obese women. Int J Obes [Internet]. 2006 Jan 4 [cited 2017 Nov 7];30(1):147–55. Available from: http://www.nature.com/articles/0803105.

11.

DeJoy SB, Bittner K, Mandel D. A qualitative study of the maternity care experiences of women with obesity: “More than just a number on the scale.” J Midwifery Womens Health [Internet]. 2016 Mar 1 [cited 2020 Mar 27];61(2):217–23. Available from: http://doi.wiley.com/10.1111/jmwh.12375.

12.

Mulherin K, Miller YD, Barlow FK, Diedrichs PC, Thompson R. Weight stigma in maternity care: Women’s experiences and care providers’ attitudes. BMC Pregnancy Childbirth [Internet]. 2013 Jan [cited 2016 Feb 13];13:19. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3577669&tool=pmcentrez&rendertype=abstract.

13.

Furber CM, McGowan L. A qualitative study of the experiences of women who are obese and pregnant in the UK. Midwifery [Internet]. 2011 Aug [cited 2016 Feb 5];27(4):437–44. Available from: http://www.sciencedirect.com/science/article/pii/S0266613810000562.

14.

McPhail D, Bombak A, Ward P, Allison J. Wombs at risk, wombs as risk: Fat women’s experiences of reproductive care. Fat Stud [Internet]. 2016 May 27 [cited 2016 May 28];5(2):98–115. Available from: http://www.tandfonline.com/doi/full/10.1080/21604851.2016.1143754.

15.

Bombak AE, McPhail D, Ward P. Reproducing stigma: Interpreting “overweight” and “obese” women’s experiences of weight-based discrimination in reproductive healthcare. Soc Sci Med [Internet]. 2016 Oct [cited 2017 Mar 9];166:94–101. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0277953616304373.

16.

Vartanian LR, Smyth JM. Primum non nocere: Obesity stigma and public health. J Bioeth Inq [Internet]. 2013 [cited 2013 Nov 21];10(1):49–57. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23288439.

17.

Jackson SE, Beeken RJ, Wardle J. Perceived weight discrimination and changes in weight, waist circumference, and weight status. Obesity (Silver Spring) [Internet]. 2014 Dec [cited 2015 Mar 10];22(12):2485–8. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4236245&tool=pmcentrez&rendertype=abstract.

18.

Sutin A, Terracciano A. Perceived weight discrimination and obesity. PLoS One. 2013 Jan;8(7):1–4.CrossRef

19.

Kim SY, Dietz PM, England L, Morrow B, Callaghan WM. Trends in pre-pregnancy obesity in nine states, 1993-2003. Obesity (Silver Spring) [Internet]. 2007 [cited 2015 Dec 9];15(4):986–93. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17426334.

20.

Deputy NP, Sharma AJ, Kim SY, Hinkle SN. Prevalence and characteristics associated with gestational weight gain adequacy. Obstet Gynecol [Internet]. 2015 Apr [cited 2017 Sep 18];125(4):773–81. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25751216.

21.

Incollingo Rodriguez AC, Dunkel Schetter C, Brewis A, Tomiyama AJ. The psychological burden of baby weight: Pregnancy, weight stigma, and maternal health. Soc Sci Med [Internet]. 2019 Aug 1 [cited 2019 Aug 8];235:112401. Available from: https://www.sciencedirect.com/science/article/pii/S0277953619303879.

22.

Incollingo Rodriguez AC, Tomiyama AJ, Guardino CM, Dunkel Schetter C. Association of weight discrimination during pregnancy and postpartum with maternal postpartum health. Heal Psychol [Internet]. 2019 Mar [cited 2019 Feb 18];38(3):226–37. Available from: http://doi.apa.org/getdoi.cfm?doi=10.1037/hea0000711.

23.

AAP, ACOG. Guidelines for Perinatal Care. 8th ed. Kilpatrick S, Papile L, Macones G, editors. Washington, D.C.; 2017.

24.

Osterman M, Martin J. Timing and adequacy of prenatal care in the United States, 2016. Natl Vital Stat Reports. 2018;67(3).

25.

Vartanian LR, Pinkus RT, Smyth JM. The phenomenology of weight stigma in everyday life. J Context Behav Sci [Internet]. 2014 Jul 1 [cited 2019 Jun 22];3(3):196–202. Available from: https://www.sciencedirect.com/science/article/pii/S2212144714000040.

26.

Vartanian LR, Pinkus RT, Smyth JM. Experiences of weight stigma in everyday life: Implications for health motivation. Stigma Heal [Internet]. 2018 May [cited 2018 Oct 10];3(2):85–92. Available from: http://doi.apa.org/getdoi.cfm?doi=10.1037/sah0000077.

27.

Incollingo Rodriguez AC, Dunkel Schetter C, Tomiyama AJ. Weight stigma among pregnant and postpartum women: A new context of stigmatization. Stigma Heal [Internet]. 2020 May [cited 2020 Apr 27];5(2):209–16. Available from: http://doi.apa.org/getdoi.cfm?doi=10.1037/sah0000191.

28.

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol [Internet]. 2006 Jan [cited 2019 Jul 29];3(2):77–101. Available from: http://www.tandfonline.com/doi/abs/10.1191/1478088706qp063oa.

29.

Dunkel Schetter C, Niles AN, Guardino CM, Khaled M, Kramer MS. Demographic, medical, and psychosocial predictors of pregnancy anxiety. Paediatr Perinat Epidemiol [Internet]. 2016 Sep 1 [cited 2019 Sep 10];30(5):421–9. Available from: http://doi.wiley.com/10.1111/ppe.12300.

30.

Guardino CM, Dunkel SC. Understanding pregnancy anxiety: concepts, correlates, and consequences. Zero Three. 2014;34(4):12–21.

31.

Dunkel Schetter C, Tanner L. Anxiety, depression and stress in pregnancy: Implications for mothers, children, research, and practice. Curr Opin Psychiatry [Internet]. 2012 Mar [cited 2019 Sep 10];25(2):141–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22262028.

32.

Ehrenberg HM, Dierker L, Milluzzi C, Mercer BM. Low maternal weight, failure to thrive in pregnancy, and adverse pregnancy outcomes. Am J Obstet Gynecol [Internet]. 2003 Dec [cited 2016 Feb 11];189(6):1726–30. Available from: http://www.sciencedirect.com/science/article/pii/S0002937803008603.

33.

Marsoosi V, Jamal A, Eslamian L. Pre-pregnancy weight, low pregnancy weight gain, and preterm delivery. Int J Gynaecol Obstet [Internet]. 2004 Oct [cited 2016 Feb 13];87(1):36–7. Available from: http://www.sciencedirect.com/science/article/pii/S0020729204002188.

34.

Blomberg M. Maternal and neonatal outcomes among obese women with weight gain below the new Institute of Medicine Recommendations. Obstet Gynecol [Internet]. 2011 May [cited 2020 Mar 29];117(5):1065–70. Available from: http://journals.lww.com/00006250-201105000-00007.

35.

Liu J, Smith MG, Dobre MA, Ferguson JE. Maternal obesity and breast-feeding practices among white and black women. Obesity [Internet]. 2010 Jan 1 [cited 2019 Aug 29];18(1):175–82. Available from: http://doi.wiley.com/10.1038/oby.2009.182.

36.

Masho SW, Cha S, Morris MR. Prepregnancy obesity and breastfeeding noninitiation in the United States: An examination of racial and ethnic differences. Breastfeed Med [Internet]. 2015 Jun 9 [cited 2019 Aug 29];10(5):253–62. Available from: http://www.liebertpub.com/doi/10.1089/bfm.2015.0006.

37.

Dix DN. Why women decide not to breastfeed. Birth [Internet]. 1991 Dec 1 [cited 2020 Apr 2];18(4):222–5. Available from: http://doi.wiley.com/10.1111/j.1523-536X.1991.tb00105.x.

38.

Dennis C-L, McQueen K. The relationship between infant-feeding outcomes and postpartum depression: a qualitative systematic review. Pediatrics. 2009;123(4):736–51.CrossRef

39.

Bartick MC, Schwarz EB, Green BD, Jegier BJ, Reinhold AG, Colaizy TT, et al. Suboptimal breastfeeding in the United States: Maternal and pediatric health outcomes and costs. Matern Child Nutr [Internet]. 2017 Jan 1 [cited 2019 Aug 29];13(1):e12366. Available from: http://doi.wiley.com/10.1111/mcn.12366.

40.

Headen I, Cohen AK, Mujahid M, Abrams B. The accuracy of self-reported pregnancy-related weight: a systematic review. Obes Rev [Internet]. 2017 Mar 1 [cited 2019 Jun 22];18(3):350–69. Available from: http://doi.wiley.com/10.1111/obr.12486.

41.

Holland E, Moore Simas TA, Doyle Curiale DK, Liao X, Waring ME. Self-reported pre-pregnancy weight versus weight measured at first prenatal visit: Effects on categorization of pre-pregnancy Body Mass Index. Matern Child Health J [Internet]. 2013 Dec 18 [cited 2019 Jun 22];17(10):1872–8. Available from: http://link.springer.com/10.1007/s10995-012-1210-9.

42.

Stotland NE, Gilbert P, Bogetz A, Harper CC, Abrams B, Gerbert B. Preventing excessive weight gain in pregnancy: How do prenatal care providers approach counseling? J Women’s Heal [Internet]. 2010 Apr 26 [cited 2019 May 21];19(4):807–14. Available from: http://www.liebertpub.com/doi/10.1089/jwh.2009.1462.

Title: Pregnant and postpartum women’s experiences of weight stigma in healthcare
Authors: Angela C. Incollingo Rodriguez
Stephanie M. Smieszek
Kathryn E. Nippert
A. Janet Tomiyama
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Obesity
Obesity
Published in: BMC Pregnancy and Childbirth / Issue 1/2020
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-020-03202-5

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Pregnant and postpartum women’s experiences of weight stigma in healthcare

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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