Managing Anti-Fat Stigma in Primary Care: An Observational Study

In many wealthy countries, fatness is stigmatized as a sign of personal failure. Health care interactions can enact fat-related stigmatization, which can worsen health outcomes. The present analysis highlights how stigmatizing discourses about fat bodies emerge in primary care appointments, and examines immediate conversational effects. METHODS: Observational study in three primary care clinics in Canada, using conversation and discourse analytic methods on transcripts of 29 audio-recorded appointments with adults. Talk about weight and blood pressure are contrasted. RESULTS: During measurement and review of measurements, clinicians routinely interpreted the blood pressure result but rarely interpreted weight. Patients of varied ages and body sizes often filled the interpretative vacuum, and focused on behaviors. Overall, neither patients nor clinicians challenged the stigmatizing discourses associated with fat bodies, but sometimes agreed that the "personal failure" frame associated with fatness does not apply to the particular patient. Physicians rarely raised other determinants of weight, but often did so when talking about blood pressure. CONCLUSIONS: Across most body types and ages, weight-related talk spurred stigma management from adult patients. Patients' interpretations were consistent with accepting or avoidant strategies to manage stigma. The findings challenge clinicians and researchers to frame patients' defensiveness or sensitivity as a predictable response to mitigate stigma, and consider how clinical care might be better structured to avoid stigmatization. Recognizing the range of determinants of weight with interpretation of weight may help, particularly if combined with other methods to de-stigmatize care. The results have implications for clinical weight management and behavior change support.