“Some Providers Focus on the Weight so Much They Forget to Help You”: Weight Stigma and Avoiding Healthcare

Background and Purpose: Weight stigma is a common experience for individuals in large bodies and the relationship between weight discrimination and healthcare avoidance is well established among primarily white samples. This study addresses a critical gap in the literature, examining weight stigma and weight discrimination as predictors of healthcare avoidance among Black adults in large bodies. This research is essential for advancing healthcare utilization as a tool in advancing racial health equity.

Methods: We conducted a mixed methods, cross-sectional survey of Black adults in the United States in late 2025, recruiting participants through Prolific. Eligibility requirements included identifying as Black, being 35 or older, having a Body Mass Index of 25 or higher, and English as a first language. The final sample (N = 473) was mostly female (n = 371, 79.8%) and the mean age was 48.7 (SD = 9.9, range = 35-81). Independent variables included internalized weight stigma (Weight Bias Internalization Scale; Durso & Latner, 2008), weight discrimination (modified Everyday Discrimination Scale; Williams et al., 1997), and the frequency of provider weight‑related discussions. The dependent variables were ever avoiding healthcare and ever avoiding healthcare for chronic disease management. Covariates included age, sex, and socioeconomic status (Financial Strain Index; Hamby et al, 2011). We conducted descriptive statistics and logistic regressions. Qualitative analysis examined responses to open-ended questions about reasons for avoiding healthcare. Qualitative responses were analyzed using a summative content analysis approach and integrated thematic coding.

Results: Among participants, 43.3% (n = 202) reported ever avoiding healthcare, 13.8% (n = 64) reported ever avoiding healthcare for chronic disease management, and almost one-third indicated that providers bringing up their weight at most visits or every visit (n = 151, 32.3%). Higher internalized weight stigma was significantly related to ever avoiding care (OR = 1.54, p < .001) and ever avoiding care for chronic disease management (OR = 1.79, p < .001). Higher weight discrimination was significantly associated with ever avoiding care (OR = 1.98, p < .001) and ever avoiding care for chronic disease management (OR = 1.99, p < .001). Qualitative reasons for avoiding care fell into 9 themes: 1) impact on patient feelings and mental health (50.5%), 2) poor provider rapport (31.6%), 3) accessibility and convenience concerns (31.6%), 4) health anxiety and avoidance (29.5%), 5) shaming based on identities and behaviors (22.1%), 6) dislike of procedures (19.0%), 7) perceived poor quality of care (17.9%), 8) patient needs and concerns missed (9.5%), and 9) stigmatizing discussions of weight and health (7.4%).

Conclusion and Implications: Internalized weight stigma and weight discrimination emerged as strong, independent predictors of healthcare avoidance among Black adults in large bodies. Qualitative findings further illustrate how stigmatizing encounters shape decisions to delay or forgo care. Together, these results highlight weight stigma as a multidimensional barrier to timely healthcare engagement in a population already disproportionately affected by chronic disease. Interventions that reduce discriminatory experiences, strengthen provider-patient relationships, and promote weight‑inclusive communication may be essential for improving healthcare utilization and advancing racial health equity.