Obesity and stigma : studies on children, adults and health care professionals

Abstract

Obesity may not only pose a threat to an individual's physical health but may also have socioeconomic and psychosocial consequences. Stigma is assumed to be a common experience among individuals with obesity and is also suggested to be one of the major contributors to health disparities. The overall aim of this thesis was to study obesity and stigma from children's, adults' and health care professionals' perspectives in Sweden.

A quantitative design with statistical analyses was used in Study I, II and III. These studies included national random samples of approximately 1400 10-year-old children and their parents and about 2600 men and women between 25 and 64 years of age. A qualitative descriptive design involving a phenomenographic analysis was used in Study IV. This study included a strategic sample of 10 general practitioners (GPs) and 10 district nurses (DNs) from primary health care centres in Stockholm County.

Children were more likely to be prejudiced against obesity than against average weight and thinness. The likelihood of children being prejudiced was found to vary with children s sex and with the rated figure s sex and body size. Children with high socioeconomic status (SES) were more likely to be prejudiced against a target with obesity than children with low SES (Study I). Boys' lower body esteem predicted a higher level of stereotyping of a girl figure with obesity, whereas girls' body esteem could not explain the variation in girl obesity stereotypes. Parents' strong beliefs about the controllability of weight and larger body size both independently predicted a higher level of obesity stereotypes in their children (Study II). Women with severe obesity reported discrimination more often than normal weight women and this was documented in all investigated contexts, i.e. workplace, health care and interpersonal encounters. Reports of discrimination among men seemed to depend on both the context and the level of obesity. Insulting treatment by physicians and nurses, and also experiencing inferior medical care than others and avoiding care due to fear of being mistreated, were most common among individuals with severe obesity (Study III). Even though health care professionals themselves did not explicitly expose negative attitudes towards obesity their conceptions of obesity were centred almost exclusively on lifestyle behaviours as causes and remedies. Successful encounters with individuals with obesity in primary care were conceived to rely a great deal on patient attitudes (motivation to change lifestyle, evasive behaviour, trusting in care, lack of self-confidence). However, the importance of both organizational and staff aspects for improving provider-patient encounters regarding obesity was stressed by both GPs and DNs. The conception that primary care is not an entirely appropriate setting for approaching obesity applied to both professional groups, but especially GPs (Study IV).

In conclusion, the findings in this thesis support the idea that obesity is a stigmatizing attribute in Swedish society; however, different social contexts and social identities condition the stigmatization of people with obesity. The results presented in this thesis can, for instance, contribute to new ideas about how to reduce stereotypes in children. The findings and knowledge gained from health care professionals conceptions of their encounters with patients with obesity may also be useful in the continuing efforts to improve care of these patients.