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Weight bias and health care utilization: a scoping review

  • Angela S. Alberga (a1), Iyoma Y. Edache (a1), Mary Forhan (a2) and Shelly Russell-Mayhew (a3)



The purpose of this scoping review was to explore the evidence on how perceptions and/or experiences of weight bias in primary health care influence engagement with and utilization of health care services by individuals with obesity.


Prior studies have found discrepancies in the use of health care services by individuals living with obesity; a greater body mass index has been associated with decreased health care utilization, and weight bias has been identified as a major barrier to engagement with health services.


PubMed was searched from January 2000 to July 2017. Four reviewers independently selected 21 studies examining perceptions of weight bias and its impact on engagement with primary health care services.


A thematic analysis was conducted on the 21 studies that were included in this scoping review. The following 10 themes were identified: contemptuous, patronizing, and disrespectful treatment, lack of training, ambivalence, attribution of all health issues to excess weight, assumptions about weight gain, barriers to health care utilization, expectation of differential health care treatment, low trust and poor communication, avoidance or delay of health services, and ‘doctor shopping’. Overall, our scoping review reveals how perceptions and/or experiences of weight bias from primary care health professionals negatively influence patient engagement with primary health care services.

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This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Author for correspondence: Angela S. Alberga, Assistant Professor, Department of Health, Kinesiology & Applied Physiology, Concordia University, 7141 Sherbrooke Street West, SP-165.31, Montreal, QC H4B1R6, Canada. E-mail:


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Adams, CH, Smith, NJ, Wilbur, DC and Grady, KE (1993) The relationship of obesity to the frequency of pelvic examinations: do physician and patient attitudes make a difference? Women Health 20, 4557.
Alberga, A, Russell-Mayhew, S, Von Ranson, K, Mclaren, K, Ramos-Salas, X and Sharma, A (2016a) Future research in weight bias: what next? Obesity 24, 1207–1209.
Alberga, AS, Pickering, BJ, Alix Hayden, K, Ball, GD, Edwards, A, Jelinski, S, Nutter, S, Oddie, S, Sharma, AM and Russell-Mayhew, S (2016b) Weight bias reduction in health professionals: a systematic review. Clinical Obesity 6, 175–188.
Aldrich, T and Hackley, B (2010) The impact of obesity on gynecologic cancer screening: an integrative literature review. Journal of Midwifery & Women’s Health 55, 344–356.
Amy, NK, Aalborg, A, Lyons, P and Keranen, L (2006) Barriers to routine gynecological cancer screening for White and African-American obese women. International Journal of Obesity (London) 30, 147–155.
Andreyeva, T, Puhl, RM and Brownell, KD (2008) Changes in perceived weight discrimination among Americans, 1995–1996 through 2004–2006. Obesity (Silver Spring) 16, 1129–1134.
Arksey, H and O’malley, L (2005) Scoping studies: towards a methodological framework. International Journal of Social Science Research Methodology 8, 1932.
Bottone, FG, Musich, S, Wang, SS, Hommer, CE, Yeh, CS and Hawkins, K (2014) Obese older adults report high satisfaction and positive experiences with care. BMC Health Services Research 14, 220.
Brown, I, Thompson, J, Tod, A and Jones, G (2006) Primary care support for tackling obesity: a qualitative study of the perceptions of obese patients. British Journal of General Practice 56, 666–672.
Brownell, KD (1982) Obesity: understanding and treating a serious, prevalent, and refractory disorder. Journal of Consulting and Clinical Psychology 50, 820–840.
Buxton, BK and Snethen, J (2013) Obese women’s perceptions and experiences of healthcare and primary care providers: a phenomenological study. Nursing Research 62, 252–259.
Carels, RA, Young, KM, Wott, CB, Harper, J, Gumble, A, Oehlof, MW and Clayton, AM (2009) Weight bias and weight loss treatment outcomes in treatment-seeking adults. Annals of Behavioral Medicine 37, 350–355.
Coughlin, SS, Uhler, RJ, Hall, HI and Briss, PA (2004) Nonadherence to breast and cervical cancer screening: what are the linkages to chronic disease risk? Preventing Chronic Disease 1, A04.
Dejoy, SB, Bittner, K and Mandel, D (2016) A qualitative study of the maternity care experiences of women with obesity: ‘More than Just a Number on the Scale’. Journal of Midwifery & Women’s Health 61, 217–223.
Drury, CA and Louis, M (2002) Exploring the association between body weight, stigma of obesity, and health care avoidance. Journal of the American Association of Nurse Practitioners 14, 554–561.
Ferrante, JM, Chen, PH, Crabtree, BF and Wartenberg, D (2007) Cancer screening in women: body mass index and adherence to physician recommendations. American Journal of Preventive Medicine 32, 525–531.
Ferrante, JM, Seaman, K, Bator, A, Ohman-Strickland, P, Gundersen, D, Clemow, L and Puhl, R (2016) Impact of perceived weight stigma among underserved women on doctor-patient relationships. Obesity Science & Practice 2, 128–135.
Fontaine, KR, Faith, MS, Allison, DB and Cheskin, LJ (1998) Body weight and health care among women in the general population. Archives of Family Medicine 7, 381–344.
Forhan, M, Risdon, C and Solomon, P (2013) Contributors to patient engagement in primary health care: perceptions of patients with obesity. Primary Health Care Research & Development 14, 367–372.
Gudzune, KA, Beach, MC, Roter, DL and Cooper, LA (2013) Physicians build less rapport with obese patients. Obesity (Silver Spring) 21, 2146–2152.
Gudzune, KA, Bennett, WL, Cooper, LA and Bleich, SN (2014a) Patients who feel judged about their weight have lower trust in their primary care providers. Patient Education and Counseling 97, 128–131.
Gudzune, KA, Bennett, WL, Cooper, LA, Clark, JM and Bleich, SN (2014b) Prior doctor shopping resulting from differential treatment correlates with differences in current patient-provider relationships. Obesity (Silver Spring) 22, 1952–1955.
Hansson, LM and Rasmussen, F (2014) Association between perceived health care stigmatization and BMI change. Obesity Facts 7, 211–220.
Hilbert, A, Braehler, E, Haeuser, W and Zenger, M (2014) Weight bias internalization, core self-evaluation, and health in overweight and obese persons. Obesity (Silver Spring) 22, 7985.
Kaminsky, J and Gadaleta, D (2002) A study of discrimination within the medical community as viewed by obese patients. Obesity surgery 12, 1418.
Lyznicki, JM, Young, DC, Riggs, JA, Davis, RM and Council on Scientific Affairs, A. M. A (2001) Obesity: assessment and management in primary care. American Family Physician 63, 2185–2196.
Merrill, E and Grassley, J (2008) Women’s stories of their experiences as overweight patients. Journal of Advanced Nursing 64, 139–146.
Olson, CL, Schumaker, HD and Yawn, BP (1994) Overweight women delay medical care. Archives of Family Medicine 3, 888–892.
Phelan, SM, Burgess, DJ, Yeazel, MW, Hellerstedt, WL, Griffin, JM and Van Ryn, M (2015) Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obesity Reviews 16, 319–326.
Pryor, W (2002) The health care disadvantages of being obese. NSW Public Health Bulletin 13, 163–165.
Puhl, RM, Andreyeva, T and Brownell, KD (2008) Perceptions of weight discrimination: prevalence and comparison to race and gender discrimination in America. International Journal of Obesity (London) 32, 9921000.
Puhl, RM and Heuer, CA (2009) The stigma of obesity: a review and update. Obesity (Silver Spring) 17, 941–964.
Puhl, RM, Peterson, JL and Luedicke, J (2013) Motivating or stigmatizing? Public perceptions of weight-related language used by health providers. International Journal of Obesity (London) 37, 612–619.
Rueda-Clausen, CF, Benterud, E, Bond, T, Olszowka, R, Vallis, MT and Sharma, AM (2014) Effect of implementing the 5As of obesity management framework on provider-patient interactions in primary care. Clinical Obesity 4, 3944.
Russell, N and Carryer, J (2013) Living large: the experiences of large-bodied women when accessing general practice services. Journal of Primary Health Care 5, 199205.
Teachman, BA and Brownell, KD (2001) Implicit anti-fat bias among health professionals: is anyone immune? International Journal of Obesity and Related Metabolic Disorders 25, 1525–1531.
Tricco, AC, Lillie, E, Zarin, W, O’brien, KK, Colquhoun, H, Levac, D, Moher, D, Peters, MD, Horsley, T and Weeks, L (2018) PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Annals of Internal Medicine 169, 467473.
Vartanian, LR and Shaprow, JG (2008) Effects of weight stigma on exercise motivation and behavior: a preliminary investigation among college-aged females. Journal of Health Psychology 13, 131–138.
Wadden, TA, Anderson, DA, Foster, GD, Bennett, A, Steinberg, C and Sarwer, DB (2000) Obese women’s perceptions of their physicians’ weight management attitudes and practices. Archives of Family Medicine 9, 854–860.
Washington, RL (2011) Peer reviewed: childhood obesity: issues of weight bias. Preventing Chronic Disease 8 A94.



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