University of Washington School of Social Work, 4101 15th Ave NE, Seattle, WA 98105, USA; University of Denver Graduate School of Social Work, 2148 South High Street, Denver, CO 80208, USA.
University of Washington School of Public Health, Hans Rosling Center for Population Health, 3980 15th Ave NE, Seattle, WA 98195, USA.
Body Image. 2023 Sep;46:48-61. doi: 10.1016/j.bodyim.2023.04.008. Epub 2023 May 24.
Eating disorders (ED) and weight stigma pose significant healthcare challenges. Patients at higher weights, like some with atypical anorexia (AAN), may face increased challenges due to weight stigma. This study analyzed patients' lived experiences with weight stigma in healthcare. Thirty-eight adult patients with AAN completed in-depth, semi-structured interviews regarding healthcare experiences. Guided by narrative inquiry approaches, transcripts were thematically coded. Across the illness trajectory (ED development, pre-treatment, treatment, post-treatment), patients reported that weight stigma in healthcare contributed to initiation and persistence of ED behaviors. Themes included "providers pathologizing patient weight," which patients reported triggered ED behaviors and relapse, "provider minimization and denial" of patients' EDs, which contributed to delays in screening and care, and "overt forms of weight discrimination," leading to healthcare avoidance. Participants reported that weight stigma prolonged ED behaviors, delayed care, created suboptimal treatment environments, deterred help-seeking, and lowered healthcare utilization. This suggests that many providers (pediatricians, primary care providers, ED treatment specialists, other healthcare specialists) may inadvertently reinforce patients' EDs. Increasing training, screening for EDs across the weight spectrum, and targeting health behavior promotion rather than universal weight loss, could enhance quality of care and improve healthcare engagement for patients with EDs, particularly those at higher weights.
饮食失调（ED）和体重污名化对医疗保健构成重大挑战。体重较高的患者，如某些非典型厌食症（AAN）患者，由于体重污名化可能面临更大的挑战。本研究分析了患者在医疗保健中经历的体重污名化。38 名患有 AAN 的成年患者完成了关于医疗保健经验的深入、半结构化访谈。根据叙事探究方法，对转录本进行主题编码。在疾病轨迹（ED 发展、治疗前、治疗中、治疗后）中，患者报告称医疗保健中的体重污名化导致 ED 行为的开始和持续。主题包括“提供者将患者体重病理化”，患者报告称这引发了 ED 行为和复发，“提供者对患者 ED 的最小化和否认”，这导致了筛查和护理的延迟，以及“明显的体重歧视形式”，导致医疗保健的回避。参与者报告称，体重污名化延长了 ED 行为，延迟了治疗，创造了不理想的治疗环境，阻碍了寻求帮助，并降低了医疗保健利用率。这表明许多提供者（儿科医生、初级保健提供者、ED 治疗专家、其他医疗保健专家）可能无意中加剧了患者的 ED。增加培训，对整个体重范围内的 ED 进行筛查，并针对健康行为促进而不是普遍的体重减轻，可以提高 ED 患者的护理质量，并改善他们的医疗保健参与度，特别是那些体重较高的患者。
