Tran Chloe, Pirotta Stephanie, Hailu Haimanot, Kandel Pragya, Skouteris Helen, Hill Briony
Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Warwick Business School, University of Warwick, Coventry, UK.
Obes Rev. 2025 Sep;26(9):e13933. doi: 10.1111/obr.13933. Epub 2025 May 15.
Structural weight stigma for reproductive-aged women can limit healthcare access and increase physical and mental health concerns, with adverse intergenerational outcomes. The aim of this systematic review was to synthesize evidence of structural weight stigma in healthcare and determine how that impacts the care for women across the preconception, pregnant, and postpartum periods.
The concepts of stigma, weight, healthcare, and women of reproductive age were combined and searched in five databases (Ovid Medline, PsycINFO, Web of Science, Scopus, CINAHL) and 12 gray literature sources. Inclusion criteria consisted of any peer-reviewed study or government policy that described a structural element within healthcare (e.g., guidelines, funding, insurance, equipment, physical environment) relevant to women of reproductive age (18-50 years) between 2001 and 2023. A narrative synthesis using a convergent approach was employed to analyze results.
A total of 70 studies were included in this review; 24 qualitative, 21 quantitative, 10 policies, 3 dissertations, and one mixed-method study. Structural weight stigma in healthcare presented across: 1) institutional policies that are weight-centric and often placed women in larger bodies on "high-risk" pathways; 2) the lack of government funding and insurance coverage for weight-related services; 3) uncertainty amongst healthcare professions regarding their roles and responsibilities, 4) stigmatizing physical environments; and 5) lack of appropriately sized equipment.
Structural weight stigma impacting preconception, pregnant and postpartum women living in larger bodies was highly prevalent. Reducing structural weight stigma is important to improve healthcare access and improve the quality of care.
育龄女性面临的结构性体重歧视会限制她们获得医疗保健的机会，并增加身心健康方面的担忧，还会产生不良的代际影响。本系统综述的目的是综合医疗保健中结构性体重歧视的证据，并确定其如何影响孕前、孕期和产后女性的护理。
将歧视、体重、医疗保健和育龄女性的概念相结合，在五个数据库（Ovid Medline、PsycINFO、科学网、Scopus、护理学与健康领域数据库）和12个灰色文献来源中进行检索。纳入标准包括2001年至2023年间任何描述医疗保健中与育龄女性（18至50岁）相关的结构性要素（如指南、资金、保险、设备、物理环境）的同行评审研究或政府政策。采用趋同方法进行叙述性综合分析结果。
本综述共纳入70项研究；其中24项定性研究、21项定量研究、10项政策研究、3项学位论文和1项混合方法研究。医疗保健中的结构性体重歧视体现在以下方面：1）以体重为中心的机构政策，这些政策常常将体型较大的女性置于“高风险”路径；2）缺乏与体重相关服务的政府资金和保险覆盖；3）医疗行业对其角色和责任存在不确定性；4）带有歧视性的物理环境；5）缺乏尺寸合适的设备。
影响体型较大的孕前、孕期和产后女性的结构性体重歧视非常普遍。减少结构性体重歧视对于改善医疗保健可及性和提高护理质量至关重要。
