Bariatric Surgery Patients' Perceptions of Weight-Related Stigma in Healthcare Settings Impair Post-surgery Dietary Adherence

Abstract

Background: Weight-related stigma is reported frequently by higher body-weight patients in healthcare settings. Bariatric surgery triggers profound weight loss. This weight loss may therefore alleviate patients' experiences of weight-related stigma within healthcare settings. In non-clinical settings, weight-related stigma is associated with weight-inducing eating patterns. Dietary adherence is a major challenge after bariatric surgery.Objectives: (1) Evaluate the relationship between weight-related stigma and post-surgical dietary adherence; (2) understand if weight loss reduces weight-related stigma, thereby improving post-surgical dietary adherence; and (3) explore provider and patient perspectives on adherence and stigma in healthcare settings.Design: This mixed methods study contrasts survey responses from 300 postoperative bariatric patients with ethnographic data based on interviews with 35 patients and extensive multi-year participant-observation within a clinic setting. The survey measured experiences of weight-related stigma, including from healthcare professionals, on the Interpersonal Sources of Weight Stigma scale and internalized stigma based on the Weight Bias Internalization Scale. Dietary adherence measures included patient self-reports, non-disordered eating patterns reported on the Disordered Eating after Bariatric Surgery scale, and food frequencies. Regression was used to assess the relationships among post-surgical stigma, dietary adherence, and weight loss. Qualitative analyses consisted of thematic analysis.Results: The quantitative data show that internalized stigma and general experiences of weight-related stigma predict worse dietary adherence, even after weight is lost. The qualitative data show patients did not generally recognize this connection, and health professionals explained it as poor patient compliance.Conclusion: Reducing perceptions of weight-related stigma in healthcare settings and weight bias internalization could enhance dietary adherence, regardless of time since patient's weight-loss surgery.

Weight bias internalization and health: a systematic review

“…Across these measures, studies have demonstrated significant correlations between WBI and dietary restraint ( r values = 0.21–0.50), eating concerns ( r values = 0.37–0.64), drive for thinness ( r = 0.47) and measures assessing disinhibition, uncontrolled eating and emotional eating ( r values = 0.46–0.65). Moderate to strong correlations ( r values = 0.29–0.77) were documented for associations between WBI and global or total scores for measures of disordered eating . As with binge eating, measures of eating pathology were associated with WBI in both clinical and community samples and across body weight statuses.…”

“…normal weight, overweight and obesity). Among samples that only included persons with overweight/obesity, 16 studies found significant associations between WBI and BMI or weight status , and 17 found no significant associations . In studies that found significant associations, r values ranged from 0.12 to 0.40.…”

Comment: obesity as a disease – some implications for the World Obesity Federation's advocacy and public health activities

“…Firstly, a medical diagnosis can act to help people to cope with their weight concerns by reducing their internalized stigma or the belief that their problems are self‐inflicted and shameful. Such internalized stigma is itself a barrier to effective weight loss and may impair weight loss maintenance .…”

Micronutrient Deficiencies After Bariatric Surgery: An Emphasis on Vitamins and Trace Minerals

“…Brolin et al 20 reported only one‐third of patients adhered to supplements at 10 years while 8% never took supplements at all. Raves et al 21 surveyed postoperative bariatric patients to measure experiences of weight‐related stigma and demonstrated that internalized stigma and general experiences of weight‐related stigma predicted worse dietary adherence, even after weight loss. Spadola et al 22 reported alcohol abuse was present in 21% of young adults before bariatric surgery (and was a risk factor for increased alcohol use after bariatric surgery) while 4.2% developed alcohol abuse after bariatric surgery.…”