The Role of Weight Stigma and Internalized Weight Bias in Health Care Avoidance and Mistrust

Weight stigma experienced in health care contexts and internalized weight bias (IWB) may negatively impact the relationships between patients and their health care providers and result in health care avoidance and medical mistrust. This investigation examined whether IWB mediated the relationships between experienced stigma in health care and health care avoidance and trust in one's health care provider. Using a Qualtrics panel, we assessed 435 participants (69.9% White; Mage = 48.9, SDage = 17.4; Mbody mass index = 28.8, SDbody mass index = 7.3) on experienced weight stigma in health care, IWB, trust in health care provider, and health care avoidance via an online survey. Results showed that higher experienced weight stigma in health care was associated with higher IWB. In addition, higher levels of IWB and experienced weight stigma in health care were associated with lower trust in provider and greater proximal and distal health care avoidance. The relationship between experienced weight stigma in health care and trust in one's provider and health care avoidance remained significant after controlling for the effect of IWB. When trust in provider was added as a serial mediator to the models with health care avoidance, the indirect effects of trust in provider on health care avoidance and through IWB were not significant. These findings suggest that the assessment of experienced weight stigma and IWB is warranted to identify patients who might be vulnerable to avoiding health care visits or experiencing decreased trust in providers, which could negatively impact health. Further research is needed on interventions that target health care trust and avoidance via reducing stigma and IWB.