In a recent study published in the journal eClinical Medicine, researchers in the United States reported findings of qualitative research that they pursued to understand the perceived impact of weight stigma and weight-neutral care among women receiving treatment for binge eating disorder (BED) with type 2 diabetes. BED is the most common eating disorder in the United States (US).
Study: Women’s perceptions of weight stigma and experiences of weight-neutral treatment for binge eating disorder: A qualitative study. Image Credit: New Africa / Shutterstock
Background
Weight-based discrimination or bias due to higher weight, which includes negative attitudes, beliefs, and judgments, adversely affects the mental and physical health of affected individuals, especially women. Studies have specifically associated perceived weight discrimination with approximately 1.3 higher odds of type 2 diabetes, especially in women with higher body mass index (BMI).
Though weight stigma is concerning from public health perspective, experiencing it in healthcare settings could be much more devastating. BED patients, like type 2 diabetes patients, have often reported being judged and shamed for their weight by healthcare providers. Receiving low-quality clinical care could result in healthcare avoidance.
Thus, a better understanding of the occurrence and sequelae of weight stigma is needed, focused on supporting health-related behavior change rather than weight loss per se. Empirical evaluation of the effectiveness of weight-neutral interventions is ongoing; however, the literature regarding the same is limited and includes only small studies with no robust findings.
A recent systematic review found that health-related interventions based on a weight-neutral model led to positive psychological and eating behavior outcomes. However, little is known about patients’ actual experiences in weight-neutral treatment settings.
About the study
In the present study, researchers screened 319 medical records of admissions to the intensive outpatient program (IOP) held in Massachusetts between Jan 1, 2015, and Apr 30, 2019. They sent recruitment letters to invite participants (all women) who received BED treatment under this IOP. The inclusion criteria also mandated that these patients had type 2 diabetes, completed over two weeks of IOP, and got discharged at least six months before enrolling in the present study. Importantly, this program provided weight-neutral treatment.
All participating women attended a 60-minute in-person visit at the treatment center, where the researchers used purposive sampling to conduct interviews. With these, they collected patient-level qualitative data about their perception of primary healthcare versus weight-neutral healthcare services concerning body weight and weight stigma.
The team used thematic analysis to de-identify interview transcripts and entered marked transcripts into NVivo software to organize and facilitate the theme grouping. Next, they applied the Standards for Reporting Qualitative Research (SRQR) checklist to support methodological rigor in reporting these findings.
Study findings
Regarding prior healthcare treatments, the study participants reported experiencing weight stigma, which they felt diminished the quality of care they received. It triggered feelings of embarrassment and a sense of failure while they attempted to lose weight.
On the contrary, while attending a BED IOP providing care in a weight-neutral setting, participants felt adequately supported, which helped them attain consistency in their eating patterns. Accordingly, they experienced fewer binge eating episodes and alleviated feelings of shame and negative self-perceptions.
The researchers also noted that some participants found the lack of the quest for weight loss stressful. Thus, healthcare providers practicing within a weight-neutral paradigm should understand how some patients view losing weight as important based on cultural and societal factors.
Nevertheless, most participants, including people with type 2 diabetes, found this holistic person-centered care and multidisciplinary support offered under the weight-neutral paradigm more effective than just a prescription for weight loss. Notably, participants in this study also reported that their healthcare providers advocated decreasing the focus on weight, which improved their patient–provider relationship.
Healthcare providers incorporating weight-neutral care built a safe healthcare environment. They encouraged patient inquest and participation in recognizing healthcare priorities. They shifted conversations to other aspects of health, e.g., mental health and behavioral patterns, which is particularly relevant to clinical practice.
Conclusions
This research brings forth novel findings about the perceived effect of healthcare in a weight-neutral treatment paradigm. Weight-neutral treatment may improve psychological and behavioral outcomes regarding binge eating, and longitudinal and quantitative research is needed. These findings could help decrease weight stigma in provider–patient conversations.
One of the most remarkable findings of this study was that participants described their experiences in great detail while receiving weight-neutral treatment; for instance, the program enhanced feelings of self-efficacy. Also, they found the program flexible, which gave them a free hand in making diet-related decisions.
In this treatment setting, though some patients reduced binge eating behaviors during the program, their experiences also showed a non-linear pattern during the recovery phase. Since one treatment episode cannot cease binge eating fully, there is an urgent need for sustained support for BED treatment and diet therapy across all settings.
To summarize, an overemphasis on weight loss can backfire and have unintended repercussions, including decreased diabetes self-care and worsening physical and mental health of some patients. Indeed, societal attitudes and beliefs of patients receiving weight-neutral care could improve or worsen the impact of weight stigma.
