Internalized Weight Stigma as a Mediator Between Past Weight Stigma and Current Healthcare Avoidance/Comfort in Seeking Medical Care

Research has found that medical providers such as physicians, nurses, and medical support staff may contribute to externalized weight stigma directed toward youth (Garcia et al., 2016; Gorlick et al., 2021). Individuals who have encountered weight stigmatization may internalize those experiences, leading to psychological, physical, and behavioral changes that reduce their quality of life (Palad et al., 2019; Romano et al., 2023; Tanas et al., 2022; Zancu & Diaconu-Gherasim, 2023). However, little is known about how historical externalized weight stigma from medical providers relates to future healthcare access behaviors. This study examined whether internalized weight stigma mediated two relationships: First, childhood and adolescent weight stigma from healthcare providers and healthcare avoidance in adulthood, and second, childhood and adolescent weight stigma from healthcare providers and comfort in seeking medical care in adulthood. The initial sample consisted of 543 students, with a final sample size of 488 (Mage = 20.00 years, SD = 4.47) from the University of Nevada, Las Vegas student subject pool. Participants completed measures assessing demographics, past and current experiences of weight stigma in healthcare settings, internalization of weight stigma, healthcare avoidance, and comfort in seeking medical care. Over half of the sample (56.26%) reported experienced weight stigma from their medical providers during childhood or adolescence, whereas approximately one-third (28.85%) reported experiencing it within the past year as an adult. Results showed that childhood and adolescent weight stigma was significantly associated with both greater healthcare avoidance (B = 0.29, SE = 0.10, p = .003, 95% CI [0.10, 0.49]) and lower comfort in seeking medical care (B = -1.45, SE = 0.49, p = .003, OR = 0.24, 95% CI for OR [0.09, 0.62]) in adulthood. These relationships were fully mediated by internalized weight stigma. These findings suggest that children and adolescents who internalized experienced weight stigma from medical providers were more likely to avoid medical care and felt less comfortable seeking it as adults. These results demonstrate the need for greater medical provider education, weight-neutral practices, and stigma-reducing policies aimed at decreasing internalized weight stigma and, in turn, reducing healthcare avoidance and improving comfort in seeking medical care. Additionally, early supportive interventions for individuals who have already experienced weight-related stigma in the healthcare settings may be critical in mitigating the internalization of weight stigma and its long-term effects on healthcare engagement.