“It Makes Me Feel Bad About the World of Medicine, Makes Me Not Want to Go”: Understanding Weight Stigma, Disconfirming Messages and Health Outcomes

Weight stigma in healthcare is pervasive, and its presence in healthcare interactions contributes to breakdowns in communication between patients and providers. This study sought to better understand and explain the disconfirming experiences of individuals with larger bodies during weight-related discussions with healthcare providers. Ten in-depth interviews and two focus groups, consisting of nine and six additional participants, were collected. Two levels of coding were performed. Qualitative descriptive analysis revealed two themes of disconfirming communication: (a) minimizing effort or struggle, and (b) undermining agency. The second level applied an a priori thematic analysis to categorize the disconfirming message types using Sieburg's previously established typology, which were largely classified as (a) impervious and (b) disqualifying. Additionally, the findings suggest several maladaptive health outcomes associated with disconfirming communication during weight-related conversations, including (a) diminished trust in therapeutic relationships, (b) emotional and psychological distress, and (c) disrupted care. Theoretical and practical insights are discussed to address weight stigma and improve patient care and communication with individuals with larger bodies.