Addressing weight stigma in healthcare settings using an obesity checklist: a mixed-method development study

INTRODUCTION: Experiencing weight stigma negatively impacts health yet remains present in healthcare environments. Hospital environments must be inclusive for people living with obesity (PLwO). The aim of this study was to develop and refine a checklist to increase obesity inclusivity in United Kingdom National Health Service (UK NHS) hospital environments, with input from healthcare professionals (HCPs), researchers, PLwO, and their carers and family members (C/FM). METHODS: This study used a sequential mixed methods approach. Phase 1 used a converging coding matrix to integrate existing checklists and reviewed language for inclusivity. In phase 2, HCPs, researchers, PLwO and C/FM were recruited from professional and patient networks to provide feedback on the integrated checklist using a mixed-methods survey (February-March 2025) and qualitative semi-structured interviews (May-July 2025). Descriptive statistics and deductive and inductive framework analyses were used to identify patterns in the data to inform refinement of the checklist and implementation recommendations (Phase 3). RESULTS: Searches identified five checklists which were integrated, resulting in categories for reading materials, furniture, equipment, and access and infrastructure. Sixty-nine participants completed the survey, and eighteen were interviewed. Overall, participants considered the checklist comprehensive. Integration of the qualitative survey and interview data resulted in four themes: 1) recommendations and thoughts about checklist components, 2) wording, language, images and structure, 3) patient impact and care experiences, 4) implementation barriers and support. Primary implementation barriers related to funding, space, outdated infrastructure, and deep-rooted weight bias. Management buy-in, training, education, endorsement and accreditation schemes were considered facilitators. Twenty recommendations were developed to support hospitals with implementation. CONCLUSION: Findings indicate that a clear, practical, and inclusive checklist could support hospitals in reducing weight stigma and improving care experiences for PLwO. The collaboratively developed and refined checklist offers a practical tool for hospitals to use. However, support will be required for effective and complete implementation.