How can primary care help to reduce weight stigma?

Background: The WHO recently recognised stigma as a fundamental cause for health inequalities. Weight stigma is associated with negative health consequences, and patients experience it commonly in healthcare settings. This study forms part of systematic review that aimed to understand how weight stigma can be reduced through the adoption of whole systems approaches.

Aim: To generate new understandings of the roles primary care can take in reducing weight stigma.

Method: A systematic international literature review of peer-reviewed articles utilising EPPI guidance, and using PICOS terms in Web of Science searches. Recommendations for policy, practice and/or research were extracted and conceptually synthesised as guided by Research Unit for Research Utilisation.

Results: The search identified 194 full texts with 540 total recommendations. Approximately 45% of recommendations (248 of 540) were coded under healthcare, of which 75% were in primary care including general practice (189 of 248). Findings indicate areas where weight stigma could be addressed in primary care: 1) Training; 2) Self-awareness; 3) Non-stigmatising approaches; 4) Formal patient assessments; 5. Coping strategies; 6) Organisational/structural support; 7) Cross-sector working; 8) Anti-discrimination legislation and classify obesity as a disease.

Conclusion: Literature on reducing weight stigma focuses substantially on healthcare, and there is a range of approaches that could be taken. Tensions arise between the medicalisation of obesity and need to consider social determinants of obesity. Healthcare is only one of many settings in which the weight stigma needs to be addressed and whole systems approaches, for example working with local government, are required in particular to reduce health inequalities.