Weight Stigma in the Diabetes Clinic: Measured Consequences for Attendance and Self-Management
DOI:
https://doi.org/10.5281/zenodo.22238770Keywords:
Weight stigma, Internalised weight bias, Diabetes stigma, Clinic attendance, Health care avoidanceAbstract
Weight stigma is discussed in diabetes care mainly as a matter of courtesy. The published evidence describes something with
measurable clinical consequences. In a weight management clinic followed for six months, a third of patients did not return after
the first consultation, and those who dropped out had higher internalised weight bias scores at that first visit. In a survey of 857
adults with type 2 diabetes, those with an elevated HbA1c reported greater weight and diabetes stigma than those within the
standard-of-care range. In 3,821 adults, enacted weight stigma was associated with delay or avoidance of health care after
adjustment for body mass index, and a six-country study of 13,996 adults found the effect of experienced stigma on care avoidance
ran partly through internalised bias. Two problems limit what can be concluded. Almost all of this evidence is cross-sectional and
self-reported, so the direction of the association with HbA1c is unresolved. And every study recruits people still engaged with
services, which excludes precisely those in whom avoidance is complete.
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