PMID- 35388341
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230606
IS  - 2055-2238 (Electronic)
IS  - 2055-2238 (Linking)
VI  - 8
IP  - 2
DP  - 2022 Apr
TI  - A model of weight-based stigma in health care and utilization outcomes: Evidence 
      from the learning health systems network.
PG  - 139-146
LID - 10.1002/osp4.553 [doi]
AB  - OBJECTIVE: Obesity is stigmatized and people with obesity report experiencing 
      stigmatizing situations when seeking health care. The implications of these 
      experiences are not well understood. This study tests an indirect effects model 
      of negative care experiences as an intermediate variable between obesity and care 
      avoidance/utilization and switching primary care doctors. METHODS: A survey was 
      completed by 2380 primary care patients in the Learning Health Systems Network 
      (LHSNet) Clinical Data Research Network with a BMI >25 kg/m(2). Measures included 
      scales assessing stigmatizing situations, perceived patient-centered 
      communication, perceived respect, having delayed needed care, and having looked 
      for a new primary doctor in the past 12 months. Sequential and serial indirect 
      effects of care experiences and respect in the association between BMI and care 
      utilization outcomes was modeled. RESULTS: The hypothesized model was supported 
      by findings. The associations between BMI and delaying needed care (OR = 1.06, 
      p < 0.001) and attempting to switch primary doctors (OR = 1.02, p = 0.04) was 
      mediated by both stigmatizing situations experienced in a health care context and 
      lower patient-centered communication. Lower perceived respect mediated the 
      association between care experiences and utilization outcomes. CONCLUSIONS: 
      People with higher BMIs may avoid care or switch doctors as a result of 
      stigmatizing experiences and poor communication with doctors. These outcomes may 
      contribute to morbidity in people with obesity if they delay or avoid care for 
      health concerns when symptoms first present.
CI  - (c) 2021 The Authors. Obesity Science & Practice published by World Obesity and The 
      Obesity Society and John Wiley & Sons Ltd.
FAU - Phelan, Sean M
AU  - Phelan SM
AUID- ORCID: 0000-0003-2091-6297
AD  - Division of Health Care Delivery Research Mayo Clinic Rochester Minnesota USA.
AD  - Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery 
      Mayo Clinic Rochester Minnesota USA.
FAU - Bauer, Katherine W
AU  - Bauer KW
AD  - Department of Nutritional Sciences University of Michigan School of Public Health 
      Ann Arbor Michigan USA.
FAU - Bradley, David
AU  - Bradley D
AD  - The Ohio State Wexner Medical Center Columbus Ohio USA.
FAU - Bradley, Steven M
AU  - Bradley SM
AD  - Minneapolis Heart Institute and Minneapolis Heart Institute Foundation 
      Minneapolis Minnesota USA.
FAU - Haller, Irina V
AU  - Haller IV
AD  - Essentia Institute of Rural Health, Essentia Health Duluth Minnesota USA.
FAU - Mundi, Manpreet S
AU  - Mundi MS
AD  - Division of Endocrinology, Diabetes, Metabolism, and Nutrition Mayo Clinic 
      Rochester Minnesota USA.
FAU - Finney Rutten, Lila J
AU  - Finney Rutten LJ
AD  - Department of Quantitative Health Sciences Mayo Clinic Rochester Minnesota USA.
FAU - Schroeder, Darrell R
AU  - Schroeder DR
AD  - Department of Quantitative Health Sciences Mayo Clinic Rochester Minnesota USA.
FAU - Fischer, Kristin
AU  - Fischer K
AD  - Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery 
      Mayo Clinic Rochester Minnesota USA.
FAU - Croghan, Ivana
AU  - Croghan I
AD  - Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery 
      Mayo Clinic Rochester Minnesota USA.
AD  - Department of Quantitative Health Sciences Mayo Clinic Rochester Minnesota USA.
AD  - Department of Medicine Division of General Internal Medicine Mayo Clinic 
      Rochester Minnesota USA.
LA  - eng
GR  - P30 DK020572/DK/NIDDK NIH HHS/United States
GR  - P30 DK092926/DK/NIDDK NIH HHS/United States
PT  - Journal Article
DEP - 20210827
PL  - United States
TA  - Obes Sci Pract
JT  - Obesity science & practice
JID - 101675151
PMC - PMC8976541
OTO - NOTNLM
OT  - health care utilization
OT  - obesity
OT  - obesity bias
OT  - patient-centered care
OT  - social stigma
COIS- The authors declare no conflict of interest.
EDAT- 2022/04/08 06:00
MHDA- 2022/04/08 06:01
PMCR- 2021/08/27
CRDT- 2022/04/07 05:30
PHST- 2021/04/19 00:00 [received]
PHST- 2021/07/19 00:00 [revised]
PHST- 2021/07/25 00:00 [accepted]
PHST- 2022/04/07 05:30 [entrez]
PHST- 2022/04/08 06:00 [pubmed]
PHST- 2022/04/08 06:01 [medline]
PHST- 2021/08/27 00:00 [pmc-release]
AID - OSP4553 [pii]
AID - 10.1002/osp4.553 [doi]
PST - epublish
SO  - Obes Sci Pract. 2021 Aug 27;8(2):139-146. doi: 10.1002/osp4.553. eCollection 2022 
      Apr.