Mapping the Beneficial and Adverse Consequences of Receiving Weight-Related Advice from a Healthcare Provider: Identifying Strategies to Optimize Well-Being

Abstract

It is standard practice for healthcare providers to recommend weight loss to patients with obesity (U.S. Preventive Services Task Force). However, it is possible that people with higher weight perceive these interactions as stigmatizing even if providers are well-intentioned when delivering weight-related advice. To the extent that weight-related advice is perceived as stigmatizing, the advice itself may undermine patients' health via stress, reduced engagement in health behaviors, and healthcare avoidance. In a series of three studies, I examined the immediate consequences of receiving weight-related advice from a healthcare provider on weight-based identity threat and behavioral motivation. In Study 1, I used a doctor-patient interaction scenario study to document people's responses to weight-related advice (versus control advice) from a healthcare provider. Participants who received weight-related advice reported greater weight-based identity threat (ps < 0.001 across three measures) and greater motivation to change their eating behavior (p < 0.001). In Study 2, participants were randomly assigned to read scenarios in which the provider: (a) requested consent to discuss weight (or did not); (b) framed behavioral recommendations around overall health (or around weight loss). These strategies were designed to maximize the motivational benefit and minimize the weight-based identity threat caused by weight-related advice. However, there were no significant differences in these outcomes based on study condition (ps > 0.48). In Study 3, undergraduates with higher weight (BMI > 25 kg/m2) attended a “student wellness check-in,” during which a trained research assistant gave them “standard” weight-related advice, “optimized” weight-related advice (i.e., in which the research assistant requested consent and used a health frame), or no weight-related advice. Receiving weight-related advice led to significantly greater weight-based identity threat and behavioral motivation (ps < 0.02), but there were no differences in threat or motivation between the standard and optimized weight-related advice groups (ps > 0.17). Taken together, these studies indicate that well-intentioned weight-related advice from healthcare providers can be perceived as stigmatizing, even when motivating. Further investigation is needed to identify strategies that reduce patients' experience of weight-based identity threat, especially because weight stigma may undermine the motivational benefits of weight-related advice and harm people's health.