Document Type

Dissertation

Degree

Doctor of Philosophy (PhD)

Major/Program

Dietetics and Nutrition

First Advisor's Name

Fatma Huffman

First Advisor's Committee Title

Committee chair

Second Advisor's Name

Elena Bastida

Second Advisor's Committee Title

Committee member

Third Advisor's Name

Tan Li

Third Advisor's Committee Title

Committee member

Fourth Advisor's Name

Adriana Campa

Fourth Advisor's Committee Title

Committee member

Keywords

medical education, medicine and health sciences, nutrition, social and behavioral sciences

Date of Defense

11-9-2022

Abstract

Introduction

Interactions that involve a woman’s body weight in a health care setting elicit emotions that can affect food and exercise behaviors and health outcomes. This study explored body weight related interactions between women that have prediabetes and type 2 diabetes with health care professionals. Body weight related interactions were analyzed from the women’s perspective, exploring how the interactions affected their feelings, cognition, self-efficacy, and health related actions. Experiences involving weight bias in a health care setting were identified and the possible association between internalized weight bias and eating disorder symptoms was investigated.

Methods

This convergent mixed-method, grounded theory study integrated survey data and narrative interviews. Participants completed the Weight Bias Internalization Survey (WBIS) and the Eating Disorder Examination Questionnaire (EDEQ). Interviews explored the women’s experiences interacting with health care professionals about their body weight. The investigation included the effects of the menopausal transition and diabetes counseling on these interactions.

Results:

The sample included 30 women, mean age 63 ± 10.07 years, 67.7% white Hispanics, and mean BMI 35.22 ± 6.75. Linear regression analysis found an association between internalized weight bias (WBIS scores) and eating disorder symptoms (EDEQ scores). An inverse relationship was found between WBIS scores and the participant’s age. No correlation was found between WBIS scores and the participant’s body mass index. Ninety body weight interactions were identified in the interview data, 66.7% of the body weight related interactions involved weight bias. Four common themes emerged: “Gutted”: Negative feelings after body weight-related interactions with health care professionals, “Adrift and ineffective”: Lack of understanding and reduced self-efficacy, “Behavioral inertia”: Lack of food and exercise behavioral changes and “Going solo”: Break in therapeutic relationships and resistance to follow-up medical care.

Conclusion

This study identified a need for improvements in the way health care professionals interact with middle-aged women about their body weight. Experiences that increase internalized weight bias can increase a woman’s risk of developing eating disorder symptoms. Based on these findings, health care professionals can begin by addressing their own weight bias and use sensitive communication when discussing body weight. Developing a partnership that identifies barriers to care and addresses each woman’s individual needs can lead to effective behavior changes that improve health and wellbeing.

Identifier

FIDC010942

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