Understanding Racially Diverse Community Member Views of Obesity Stigma and Bariatric Surgery

Abstract

Purpose: The obesity epidemic poses serious challenges to health equity. Despite bariatric surgery being one of the most effective obesity treatments, utilization remains low. In this context, we explored public perceptions of bariatric surgery, centering voices of Black individuals. Materials and Methods: Semi-structured interviews with individuals who have never considered bariatric surgery with purposive sampling to ensure the majority of participants were Black. Transcripts were iteratively analyzed. We employed an Interpretive Description framework to arrive at a collective description of perceptions of bariatric surgery. Results: Thirty-two participants self-identified as 88% female, 72% Black, 3% Hispanic, 3% Pacific Islander, 3% Mixed Race, and 19% White. Participants reported a complex interplay of deeply held, stigmatized beliefs about identity. According to the stigma, persons with obesity lacked willpower and thus were considered devalued. Participants internalized this stigma, describing themselves with words like “glutton,” “lazy,” and “slack off.” Because stigma caused participants to view obesity as resulting from personal failings alone, socially acceptable ways to lose weight were discipline through diet and exercise. Working for weight loss was “self-love, self-discipline, and determination.” Thus, bariatric surgery was illegitimate, a “shortcut to weight loss” or “easy way out,” since it was outside acceptable methods of effort. Conclusion: This qualitative study of community members who qualify for bariatric surgery shows obesity stigma was the main reason individuals rejected bariatric surgery. Obesity was stigmatizing, but undergoing bariatric surgery would further stigmatize individuals. Thus, healthcare providers may be instrumental in increasing bariatric surgery uptake by shifting social discourse from stigmatized notions of obesity towards one focusing on health. Graphical Abstract: [Figure not available: see fulltext.]