“Constantly justifying my existence”: Lower-income, higher-weight Canadian adults’ stigma coping mechanisms

Submitted: 15 March 2024
Accepted: 18 September 2024
Published: 20 November 2024
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PDF: 39
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Individuals who are higher-weight and low-income may disproportionately experience weight and income stigmas in healthcare experiences compared to lower-weight, higher-income individuals. The ways that weight and income stigmas interact in healthcare should be better understood in order to provide better, less stigmatizing care to higher-weight, low-income patients. This study assesses how patients manage stigmatizing experiences in both healthcare and everyday experiences and how that impacts health seeking and stigma management behaviors through semistructured interviews with 11 higher-weight (Body Mass Index ≥30), low-income adults (≥18 years of age) in an Atlantic Canadian province. Participants took part in two interviews that focused on healthcare experiences and both positive and negative places/spaces. The two face-to-face interviews for each participant (total 21 interviews) were audio-recorded and professionally transcribed verbatim. The transcripts were analyzed using thematic analysis to identify recurring concepts and patterns within the data. Two major themes emerged from the data, uptake of stigmatizing, neoliberal health messaging and coping with stigma. Coping with stigma included subthemes control over stigmatizing experiences and stoicism in the face of stigma. The findings suggest that individuals understand their health and wellness through a neoliberal lens and that they deploy strategies of control and stoicism to cope with the stigmas they face.

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Alberga, A. S., Edache, I. Y., Forhan, M., & Russell-Mayhew, S. (2019). Weight bias and health care utilization: A scoping review. Primary Health Care Research & Development, 20(e116). DOI: https://doi.org/10.1017/S1463423619000227
Allen, H., Wright, B. J., Harding, K., & Broffman, L. (2014). The role of stigma in access to health care for the poor. The Milbank Quarterly, 92(2), 289–318. DOI: https://doi.org/10.1111/1468-0009.12059
Amy, N. K., Aalborg, A., Lyons, P., & Keranen, L. (2006). Barriers to routine gynecological cancer screening for White and African-American obese women. International journal of obesity, 30(1), 147-155. DOI: https://doi.org/10.1038/sj.ijo.0803105
Bacon, L., & Aphramor, L. (2011). Weight science: Evaluating the evidence for a paradigm shift. Nutrition Journal, 10(1), 1-13. DOI: https://doi.org/10.1186/1475-2891-10-9
Bombak, A. E., Chinho, N., Thomson, L., Burk, C., Akhter, S., O'Keefe, K., & Turner, L. (2024). Bright-siding stigma: Older adults' experiences at a higher weight in Atlantic Canada. Health, 13634593241238869. Advance online publication. https://doi.org/10.1177/13634593241238869 DOI: https://doi.org/10.1177/13634593241238869
Bombak, A., McPhail, D., & Ward, P. (2016). Reproducing stigma: Interpreting “overweight” and “obese” women's experiences of weight-based discrimination in reproductive healthcare. Social Science, 166, 94-101. DOI: https://doi.org/10.1016/j.socscimed.2016.08.015
Bombak, A., Turner, L., Thomson, L., O'Keefe, K., Chinho, N., Burk, C., & Akhter, S. (2024, 07/19). “You're Just Too Much”: Higher-Weight Sexual and Gender Minorities’ Experiences of Stigma in Atlantic Canada. Journal of Critical Dietetics, 7, 139-185. DOI: https://doi.org/10.32920/jcd.v7i2.1922
Bringer, J., Johnston, L., & Brackenridge, C. (2006). Using computer-assisted qualitative data analysis software to develop a grounded theory project. Field Methods, 18(3), 245-266. DOI: https://doi.org/10.1177/1525822X06287602
Bronner, S. E. (2011). Critical Theory: a Very Short Introduction. Oxford University Press, USA. http://www.SLQ.eblib.com.au/patron/FullRecord.aspx?p=679437 DOI: https://doi.org/10.1093/actrade/9780199730070.001.0001
Cagle, J., & Bunting, M. (2017). Patient reluctance to discuss pain: Understanding stoicism, stigma, and other contributing factors. Journal of Social Work in End-Of-Life & Palliative Care, 13(1), 27–43. DOI: https://doi.org/10.1080/15524256.2017.1282917
Campbell, S., Greenwood, M., Prior, S., Shearer, T., Walkem, K., Young, S., ... & Walker, K. (2020). Purposive sampling: complex or simple? Research case examples. Journal of research in Nursing, 25(8), 652-661. DOI: https://doi.org/10.1177/1744987120927206
Carastathis, A. (2014). The concept of intersectionality in feminist theory: The concept of intersectionality in feminist theory. Philosophy Compass, 9(5), 304–314. DOI: https://doi.org/10.1111/phc3.12129
Collins, P. H., da Silva, E. C. G., Ergun, E., Furseth, I., Bond, K.D., Martínez-Palacios, J. (2021). Intersectionality as a critical social theory: critical exchange. Contemporary Political Theory, 20, 690-725. DOI: https://doi.org/10.1057/s41296-021-00490-0
Colls, R., & Evans, B. (2014). Making space for fat bodies?: A critical account of ‘the obesogenic environment’. Progress in Human Geography, 38(6), 733-753. DOI: https://doi.org/10.1177/0309132513500373
Cooper, C. (2010). Fat studies: Mapping the field. Sociology Compass, 4(12), 1020-1034. DOI: https://doi.org/10.1111/j.1751-9020.2010.00336.x
Crawford, R. (1980). Healthism and the medicalization of everyday life. International Journal of Health Services, 10(3), 365-388. DOI: https://doi.org/10.2190/3H2H-3XJN-3KAY-G9NY
Crenshaw, K. (1989). Demarginalizing the intersection of race and sex: A black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. In K. Maschke (ed.) (1997)s, Feminist Legal Theories (pp. 23-41). Routledge. DOI: https://doi.org/10.1093/oso/9780198782063.003.0016
Creswell, J. W., & Poth, C. N. (2007). Qualitative inquiry and research design: Choosing among five approaches. Sage publications.
Devetak, R. (2013). Critical theory. In Theories of international relations (pp. 162-186). Palgrave, London. DOI: https://doi.org/10.1007/978-1-137-31136-8_7
Durante, F., & Fiske, S. T. (2017). How social-class stereotypes maintain inequality. Current Opinion in Psychology, 18, 43-48. DOI: https://doi.org/10.1016/j.copsyc.2017.07.033
Emerson, R. M., Fretz, R. I., & Shaw, L. L. (2011). Writing ethnographic fieldnotes. University of Chicago Press. DOI: https://doi.org/10.7208/chicago/9780226206868.001.0001
Farrell, L. C., Warin, M. J., Moore, V. M., & Street, J. M. (2016). Socio-economic divergence in public opinions about preventive obesity regulations: Is the 140 purpose to ‘make some things cheaper, more affordable’ or to ‘help them get over their own ignorance’?. Social Science & Medicine, 154, 1-8. DOI: https://doi.org/10.1016/j.socscimed.2016.02.028
Ferrante, J. M., Ohman-Strickland, P., Hudson, S. V., Hahn, K. A., Scott, J. G., & Crabtree, B. F. (2006). Colorectal cancer screening among obese versus non-obese patients in primary care practices. Cancer detection and prevention, 30(5), 459–465. DOI: https://doi.org/10.1016/j.cdp.2006.09.003
Gard, M., & Wright, J. (2005). The obesity epidemic: Science, morality and ideology. Routledge. DOI: https://doi.org/10.4324/9780203619308
Godley, J., & McLaren, L. (2010). Socioeconomic status and body mass index in Canada: Exploring measures and mechanisms. Canadian Review of Sociology/Revue canadienne de sociologie, 47(4), 381-403. DOI: https://doi.org/10.1111/j.1755-618X.2010.01244.x
Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Prentice-Hall.
Harwood, A., Carter, D., & Eliott, J. (2022). A public health framework for reducing stigma: the example of weight stigma. Journal of bioethical inquiry, 19(3), 511–520. DOI: https://doi.org/10.1007/s11673-022-10199-3
Heijnders, M., & Van Der Meij, S. (2006). The fight against stigma: An overview of stigma-reduction strategies and interventions. Psychology, Health & Medicine, 11(3), 353-363. DOI: https://doi.org/10.1080/13548500600595327
Joy, E., Braun, V. & Clarke, V. (2023). Doing reflexive thematic analysis: A reflexive account. In F. Meyer & K. Meissel (Eds.), Research Methods in Education, Social Work, and Counselling (pp. 155-171). New Zealand Council for Educational Research Press.
Kaba, R., Sooriakumaran, P. (2007). The evolution of the doctor-patient relationship. Internationa Journal of Surgery, 5(1), 57-65. DOI: https://doi.org/10.1016/j.ijsu.2006.01.005
Kaufman, J. M., & Johnson, C. (2004). Stigmatized individuals and the process of identity. The Sociological Quarterly, 45(4), 807–833. DOI: https://doi.org/10.1111/j.1533-8525.2004.tb02315.x
Kirkland, A. (2011). The environmental account of obesity: A case for feminist skepticism. Signs, 36(2), 463-485. DOI: https://doi.org/10.1086/655916
Latimer, M., Young, S., Dell, C., & Finley, G. A. (2012). Aboriginal children and physical pain: What do we know?. International Journal of Indigenous Health, 9(1), 7-14. DOI: https://doi.org/10.18357/ijih91201212389
Latimer, M., Finley, G. A., Rudderham, S., Inglis, S., Francis, J., Young, S., & Hutt-MacLeod, D. (2014). Expression of pain among Mi'kmaq children in one Atlantic Canadian community: A qualitative study. CMAJ open, 2(3), E133–E138. DOI: https://doi.org/10.9778/cmajo.20130086
LeBesco, K. (2011). Neoliberalism, public health, and the moral perils of fatness. Critical public health, 21(2), 153-164. DOI: https://doi.org/10.1080/09581596.2010.529422
LeCompte, M. D., & Schensul, J. J. (2010). Designing and conducting ethnographic research: An introduction (Vol. 1). Rowman Altamira.
Legard, R., Keegan, J., & Ward, K. (2003). In-depth interviews. In Ritchie, J. & Lewis, J. (eds.), Qualitative research practice: A guide for social science students and researchers (pp. 138-169). SAGE Publications.
Link, B. G., & Phelan, J. C. (2001). Conceptualizing Stigma. Annual Review of Sociology, 27(1), 363-385 DOI: https://doi.org/10.1146/annurev.soc.27.1.363
McGregor, S. (2001). Neoliberalism and health care. International Journal of Consumer Studies, 25(2), 82-89. DOI: https://doi.org/10.1111/j.1470-6431.2001.00183.x
Meadows, A., & Daníelsdóttir, S. (2016). What's in a word? On weight stigma and terminology [Opinion]. Frontiers in Psychology, 7(1527). DOI: https://doi.org/10.3389/fpsyg.2016.01527
Mensinger, J. L., Tylka, T. L., & Calamari, M. E. (2018). Mechanisms underlying weight status and healthcare avoidance in women: A study of weight stigma, body related shame and guilt, and healthcare stress. Body Image, 25, 139-147. DOI: https://doi.org/10.1016/j.bodyim.2018.03.001
Mitchell, R. S., Padwal, R. S., Chuck, A. W., & Klarenbach, S. W. (2008). Cancer screening among the overweight and obese in Canada. American journal of preventive medicine, 35(2), 127–132. DOI: https://doi.org/10.1016/j.amepre.2008.03.031
Monaghan, L. F., Bombak, A. E., & Rich, E. (2018). Obesity, neoliberalism and epidemic psychology: Critical commentary and alternative approaches to public health. Critical Public Health, 28(5), 498-508. DOI: https://doi.org/10.1080/09581596.2017.1371278
Monaghan, L. F., Rich, E., & Bombak, A. E. (2022). Rethinking obesity: Critical perspectives in crisis times. Routledge. DOI: https://doi.org/10.4324/9781315658087
Moore, A., Grime, J., Campbell, P., & Richardson, J. (2012). Troubling stoicism: Sociocultural influences and applications to health and illness behavior. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, 17(2), 159–73. DOI: https://doi.org/10.1177/1363459312451179
Morgan, D. L., & Nica, A. (2020). Iterative thematic inquiry: A new method for analyzing qualitative data. International Journal of Qualitative Methods, 19. DOI: https://doi.org/10.1177/1609406920955118
Odero, A., Pongy, M., Chauvel, L., Voz, B., Spitz, E., Pétré, B., & Baumann, M. (2020). Core values that influence the patient-healthcare professional power dynamic: Steering interaction towards partnership. International Journal Of Environmental Research And Public Health, 17(22), 8458. DOI: https://doi.org/10.3390/ijerph17228458
Palinkas, L. A., Horwitz, S. M., Green, C. A., Wisdom, J. P., Duan, N., & Hoagwood, K. (2015). Purposeful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implementation Research. Administration and policy in mental health, 42(5), 533–544. DOI: https://doi.org/10.1007/s10488-013-0528-y
Pathak E. B., Wieten S. E., Wheldon C.W. (2017). Stoic beliefs and health: Development and preliminary validation of the Pathak-Wieten Stoicism Ideology Scale. BMJ Open, 7:e015137. DOI: https://doi.org/10.1136/bmjopen-2016-015137
Pausé, C. (2014). Die another day: The obstacles facing fat people in accessing quality healthcare. Narrative Inquiry in Bioethics, 4(2), 135-141. DOI: https://doi.org/10.1353/nib.2014.0039
Puhl, R., & Brownell, K. D. (2001). Bias, discrimination, and obesity. Obesity research, 9(12), 788–805. DOI: https://doi.org/10.1038/oby.2001.108
Puhl, R. M., & Heuer, C. A. (2009). Weight bias: a review and update. Obesity (Silver Spring), 17(5), 941-964. DOI: https://doi.org/10.1038/oby.2008.636
Puhl, R. M., & Heuer, C. A. (2010). Obesity stigma: Important considerations for public health. American Journal of Public Health, 100(6), 1019-1028. DOI: https://doi.org/10.2105/AJPH.2009.159491
Raisborough, J. (2016) Fat bodies, health and the media. Palgrave Macmillan UK. DOI: https://doi.org/10.1057/978-1-137-28887-5
Raphael, D. (2016). Social determinants of health: canadian perspectives (Third). Canadian Scholars’ Press.
Rich, E., Evans, J. ‘Fat Ethics’ – The Obesity Discourse and Body Politics. Soc Theory Health 3, 341–358 (2005). DOI: https://doi.org/10.1057/palgrave.sth.8700057
Ruckert, A., Huynh, C., & Labonté, R. (2018). Reducing health inequities: Is universal basic income the way forward?. Journal of Public Health, 40(1), 3-7. DOI: https://doi.org/10.1093/pubmed/fdx006
Russell, E.-J. (2024). Certainty in an Uncertain World: Toward A Critical Theory of Opinion. Critical Sociology, 50(4-5), 691-706. DOI: https://doi.org/10.1177/08969205231214806
Ryan, G. W., & Bernard, H. R. (2003). Techniques to identify themes. Field Methods, 15(1):85-109. DOI: https://doi.org/10.1177/1525822X02239569
Ryoo, J. J., & Crawford, J. (2023). Critical theory in qualitative research in education. In Tierney, R., Rizvi, F., & Ercikan, K. (Eds.), International Encyclopedia of Education (Fourth Edition) (pp. 1-10). Elsevier. DOI: https://doi.org/10.1016/B978-0-12-818630-5.11082-6
Ryoo, J. J., & McLaren, P. (2010). Critical theory. In Peterson, P., Baker, E., & McGraw, B. (Eds.), International Encyclopedia of Education (Third Edition) (pp. 348-353). Elsevier. DOI: https://doi.org/10.1016/B978-0-08-044894-7.01388-9
Szasz, T. S., & Hollender, M. H. (1956). A contribution to the philosophy of medicine: The basic models of the doctor-patient relationship. A.M.A. Archives of Internal Medicine, 97(5), 585–592. DOI: https://doi.org/10.1001/archinte.1956.00250230079008
Thornicroft, G., Rose, D., Kassam, A., & Sartorius, N. (2007). Stigma: ignorance, prejudice or discrimination?. The British journal of psychiatry : the journal of mental science, 190, 192–193. DOI: https://doi.org/10.1192/bjp.bp.106.025791
Tylka, T. L., Annunziato, R. A., Burgard, D., Daníelsdóttir, S., Shuman, E., Davis, C., & Calogero, R. M. (2014). The weight-inclusive versus weight-normative approach to health: Evaluating the evidence for prioritizing well-being over weight loss. Journal of Obesity, 2014, 983495. DOI: https://doi.org/10.1155/2014/983495
Veatch, R. M. (2000). Doctor does not know best: Why in the new century physicians must stop trying to benefit patients. The Journal of Medicine and Philosophy, 25(6), 701–21. DOI: https://doi.org/10.1076/jmep.25.6.701.6126
Weis, D., & Willems, H. (2017). Aggregation, validation, and generalization of qualitative data-methodological and practical research strategies illustrated by the research process of an empirically based typology. Integrative Psychological and Behavioral Science, 51(2), 223-243. DOI: https://doi.org/10.1007/s12124-016-9372-4
Windsong, E. A. (2016). Incorporating intersectionality into research design: An example using qualitative interviews. International Journal of Social Research Methodology, 21(2), 135-147. DOI: https://doi.org/10.1080/13645579.2016.1268361
Yong, H. H., Gibson, S. J., de L. Horne, D. J., & Helme, R. D. (2001). Development of a pain attitudes questionnaire to assess stoicism and cautiousness for possible age differences. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 56(5), P279-P284. DOI: https://doi.org/10.1093/geronb/56.5.P279

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New Brunswick Health Research Foundation

How to Cite

Turner, Lee, and Andrea E. Bombak. 2024. “‘Constantly Justifying My existence’: Lower-Income, Higher-Weight Canadian adults’ Stigma Coping Mechanisms”. Qualitative Research in Medicine and Healthcare 8 (3). https://doi.org/10.4081/qrmh.2024.12480.