Weight stigma in healthcare in Aotearoa : Pacific women’s voice : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Nutrition and Dietetics at Massey University, Albany, New Zealand

Abstract

This thesis is an exploratory study of the phenomenon of weight stigma in healthcare settings towards larger Pacific women living in Aotearoa New Zealand. It explores their experiences of weight stigma, how these experiences have impacted their health and wellbeing, shaped their views on health and self, and their perspectives on how healthcare should be delivered to prevent weight stigma. Weight stigma has become an area of increasing interest within the health and scientific community. Research indicate that weight stigma has significant physiological and psychological impacts on health, yet our health system continues to prioritise weight-centric measures and responses to health. As there are numerous ways in which the health system does not adequately serve larger bodied Pacific peoples, this research seeks to examine how weight stigma compounds their poor healthcare experiences. Young Pacific women are not immune to society’s fixation on body weight. There are myriad social, health and cultural forces which increase preoccupation with weight, body size, body image and health. However, to date, no research has explored Pacific women’s experiences of weight stigma in healthcare contexts. Guided by the methodological framework of Talanoa, the study involved individual talanoa with 10 Pacific women (aged 28-65) throughout Aotearoa who reported experiences of weight stigma in healthcare settings. Phenomenology, the Fonua model (a Tongan health framework), and Talanoa epistemology provided the theoretical lens, ensuring a holistic and culturally grounded analysis. The talanoa were conducted in person or via Zoomᵀᴹ, then were recorded, transcribed verbatim and analysed using reflexive thematic analysis. The themes were presented as composite narratives representing shared experiences, an approach that aligns with the Talanoa methodology. Three overarching themes were generated: (1) experiences and impacts of dismissal and weight stigma in healthcare on health, (2) healthcare for Pacific women transcends clinical spaces extending into interpersonal relationships, self-worth, cultural identity, spirituality, social and economic domains and (3) underlying interpersonal and systemic biases must be addressed to provide equitable healthcare. Pacific women recommended a paradigm shift away from weight-centric care towards culturally safe, patient-centred and weight-inclusive practice. This includes review of aspects of the health system which reinforces structural barriers to health such as BMI (Body Mass Index) used as an individual measure of health and health professional biases alongside cultural humility training which addresses implicit and explicit weight and ethnic bias, that values Pacific knowledge and the creation of safe health environments. In summary, this thesis is believed to be the first documentation of Pacific women’s experiences of weight stigma in healthcare in Aotearoa. By centering their voices, it importantly exposes the multifaceted harms of weight stigma and underscores the urgent need for systemic change to achieve equitable and culturally grounded healthcare for Pacific women.