Clinician perspectives on weight stigma highlight opportunities to improve preventive cancer screenings for patients with obesity

Background: Obesity increases cancer risk and impairs cancer survival. Patients with obesity may be less likely to receive cancer screenings that reduce cancer morbidity and mortality. Weight stigma may represent an under-recognized barrier to participation in cancer screening. We characterized clinicians' perceptions of weight stigma and how obesity may impact cancer screening. Methods: We conducted qualitative interviews with fifteen practicing clinicians (physicians, advanced practitioners) with experience delivering care related to obesity and cancer screening. The interviews focused on their clinical approaches to and experiences with obesity and cancer screening separately, and their interplay. We isolated quotations from content codes on weight stigma and the interaction of obesity and cancer screening, then mapped patterns in the clinicians' responses within and across these codes. Results: The clinicians observed sources of weight stigma in healthcare and society and described patients' experiences with internalized stigma. They described attempting to counter stigma by focusing on broader health-related goals and avoiding blame and judgement in clinical encounters. Four principal themes connected obesity and cancer screening. First, clinicians worried body size-related technical limitations may impair exam quality and comfort. Second, they noted weight-related shame may impair screening engagement. Third, there were inconsistencies in how clinicians considered obesity as a cancer risk factor. Finally, some clinicians viewed weight and cancer screening as unrelated. While participants commonly recognized that weight stigma affects care in general, this recognition did not necessarily translate to concerns about weight stigma in cancer screening nor its impact on screening completion. Conclusions: Clinicians' perspectives highlight the pervasiveness of weight stigma, which may contribute to several of the obesity-related screening challenges they observed. For example, being subjected to technical screening limitations may heighten patients' experience of stigma. Clinicians' recognition of weight stigma but their inconsistent connection of that stigma to patients' cancer screening experiences represents an important clinical blind spot. Future work is needed to ensure cancer screening practices accommodate patients of all sizes and equip clinicians to address harms of weight stigma that may extend to cancer screening.