Weight bias and stigma in healthcare professionals: a narrative review with a Singapore lens

Abstract

Addressing weight stigma is essential to obesity management as it causes inequalities in healthcare and impacts the outcomes of health. This narrative review summarises systematic review findings about the presence of weight bias in healthcare professionals, and interventions to reduce weight bias or stigma in these professionals. Two databases (PubMed and Cumulative Index to Nursing and Allied Health Literature [CINAHL]) were searched. Seven eligible reviews were identified from 872 search results. Four reviews identified the presence of weight bias, and three investigated trials to reduce weight bias or stigma in healthcare professionals. The findings may help further research and the treatment, health and well-being of individuals with overweight or obesity in Singapore. Weight bias was prevalent among qualified and student healthcare professionals globally, and there is a lack of clear guidance for effective interventions to reduce it, particularly in Asia. Future research is essential to identify the issues and inform initiatives to reduce weight bias and stigma among healthcare professionals in Singapore.

INTRODUCTION

The obesity pandemic is upon us and it is relentless.[1] World Obesity Atlas 2022 by the World Obesity Federation estimated that 15% of adults (i.e. nearly 800 million people) were living with obesity globally in 2020.[2] This number is expected to rise to more than 1 billion adults, affecting one in five women and one in seven men worldwide by 2030.[2] In Southeast Asia, predictions forecast that the prevalence of obesity will double between 2010 and 2030[3] and will affect 50% of children by 2030.[2] In Singapore, about one-third of adults are living with overweight and 11% are living with obesity.[4] Further, overweight and obesity appear to disproportionally affect Malay and Indian communities living in Singapore.[5] Estimated figures for Singapore are, at best, conservative and likely to underestimate the scale of the problem, given that people of Asian descent have a higher proportion of body fat detrimental to health and experience obesity-related complications at lower body mass index (BMI) values, relative to other populations.[3]

Leading global healthcare professional organisations are increasingly recognising overweight and obesity as a disease and a serious population health issue. In Asia, this is evidenced by the 2015 Nagoya Declaration, which was signed by nine countries, including Singapore.[6] Obesity is best described as a chronic, relapsing disease where genetic and epigenetic factors interact with environmental exposures, leading to alteration in the normal neuroendocrine mechanisms that regulate energy balance.[7] Obesity is closely associated with the development and progression of several noncommunicable diseases such as cardiovascular disease, type 2 diabetes mellitus, musculoskeletal conditions and cancer.[8] These obesity-related complications substantially increase mortality and impact disability-adjusted life years (DALYs).[9] In Singapore, the aggregate burden to the economy created by adults living with overweight or obesity is estimated to be SGD261 million.[5]

People living with overweight or obesity commonly report being viewed as greedy, lazy, weak-willed or unmotivated, or their situation is seen as a personal failing.[10] Such negative beliefs form weight bias and can lead to weight stigma, which is defined by the World Obesity Federation as the discriminatory acts and ideologies targeted towards individuals because of their weight and size.[11] An example of weight bias leading to weight stigma is not offering an individual who is overweight the same exercise intervention as an individual deemed to be of normal weight, due to the belief that he/she would not engage with the intervention. Weight bias can be either explicit or implicit.[12,13] Explicit biases are intentional and conscious, for example, the belief that an individual who is overweight is lazy or greedy. These explicit biases can be assessed through self-reported measures such as the Fat Phobia Scale[14] or the Antifat Attitudes Questionnaire.[15] Implicit biases are activated subconsciously, for example, more readily associating an individual who is overweight as ’bad’. Implicit biases are most commonly assessed through response latency measures such as the Fat–Thin Implicit Association Test.[13] Weight bias and subsequent weight stigma are pervasive in societies globally and can be displayed across various contexts, such as the media, public places, places of employment and seemingly safe places, such as education institutes, families and even healthcare settings. Children with obesity are especially vulnerable to weight stigma, often reporting that they are teased and bullied because of their weight, with detrimental effects on their self-esteem, academic achievements and school attendances.[16]

Limited research exploring weight bias and stigma exists in Singapore. Lee et al.[17] surveyed 107 people attending a public forum event on obesity at a tertiary centre. The majority of responders demonstrated explicit weight bias; for example, responders often believed that obesity is a lifestyle choice (73%), due to a lack of willpower (71%) or due to an addiction to food (65%). Another study by Chue et al.[18] surveyed patients attending a multidisciplinary weight management clinic in Singapore. Two-thirds of responders reported that they had been stigmatised, criticised or abused as a direct result of their weight, and one in four responders felt that they missed out on jobs, were overlooked for promotion or were retrenched because of their weight. These findings suggest that weight bias and weight stigma are common in Singapore society.

Considering overweight and obesity are increasing population health issues worldwide, healthcare professionals should be equipped with appropriate knowledge about the disease and not discriminate individuals with the disease when providing care or signposting to sources of care. Despite this, research has identified that healthcare professionals are the second-most common source of weight stigma,[19] with up to two-thirds of adults enrolled in weight management programmes across six different countries reporting stigmatising experiences in healthcare settings.[20] Even healthcare professionals who specialise in obesity have been reported to describe people with obesity as lazy, stupid, noncompliant or lacking in willpower and discipline.[21] Weight stigma from healthcare professionals can lead to a breakdown in the therapeutic alliance and emotional distress, which can result in refusal, delay or disengagement with care,[22] participation in adverse health risk behaviours such as maladaptive eating,[23,24] reduced engagement in physical activity,[25,26] higher likelihood of mood disorders,[27,28] poorer treatment outcomes[29,30] and increase in mortality.[31] As weight stigma can potentially undermine successful treatment outcomes, including those for obesity, interventions to identify and reduce weight bias and weight stigma in healthcare professionals are as important as any obesity intervention itself. However, to our knowledge, research investigating the presence of, or interventions to reduce, weight bias and stigma among healthcare professionals in Singapore has not been explored.

This narrative review summarises international findings on the presence of weight bias among healthcare professionals and interventions to reduce their weight bias or weight stigma. These critically discussed findings may help further future research, as well as influence the treatment, health and well-being of individuals with overweight or obesity in Singapore.

METHODS

This review of published systematic reviews was conducted in alignment with the Scale for the Assessment of Narrative Review Articles (SANRA).[32] It was not pre-registered.

Literature search and identification of reviews

A search was performed on two databases — PubMed, a medical database and Cumulative Index to Nursing and Allied Health Literature (CINAHL), an allied health database — on 12 January 2023 by one researcher (AJG). The following search terms were used: ’weight stigma’ OR ’obesity stigma’ OR ’weight bias’ AND ’healthcare professional’. These terms were chosen to include the broad terminologies used to describe weight bias and stigma associated with people who are overweight and to identify studies specifically relating to healthcare professionals. There were no date restrictions, and the language was restricted to English only.

Abstracts of studies from the search results were screened by one researcher (AJG) to identify potentially eligible reviews. Potentially eligible reviews were then presented to other members of the research team (YL and KWT) for full-text review and final agreement. We included any systematic review or meta-analysis that either assessed the presence of implicit or explicit weight bias, or assessed the effectiveness of interventions to reduce weight bias or stigma among healthcare professionals (both qualified professionals and students). We defined healthcare professionals as any medical, allied health or nursing professional.

Data extraction

After eligible reviews were identified, two researchers (AJG and YL) extracted the following data from each review: authors and year of review, number of included studies, country in which the included studies were performed, number of participants, profession of participants and assessment tool(s) observed within each review. The data were presented descriptively. A summary of the main findings of each review was then agreed upon by all three members of the research team and included in descriptive tables.

RESULTS

The search yielded 872 results (521 via PubMed and 351 via CINAHL). Ten potentially eligible reviews were identified based upon the abstract and discussed among all researchers after full-text review. Three reviews were then excluded: one was a narrative review,[33] one systematic review did not solely focus on weight bias or stigma[34] and one was a meta-ethnography review.[35] Seven reviews were included for quantitative and qualitative analyses.[36,37,38,39,40,41,42]

Four reviews (including one meta-analysis) assessed the presence of weight bias in healthcare professionals.[36,37,38,39] Descriptive details and findings of these reviews are presented in Table 1. In summary, most research was performed in the USA or other primarily Caucasian countries, with just one study performed in Asia (China).[43] Weight bias was most commonly assessed using explicit outcomes, most frequently using the Fat Phobia Scale[14] and the Antifat Attitudes Questionnaire.[15] Nearly all qualified and student dietitians, medics, nutritionists, nurses, physiotherapists and psychologists who were assessed displayed both explicit and implicit weight bias. However, certain populations, namely student healthcare professionals and those with higher BMIs, tended to show higher levels of weight bias.

Table 1.

Descriptive details of reviews identifying the presence of weight bias in healthcare professionals (HCPS).

Review and details of included studies	No. of participants	Profession of participants	Assessment tools observed	Summary of findings
Cavaleri et al.[37] n=7 Australia (n=4), Canada (n=1), South Africa (n=1), USA (n=1)	Total: 1,733 Qualified: 1,563 Students: 170	Physiotherapists	Explicit  Antifat Attitudes Questionnaire (n=1)  Fat Phobia Scale (n=2)  Study-specific Likert questions (n=3) Implicit  Case studies (n=1)	• Qualified and student physiotherapists demonstrated weight bias across all outcomes used •Physiotherapy students tended to display more weight bias compared to qualified physiotherapists •High-quality studies reported using the Hawker tool
Jung et al.[38] n=8 Germany (n=1), UK (n=2), USA (n=5)	Total: 2,423 Qualified: 1,009 Students: 1,414	Dietitians, nutritionists	Explicit  Assumptions about reasons for obesity (n=1)  Attitude towards obesity (n=1)  Allison’s attitudes towards obese people (n=1)  Beliefs about obese people (n=1)  Bray Attitudes Towards Obesity Scale (n=1)  Fat Phobia Scale (n=4)  Study-specific Likert questions (n=1) Implicit  Implicit association test (n=1)	•Six out of seven studies showed significant explicit weight bias •No appraisal of quality or certainty of evidence included
Lawrence et al.[36] n=41 Australia (n=4), Canada (n=3), China (n=1), Denmark (n=1), Germany (n=1), Israel (n=1), Norway (n=2), Qatar (n=1), Turkey (n=1), UAE (n=1), UK (n=2), USA (n=22), multinational (n=1)	Total: 12,818 (All qualified)	Multidisciplinary group of HCPS: Nurses, dietitians, physicians/doctors, physiotherapists, psychologists, physician assistants	Explicit  Antifat  Attitudes Questionnaire (n=4)  Attitudes Towards Obese Persons Scale (n=4)  Beliefs About Obese People Scale (n=3)  Bray Attitude Towards Obesity Scale (n=3)  Fat Phobia Scale (n=6)  Nurses’ Attitudes Towards Obesity and Obese  Patients Scale (n=5)  Study-specific Likert questionnaire (n=15) Implicit  Weight Implicit Association Test (n=7)	• Pooled meta-analysis identified that healthcare professionals demonstrated explicit weight bias measured using the Fat Phobia Scale, Antifat Attitudes Questionnaire and the Attitudes Towards Obese Persons Scale •Pooled meta-analysis of the Nurses’ Attitudes Towards Obesity and Obese Patients Scale did not reveal overall explicit weight bias •Pooled meta-analysis of the Implicit Association Test indicated that healthcare professionals demonstrated implicit weight bias. •Overall certainty of evidence was very low using GRADE
Panza et al.[39]a n=16 Australia (n=3), Brazil (n=1), Germany (n=1), Israel (n=1), Mexico (n=1), South Africa (n=1), UK (n=1), USA (n=6), Unknown (n=1)	Total: 4,388 Qualified: 2,394 Students: 1,994	Physiotherapists, nutritionists	Explicit  Antifat Attitudes Questionnaire (n=1)  Attitudes Towards Obese Persons Scale (n=1)  Beliefs About Obese People Scale (n=1)  Fat Phobia Scale (n=7)  Study-specific Likert questionnaire (n=1) Implicit  Weight Implicit Association Test (n=1)  Study-specific test (n=1) Other  Focus group (n=2)	•Qualified and student physiotherapists demonstrated weight stigma •Qualified and student nutritionists demonstrated weight stigma •In both groups of professionals, those with a healthy weight tended to have less weight stigma beliefs •No appraisal of quality or certainty of evidence included

^aExcluding data relating to physical education teachers and physical trainers. GRADE: Grading of Recommendations Assessment, Development and Evaluation

Three reviews assessed trials to reduce weight bias and stigma in healthcare professionals.[40,41,42] Descriptive details and findings of these reviews are presented in Table 2. In summary, most research was performed on student healthcare professional populations in the USA or other primarily Caucasian countries. No studies were performed in Asia. The findings indicate that a variety of interventions are effective at improving knowledge and explicit outcomes in the short term; however, the heterogeneity of interventions and the generally low methodological quality of the included studies limit the ability to determine the most effective strategies. Each review provided overviews of the included studies and recommendations for future interventions.

Table 2.

Descriptive details of reviews investigating trials to reduce weight stigma in healthcare professionals.

Review and details of included studies	No. of participants	Profession of participants	Outcome	Summary of findings
Alberga et al.[40] n=17 Australia (n=1), UK (n=1), USA (n=15)	Total: 1,880 Qualified: 296 Students: 1,586	Dietitians, health promoters, kinesiologists, medics, nurses, psychiatrists	Descriptive summaries of trial findings	• Most studies assessed explicit outcomes only • Many studies reported positive short-term changes in healthcare professionals’ beliefs and knowledge about obesity • Long-term effectiveness of interventions and strategies for weight bias reduction remains unknown • Intervention methods varied significantly among studies
			Quality Assessment Scale	• Overall methodological robustness of trials is poor (mean Quality Assessment Scale 0.71/1, range 0.45–1/1) • Common issues included lack of randomisation or control groups, short follow-up periods and inconsistent outcome measures
			Qualitative analysis	Four main strategies were identified from research: 1. Emphasis on intellectual understanding of weight, overweight, obesity and weight-related bias, stigma and discrimination by providing basic information for healthcare professionals 2. Focus on empathy with the lived experience of people who are classified as having obesity by targeting peoples’ emotions 3. Emphasis on self-awareness through self-reflection and gaining an understanding of ones’ own attitudes and biases 4. Utilising respected and trusted leaders or peers who can ‘sway’ people to think one way or another
Moore et al.[42] n=14 Australia (n=1), Canada (n=2), Germany (n=1), Lebanon (n=1), UK (n=1), USA (n=8)	Total: 2,988 Qualified: 663 Students: 2,325	Dietitians, health educators, kinesiologists, medics, nurses, physiotherapists	Descriptive summary of findings	• Interventions were generally curriculum-based • Interventions were generally a ‘one-time’ experience with minimal ongoing support Intervention methods varied significantly among studies • Most studies assessed explicit outcomes only • Content focused upon empathy evoking and causality/controllability, no interventions included education to address social norms • Interventions generally result in positive short-term changes in explicit outcomes
			Meta-analysis findings	• Nine pooled interventions demonstrated a small to moderate effect to reduce obesity bias (standard deviation 0.38, 95% confidence interval −0.52 to −0.24)
Talumaa et al.[41] n=25 Australia (n=2), Canada (n=3), Germany (n=1), UK (n=2), USA (n=17)	Total: 3,554 Qualified: 382 Students: 2,470	Dietitians, health promoters, kinesiologists, medics, nurses, psychologists	Descriptive summaries of trial findings	• Most trials assessed explicit outcomes only In those which assessed implicit bias, interventions rarely changed these outcomes • Many studies reported positive short-term changes in explicit outcomes • Long-term effectiveness of intervention strategies for weight bias reduction remains unknown • Intervention methods varied significantly among studies
			Qualitative analysis	Five main strategies were identified from research: 1. Increased education – Trials successful at improving stigma focused beyond medical aspects and included uncontrollable determinants, the harm caused by social and cultural norms about weight. General education about obesity alone is insufficient for reducing stigma and may even exacerbate stigma. 2. Causal information and controllability – Exposure to education content that illustrates genetic or multiple determinants of weight with emphasis on the uncontrollable determinants of weight has yielded positive results in the reduction of weight stigma in the short- and possibly mid-term. 3. Empathy evoking – Empathy-evoking strategies may improve attitudes and stereotyping in the short term only. Rather than eliciting pity, more constructive aim may be to emphasise on acceptance at all sizes, respect and dignity (size acceptance) 4. Weight-inclusive approach – HAES perspective is encouraged to improve attitudes of stereotyping. However, effects of trials may be for short term only and require ongoing support. 5. Mixed methodology – Trials combined two or more of the above strategies. Mixed results were identified.

HAES: health-at-every-size

DISCUSSION

We identified seven systematic reviews published between 2012 and 2023.[36,37,38,39,40,41] Four reviews,[36,37,38,39] inclusive of one meta-analysis,[36] identified that weight bias is displayed by a number of healthcare professions. Three reviews, inclusive of one meta-analysis, identified that a variety of interventions appear to be effective in improving knowledge or the explicit outcomes in the short term; however, trials are generally of low methodological quality, limiting the ability to determine the true effectiveness of the interventions.[40,41,42] The global presence of weight bias in healthcare professionals, and the lack of clear guidance for the development of interventions to reduce it, is a cause for concern, considering its influence on stigma and the substantial impact that it has on people living with overweight or obesity. This review will further discuss key findings and explore how they may relate to future research, as well as influence the treatment, health and well-being of individuals with obesity in Singapore.

Our findings indicate widespread presence of explicit and implicit weight bias across multiple healthcare professions worldwide. However, future research investigating weight bias in healthcare professionals in Asia is warranted, given that only one study assessed the presence of weight bias in an Asian population.[43] It would be reasonable to hypothesise that healthcare professionals in Singapore display weight bias based upon global trends; however, research to confirm this does not exist. Interestingly, the sole Asian study by Wang et al.[43] is one of the few studies that demonstrated neutral or positive explicit outcomes (of nurses in China) towards people who are overweight or living with obesity. Wang et al.[43] hypothesised that their findings may be due to an Eastern culture of Confucianism causing a reluctance to express any dissatisfaction towards others. It is not clear whether Wang et al.'s[43] findings are representative of other healthcare professionals in Asia. It would be particularly interesting to explore if these findings are representative of healthcare professionals in Singapore, considering its healthcare system and society is influenced by both Eastern and Western cultures.

Explicit outcomes have been more frequently used in research, probably due to the ease in which they can be administered to a large number of participants. However, the self-reported nature of explicit outcomes is prone to manipulation, with responders giving what they ’feel’ the correct answer is, rather than their personal beliefs. This may have influenced the positive findings from Wang et al.'s[43] study, considering they used only explicit outcome measures. Future studies using both explicit and implicit outcomes to investigate weight bias in healthcare professionals in Asia and Singapore are encouraged, as they may provide a more accurate representation of weight bias in Asia and overcome the possible influences of Confucianism.

It is not clear ’which’ interventions are most effective for reducing weight bias among healthcare professionals, as the evidence from current systematic reviews and meta-analysis indicates that a variety of interventions are successful at improving short-term knowledge or explicit outcomes. However, current research fails to identify whether these changes are sustained in the long term, lead to behavioural changes among healthcare professionals, or improve the care provided to people living with overweight and obesity or their treatment outcomes. Further, there is a lack of real-world clinical setting data, with most interventions tested in student populations and no trials performed in Asia. Additionally, current interventions do not appear to be effective in improving implicit biases. However, in general, there is alignment among the three included reviews assessing the interventions to reduce weight bias about ’what may be important to consider’ in such interventions. First, the reviews indicate that there is a need to educate healthcare professionals beyond just medical and lifestyle aspects of overweight and obesity, by including discussions on the genetic and socioeconomic aspects (i.e. social detriments). This may help to address the misconceptions and facilitate ’new norm’ beliefs about the conditions. They also recommend that education should not be a one-off intervention and that more thought should be given to strategising ways to maintain and improve outcomes over time. Next, reflective, empathy-evoking and weight-inclusive approaches are also recommended. Talumaa et al.[41] specifically recommended the use of the health-at-every-size (HAES) approach.[44] This approach, which emphasises health promotion with an intent to improve health behaviours for people of all sizes, has been shown to be effective for improvements in physiological, psychological and behavioural outcomes, alongside lower attrition rates.[44] The included reviews also recommended that weight inclusivity should go beyond providing one-time education interventions, towards ensuring that principles are translated and embedded into the clinical setting, for example, ensuring that healthcare equipment such as clinic chairs, blood pressure cuffs, gowns, wheelchairs and hospital beds are able to accommodate people of all body sizes. Implementation of these recommendations may help to facilitate longer-term improvements in outcomes of healthcare professionals and ultimately improve the experiences and care of people living with overweight or obesity.

Clinical implications

The number of people living with overweight or obesity around the world, including Singapore, is increasing.[45,46] Currently, an estimated 58% of the population of Singapore is living with an at-risk BMI (>23 kg/m²),[4] and projections predict that the number of people living with overweight and obesity will continue to rise significantly in the next decade.[2] It is, therefore, almost certain that all current and future healthcare professionals in Singapore will encounter patients living with overweight or obesity. As weight stigma in healthcare professionals can have a detrimental effect on engagement with care,[22] health[25,26] and treatment outcomes,[29,30] it is essential that healthcare professionals possess accurate knowledge of overweight and obesity and their subsequent professional behaviours facilitate best practice alongside equal and equitable care for all people regardless of their size or weight, thus not further perpetuating weight stigma.

Clinically, we recommend a three-pronged approach to raise awareness of and reduce weight stigma in healthcare professionals in Singapore. First, we recommend that healthcare institutions be prepared for the increasing number of people living with overweight and obesity, who will be using their services in future in relation to appropriate accessibility of services, information and equipment. It may be particularly important to ensure that patient education information is accessible and culturally appropriate to those who identify as Indian and Malay, considering that overweight and obesity disproportionately affect these communities. Second, we recommend that healthcare institutions collaborate with one another, as well as with national organisations (e.g. the Singapore Association for the Study of Obesity) and people living with overweight and obesity, to provide training about the conditions, challenge misconceptions, highlight the consequences of stigma and facilitate an HAES approach. Third, we recommend that education institutions ensure that overweight, obesity and weight stigmas are appropriately addressed at entry-level and postgraduate-level training. Beyond this, as weight bias and stigma in society may be acting as a barrier for people living with overweight or obesity who are seeking or attending healthcare services, national-level initiatives are required to help facilitate ’new norms’ in the general population. Ultimately, a whole-of-systems approach involving multiple stakeholders beyond healthcare professionals, such as policymakers, educators and people living with obesity, is needed to effectively eradicate weight bias and stigma.

Research implications

Research is urgently required in Singapore to assess the presence and extent of weight bias in healthcare professionals. We recommend that such research should (a) assess weight bias using both explicit and implicit outcomes; (b) assess both student and qualified health professionals; and (c) collect data about participants’ weight, BMI and ethnicity to allow for relevant regression analyses to be performed. Such research will provide valuable data on the scale of the problem that can be tracked over time and also inform development of general or targeted interventions to reduce weight bias and its consequences (i.e. stigma). It may be especially important to assess the presence of weight bias in student healthcare professional populations in Singapore, considering that current systematic review evidence indicates that they tend to display higher levels of bias compared to qualified healthcare professionals. Investigation of current curricula is also warranted at the education institutions to understand whether the current content reflects appropriate knowledge about overweight and obesity and prevents development of inappropriate biases. We also recommend further research investigating the lived experience of people living with overweight and obesity in Singapore in general and when accessing healthcare services. Such research may be especially important to inform future initiatives to reduce barriers to access and provision of care. Finally, given the diversity of ethnic backgrounds, the unique food culture in Asia and Singapore and the influence of culture on one's view on bodyweight,[3] further research is needed on the impact of cultural beliefs on weight bias, especially implicit bias, and weight stigma.

Limitations

This narrative review is limited to weight bias in healthcare professionals. However, healthcare professionals are not solely responsible for all the detriments experienced by people who are overweight or living with obesity. For example, other employees or volunteers within the healthcare system, such as patient care and clinic assistants, administrative staff and security personnel, may also display weight stigma and create barriers to equal and equitable care for people who are overweight or living with obesity. Outside of the healthcare environment, weight stigma may be present in the general public, media, places of employment, education institutions and local policies. Therefore, significant collaborative efforts are needed to truly reduce weight stigma and the burdens that it creates in society. Limitations with our search strategy also need to be considered when interpreting our findings. For example, we did not include terms such as ’discrimination’ or ’prejudice’, which can sometimes be used to describe weight bias or weight stigma, and we did not distinguish between the various healthcare professionals (e.g. physiotherapists, nurses, etc.). Finally, although the search terms and databases used in this review ensured feasibility, we cannot rule out the presence of additional reviews.

CONCLUSION

Weight bias and stigma is a global problem that is likely displayed across a variety of sectors in Singapore, including the healthcare profession. As yet, the presence and extent of weight stigma among healthcare professionals in Singapore is unknown. Considering the rising number of people living with overweight or obesity in Singapore and the substantial personal and societal issues that weight stigma creates, future research is essential to identify the problem and to inform initiatives to reduce it. We have provided key recommendations to inform clinical practice and future research in an effort to ensure that people living with overweight and obesity have equal access to appropriate care regardless of their shape or size.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.