Learning to manage : a substantive grounded theory of large bodied women's interactions with medical professionals

A qualitative research approach using constructivist grounded theory methodology was used to further understanding and generate dialogue about the experiences of overweight and obese female healthcare consumers. Participants included 22 women, all of whom identified as large bodied. Data was collected from two major sources: semi structured interviews with participants and current literature. The value of this study lies in the documentation of a substantive theory which elucidates the issues facing overweight and obese female healthcare consumers, and the strategies they employ to manage these issues. The substantive grounded theory of ‘Learning to Manage’ details what large bodied women viewed as the salient concerns that face them as healthcare consumers, and how they resolve these issues. They identified their interactions with medical practitioners, specifically with general practitioners (GPs) as the most challenging. The women in this study felt extremely vulnerable when they became healthcare consumers. They believed they were negatively branded by their body size which worked to create a one dimensional identity – that of an overweight or obese patient. Once they were labelled their weight became the central focus of the consultation, often obscuring the reason they had sought help. Consequently, the shared social problem of women was identified as ‘being defined’. Feeling like ‘just a fat body’ (as described by participants) was common to all participants, and left women battling feelings of invisibility, shame, guilt, responsibility and fear. For large bodied female patients, being defined by their size was something which had significant ramifications both on the women themselves and on the clinical interaction. Being defined was comprised of three categories – ‘feeling invisible’, ‘expecting the worst’ and ‘feeling judged’. In order to manage or counteract the issues and feelings associated with ‘being defined’ participants developed a range of strategies which have been conceptualised as the basic social psychological process ‘Learning to Manage’. Women believed that the weight commentary from medical professionals was usually inappropriate and frequently hurtful; however they felt they had limited recourse because of the power held by medical professionals. Subsequently they learnt to manage their interactions with medical professionals in ways which blocked out or minimised the consequences of embodying the identity of an obese patient without having to overtly challenge their doctor. They believed that if they openly challenged their doctor they risked further sullying their already marked identity. Logically women knew that they could not be refused what they needed, however they felt that it was easier to manage from an emotional perspective if they engaged in strategies which pretended compliance or apology for their fat bodies. This research adds to the limited body of health science literature which has investigated weight through a framework which is cognisant of the multilayered meanings attached to fat female bodies. It also adds to the ever increasing research which recognises the impact of stigma in addressing public health crises such as obesity