Assigned Female and Fat

You will be asked to use the theory of intersectionality as a framework for investigating health inequalities by highlighting intersections of individuals multiple identities within social systems of power that compound and exacerbate experiences of ill health.
Your paper should explore health outcomes (i.e., health behaviors and conditions) that may disproportionately affect people from that cultural group (e.g., substance abuse, cardiovascular disease). You should discuss both the protective (e.g., community support, faith) and risk factors (e.g. stigma, medical mistrust, heterosexism) that may explain the health outcomes in this community.
Your paper should use peer-reviewed articles or otherwise veritable sources (e.g., departments of health) to support your conclusions.
Rubric

Content & Analysis (10 points): Is the purpose of the paper clear? Are relevant references used appropriately to support the discussion? Papers should incorporate core theory/concepts from the class content, and address the intersectionality of identity statuses where possible. Is there evidence of critical thinking and persuasive delivery of arguments?
– Dissect risk and protective factors
– Cite studies that support and/or contradict your argument/focus.
– Look at physical health outcomes

Introduction & Conclusion (4 points): Does your paper include them? Do they make sense? Do the introduction and conclusion clearly set up your paper at the start and summarize your discussion at the end?
– Intro: state theoretical framework, group, and health disparity
– Conclusion: tie it all together, make ideas for how to improve in the future

Title

Chava B. E. Kornblatt
Department of Psychology, The George Washington University
PSYC 3126-10: Multicultural Psychology & PSYC 3128-10: Health Psychology
Djordje Modrakovic & Kate AuBuchon
25 July, 2021

Title

Paper Question/Topic
How does being assigned female at birth (AFAB) and overweight/obese impact one’s access to health/medical care? Perhaps specifically with relation to (chronic) pain management. How does disability play into this?
Literature Review
Buxton, B., & Snethen, J. (2013). Obese Womens Perceptions and Experiences of Healthcare and Primary Care Providers. Nursing Research, 62(4), 252-259. https://doi.org/10.1097/nnr.0b013e318299a6ba
Used phenomenological research methods and semitortured interviews with a “diverse” sample of 26 English-speaking women whose BMI was over 30kg/m2
Purpose: to describe women with obesity’s experiences and perceptions in related to healthcare and their healthcare providers
Themes from the interviews included those regarding overall perceptions of health and healthcare, perceived respect from practitioners as people, establishment of a healthcare connection, and the necessity of assertiveness,
The issue was not that PCPs talked to the women about their weight (all but one interviewee wanted to discuss their weight with the PCP)
This study concluded that women did not feel they were treated differently on the basis of their weight.
Lee, J., & Paus, C. (2016). Stigma in Practice: Barriers to Health for Fat Women. Frontiers In Psychology, 7. https://doi.org/10.3389/fpsyg.2016.02063
Autoethnographic study to assess the barriers to health for fat people, particularly fat women.
The authors highlight the issues with the way health, and particularly, whether someone is healthy or unhealthy, is define and prioritized, bringing up the difference between societal and medical views of, for example, a fat person with Type II diabetes versus a thin person with a spinal injury that causes chronic pain.
The authors discuss the way that health and who is deemed healthy is societally and culturally determined, bringing up the example of drapetomania to showcase the way society impacts what is seen as disease and disability.
The authors discuss instances of anti-fat prejudice they have encountered including and example where, despite doing an incomplete exam and drawing perfectly normal labs, a doctor told one of the authors that she would be diabetic before she was thirty.
The authors discuss how past experiences with healthcare professionals and systems have led them to avoid healthcare at points for fear of belittlement and such negative reactions.
The authors discuss how health definitions and prioritization, anti-fat attitudes, and healthcare avoidance can relate to eating disorders, including among fat people.
Merrill, E., & Grassley, J. (2008). Womens stories of their experiences as overweight patients. Journal Of Advanced Nursing, 64(2), 139-146. https://doi.org/10.1111/j.1365-2648.2008.04794.x
The major themes of the interviews were that the women struggle to fit in, were made to feel “not quite human,” were dismissed, and refused to give up.
Many of the participants discussed the physical environment and resources, with issues related to their size, such as needing to find a seat without armrests needing to wait for a nurse for find a larger blood pressure cuff, and needing to demand larger fitting gowns proactively.
Many of the participants had a history of trying to lose weight but also continued to look forward with a send of hope regarding losing weight and becoming a “normal” size.
Many of the participants expressed that their doctors did not listen to them or give them an adequate amount of time when discussing their weight-related issues.
Many of the women sought care and were dismissed, either by receiving no treatment for their complaints/symptoms, having their weight used as a scapegoat, or not being believed by their healthcare provider(s).
Many of the participants used words and phrases like “struggle” and “constant battle” to describe their interactions with healthcare professionals, agencies, and settings.
Phelan, S., Burgess, D., Yeazel, M., Hellerstedt, W., Griffin, J., & Ryn, M. (2015). Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obesity Reviews, 16(4), 319-326. https://doi.org/10.1111/obr.12266
Practitioners do not need to be aware that they are being biased in order to cause harm, whether through direct (e.g., stereotyping the patient and making biased decisions regarding their care) or indirect (e.g., creating a hostile or uncomfortable environment for obese patients) means.
The stress of constantly being aware that one may be perceived negatively or treated differently due to their weight (and/or other factors) can in and of itself cause long-term health problems due to high allostatic load.
The physical environment is also a key factors, with such issues as waiting room chairs with affixed armrests being too small and/or uncomfortable, and even medical equipment (e.g., scales, blood pressure cuffs, examination gowns) being designed for patients with smaller bodies and even when larger alternatives are available, they are often stored separately, which can still instill a sense of not belonging.
Ranji, U., Salganicoff, A., & Rousseau, D. (2019). Barriers to Care Experienced by Women in the United States. JAMA, 321(22), 2154. https://doi.org/10.1001/jama.2019.5271
Women pay more for healthcare per capita, especially during reproductive years, with women ages 19-34 paying more than 50% more per capita than men of the same age proud.
Younger women are more likely than older women to say they do not have a regular clinician. This often results in delayed care.
Women without a regular clinician are also less likely to receive many preventative services than women with a regular clinician. This includes mammograms, pap smears, and clinical consultations regarding diet, exercise, nutrition, mental health issues, and smoking.
Women are more likely than men to have a pre-ACA declinable preexisting health conditions and to express concerns about losing ACA protections regarding preexisting conditions.
Women are more likely than men to go without healthcare because of the cost. This includes skipping recommended tests and treatments and not filling prescriptions or cutting/skipping doses of medications.

References
Buxton, B., & Snethen, J. (2013). Obese Womens Perceptions and Experiences of Healthcare and Primary Care Providers. Nursing Research, 62(4), 252-259. https://doi.org/10.1097/nnr.0b013e318299a6ba
Lee, J., & Paus, C. (2016). Stigma in Practice: Barriers to Health for Fat Women. Frontiers In Psychology, 7. https://doi.org/10.3389/fpsyg.2016.02063
Merrill, E., & Grassley, J. (2008). Womens stories of their experiences as overweight patients. Journal Of Advanced Nursing, 64(2), 139-146. https://doi.org/10.1111/j.1365-2648.2008.04794.x
Phelan, S., Burgess, D., Yeazel, M., Hellerstedt, W., Griffin, J., & Ryn, M. (2015). Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obesity Reviews, 16(4), 319-326. https://doi.org/10.1111/obr.12266
Ranji, U., Salganicoff, A., & Rousseau, D. (2019). Barriers to Care Experienced by Women in the United States. JAMA, 321(22), 2154. https://doi.org/10.1001/jama.2019.5271

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