New review reveals structural weight stigma in maternity and reproductive healthcare
A systematic review published in Obesity Reviews has uncovered widespread evidence of structural weight stigma across maternity and reproductive healthcare systems.
The review highlights how institutional norms, policies, and practices reinforce discrimination against women living in larger bodies—particularly during preconception, pregnancy, and postpartum care.
Led by researchers from Monash University, the review synthesised findings from 70 studies across 13 countries, offering a comprehensive overview of how healthcare systems themselves—beyond individual providers—contribute to weight-related inequities.
Rather than focusing on interpersonal stigma alone, the study sheds light on structural barriers such as restrictive BMI cut-offs, inflexible clinical guidelines, and physical environments not designed to accommodate all body sizes. These systemic issues, the authors argue, can limit access to care, damage trust in health professionals, and negatively impact health outcomes
What the study found
The review identified a number of recurring patterns in how weight stigma manifests at a structural level:
- Access restrictions: Many fertility and pregnancy-related services use rigid BMI thresholds that delay or deny care. These criteria are often applied without clear clinical justification or consideration of individual health profiles.
- Environmental barriers: Examination rooms, equipment, and seating often do not accommodate people in larger bodies, contributing to discomfort, exclusion, and reduced dignity during care.
- Policy and funding limitations: Some healthcare systems do not adequately reimburse or resource the longer or more complex consultations that may be needed for people with obesity, resulting in rushed or inadequate care.
- Guidelines and training gaps: Clinical protocols frequently overlook the lived experiences of higher-weight patients, and healthcare professionals often report inadequate training on respectful and evidence-based care for people living with obesity.
A shift from individual to systemic change
This review challenges the idea that weight stigma is primarily an issue of personal bias or communication style. Instead, it points to the ways in which healthcare systems, policies, and institutional cultures can reinforce stigma—even when providers intend to deliver equitable care.
Importantly, these structural barriers can intensify feelings of shame, fear, and avoidance in those seeking reproductive and maternity care—leading to poorer health outcomes and diminished trust in health systems.
read the study
Recommendations for change
To support more equitable and inclusive healthcare, the authors recommend:
- Removing arbitrary BMI cut-offs that restrict access to fertility treatment, antenatal care, and postpartum services.
- Redesigning healthcare environments—from furniture and equipment to care pathways—to be accessible to people in larger bodies.
- Reviewing and updating clinical guidelines to account for weight bias and ensure they are evidence-based and person-centred.
- Expanding training for healthcare professionals on weight-inclusive practices and the social determinants of obesity.
- Involving people with lived experience of weight stigma in policy design and health system governance.
A call for accountability and inclusion
As the global health community prepares for the UN High-Level Meeting on NCDs in September 2025, this review reinforces the urgent need to address structural weight stigma as a barrier to achieving universal health coverage and rights-based healthcare for all.
The authors call on health systems and institutions to move beyond awareness-raising and commit to tangible, structural reforms that ensure dignity, access, and equity in care—no matter a person’s body size.
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World Obesity publishes four scientific, peer-reviewed journals, each focusing on a different area of obesity research: systematic reviews, pediatrics, clinical treatment, and science and practice.
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