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Weight for care: the impact of fatphobia on Black women in healthcare settings

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Weight for care: the impact of fatphobia on Black women in healthcare settings

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Content Weight for Care: The Impact of Fatphobia on Black Women in Healthcare Settings
by
Brandi Nikkale Mabry
Rossier School of Education
University of Southern California
A dissertation submitted to the faculty
in partial fulfillment of the requirements for the degree of
Doctor of Education
May 2024

© Copyright by Brandi Nikkale Mabry 2024
All Rights Reserved

The Committee for Brandi Nikkale Mabry certifies the approval of this Dissertation
Kacee Jones
Maria Ott
Monique Datta, Committee Chair
Rossier School of Education
University of Southern California
2024

iv
Abstract
Black women classified as obese based on their BMI face medical discrimination and neglect at
disproportionate rates in comparison to other demographics. This study explored the impact of
fatphobia in medical settings on Black women who have a BMI over 30. Through quantitative
research through narrative interviews with four participants, the study uncovered three key
themes: the impact of fatphobia, the role of kinship, and the need for rethinking activism. Based
on the findings of the narrative interviews focused on the lived experiences of obese Black
women, several recommendations are proposed. Recommendations include retiring the Body
Mass Index (BMI) as a measure of health is recommended, changes in weighing practices during
office visits, implementing Health at Every Size (HAES) principles, as well as speaking up as
advocacy. These recommendations target the empowerment of Black women to assert their
needs and challenge fatphobic practices in the healthcare industry. This study intends to
encourage the promotion of health equity and eradication of fatphobia in healthcare settings.

v
Dedication
To every plus-size Black woman who has ever felt neglected, overlooked, mistreated, and
judged. May this work contribute to the collective recognition and appreciation of our humanity.
Thank you for existing in your fullness and refusing to shrink to fit spaces that feel less than
welcoming. You deserve to live a life free from oppression based on your weight. You deserve to
smile, laugh, and exist without shame. I see you. I celebrate you.

vi
Acknowledgments
This study is the product of personal experience and a love for those who share a specific,
unique intersectionality. While this completed work is mine, I could not have done it without the
support of many brilliant minds and open hearts.
To my amazing dissertation chair and committee, Dr. Monique Datta, you have pushed
me to be the best writer and thinker that I could ever be. Good writing has become excellent
writing with your guidance. Thank you for believing in the importance of my topic, no matter
how controversial. Dr. Maria Ott and Dr. Kacee Jones, thank you for reading, hearing, and
understanding. Your time, input, and guidance have been truly invaluable.
To the participants of this study, your stories have been the guiding light of this study.
Thank you for sharing your lived experiences despite the stigma that often comes with those
experiences. Your willingness and courage are inspiring.
To my family and friends, thank you for your understanding and thoughtfulness during
this time. Thank you for the grace to focus on this journey and the constant prayers that held me
up during one of the most challenging periods of my life. The list of gratitude would be never
ending if I listed every way you have shown up for me. To my mother, thank you for filling in
the gaps when I could not and hearing what I did not say. It has not gone unnoticed.

vii
Table of Contents
Abstract.......................................................................................................................................... iv
Dedication....................................................................................................................................... v
Acknowledgments.......................................................................................................................... vi
List of Tables .................................................................................................................................. x
List of Figures................................................................................................................................ xi
Chapter One: Introduction to the Study.......................................................................................... 1
Context and Background of the Problem............................................................................ 2
Purpose of the Project and Research Questions.................................................................. 4
Importance of the Study...................................................................................................... 5
Overview of Theoretical Framework and Methodology .................................................... 6
Definition of Terms............................................................................................................. 7
Organization of the Study ................................................................................................... 8
Chapter Two: Review of the Literature .......................................................................................... 9
The Intersection of Fatphobia and Black Women .............................................................. 9
Healthcare Challenges of Black Women .......................................................................... 11
Healthcare Providers and Perceptions of Black Women .................................................. 13
Industry Efforts to Eradicate Bias in Healthcare .............................................................. 14
The Exclusionary Nature of the BMI................................................................................ 16
Fatphobia and Black Women in the Media....................................................................... 18
Healthcare Inequity Across Socioeconomic Statuses....................................................... 19
Kinship Amongst Black Women ...................................................................................... 20
Conceptual Framework..................................................................................................... 22

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Conclusion ........................................................................................................................ 30
Chapter Three: Methodology........................................................................................................ 31
Research Questions........................................................................................................... 31
Overview of Design .......................................................................................................... 31
Research Setting................................................................................................................ 32
The Researcher.................................................................................................................. 32
Data Sources ..................................................................................................................... 33
Participants........................................................................................................................ 34
Instrumentation ................................................................................................................. 35
Data Collection Procedures............................................................................................... 35
Data Analysis.................................................................................................................... 36
Credibility and Trustworthiness........................................................................................ 36
Ethics……......................................................................................................................... 37
Chapter Four: Findings................................................................................................................. 38
Participants........................................................................................................................ 38
Findings Research Question One...................................................................................... 40
Discussion Research Question One .................................................................................. 48
Findings Research Question Two ..................................................................................... 49
Discussion Research Question Two.................................................................................. 58
Summary........................................................................................................................... 59
Chapter Five: Recommendations.................................................................................................. 61
Limitations and Delimitations........................................................................................... 68
Recommendations for Future Research............................................................................ 68

ix
Conclusion ........................................................................................................................ 69
References..................................................................................................................................... 70
Appendix A: Interview Protocol................................................................................................... 76

x
List of Tables
Table 1 Participant Demographics................................................................................................ 38
Table 2 Interview Protocol............................................................................................................ 76

xi
List of Figures
Figure 1 Conceptual Framework .................................................................................................. 29

1
Chapter One: Introduction to the Study
In the healthcare context, marginalized populations face challenges unique to their
intersectionality that impact the care they receive at the hands of clinicians. Namely, Black
women, who exist in bodies deemed obese based on the body mass index (BMI) medical
screening tool, face inequity in healthcare that is rooted in anti-Blackness and fatphobia (Jett &
Justin, 2022). Medical fatphobia is a discriminatory practice that assumes the aesthetic of health,
the societal belief that thinness is a reward for good health and self-control and fatness is a
punishment for poor health and laziness (Gronning et al., 2012). Consequently, Black women
face both overmedicalization as well as neglect at the hands of healthcare professionals,
including but not limited to medical fatphobia. This neglect is rooted in both racism and sexism
that is specific to the intersectionality of Black women (Campbell, 2021).
Historically, the United States views fatness as the gateway to illness and partnered with
the lack of diversity in the BMI, Black women who exist in obese bodies receive poorer quality
care in healthcare settings (Jamie & Kost, 2022). Conversely, although the BMI screening
remains in use by medical professionals as an indicator of health, there is not a direct correlation
between the screening’s measure of obesity and obesity-related illnesses in Black women. This
despite Black women being disproportionately obese according to this screening tool (Cox et al.,
2011; Jett & Justin, 2022). Adding to the misconception that the BMI is a direct indicator of
wellness, the Center for Disease Control (CDC) published a report in 2004 implying that obesity
was responsible for the death of approximately 400,000 Americans per year. The CDC released
another report in 2005 admitting that the calculations in place to arrive at the number in the
previous report were incorrect and led to a very inflated number (Harrison, 2021). Additionally,

2
the original report is still often referenced as a source of truth related to obesity and the
correlation of obesity to mortality rates and health.
According to Gasperino (1996), Black and White women differ in genetic makeup, a
difference which happens to be a major contributor to the disproportionate obesity that exists
within the Black female population. Despite the aforementioned difference in genetic makeup,
Black and White women are measured against the same medical screening tool in relation to
weight, the BMI (Gasperino, 1996). This study aims to address the previously addressed inequity
across healthcare as an industry by exploring the lived experiences of fat Black women in
healthcare settings.
Context and Background of the Problem
According to Harrison (2021), the United States have traditionally aligned beauty
standards with anti-Blackness, anti-fatness, ableism, and cisheterosexism allowing for
discrimination based on undesirability. Obese individuals face unique societal challenges due to
their weight and appearance, including challenges gaining employment, the potential of having
their employment legally terminated in 49 of the 50 United States, as well as an increased
probability for homelessness. Additionally, Harrison determined obese women experience sexual
assault more often than other groups and l law enforcement is less likely to believe them when
sexual assault is reported. In the healthcare context, overweight people die more often than other
individuals from undiagnosed or misdiagnosed medical problems (Harrison, 2021).
The connection between Blackness and fatness is attributed to laziness, greed, as well as
stupidity (Strings, 2019). To illustrate the association, William Shakespeare, whose work has
been widely considered a reflection of the times, references fatness in relation to stupidity and
that a person that fasts and starves possesses more intellect than those who do not (Strings,

3
2019). Additionally, John Kellogg, inventor, and eugenicist, considered Black people “blood
clocks,” implying that they would become an extinct race if left to their own vices as they
naturally had limited potential. Due to the belief that Black people would soon be extinct if left
to their own devices, there was little to no scientific research done on Black people, including
research related to health and wellness (Strings, 2019). This deficiency of research continues to
exist today, specifically regarding Black women facing fatphobia in healthcare settings.
Since the rise of the transatlantic slave trade, White men have historically been the
authority on the standards of beauty and wellness, evidenced by the majority of healthcare
physicians in the United States being White (Hossain, 2021; Strings 2019). Hossain (2021) noted
that many healthcare providers admit to believing in racially charged myths, including the myth
that Black people have less sensitive nerve endings, resulting in higher pain tolerance. As a
result, Black women are less likely to be believed when they express health concerns of any
kind, especially related to pain (Hossain, 2021). To further illustrate this idea, Harrison (2021)
highlighted the causal relationship between anti-fatness and the justification of harm done to fat
Black people due to their perceived lack of value. The intersectionality of anti-fatness, antiblackness, and misogynoir experienced in the healthcare context has led to Black women seeking
alternative routes to health and wellness, including seeking practitioners that specifically cater to
obese patients and forming groups specifically for obese black women to share experiences,
advice, and resources with the goal of receiving equitable care (Jamie & Kost, 2022).
Despite research dispelling the myth that Black women that meet the criteria for obesity
based on their BMI are at higher risk for illnesses due to their weight, there is a growing body of
research on the societal perceptions of obesity and the danger it holds for Black women (Cox et
al., 2011). There is a deficiency in research that focuses on the inequity that fat Black women

4
face in healthcare settings and how this impacts how they navigate their health and wellness.
This study aims to address this deficiency in research in an effort to improve health outcomes for
Black women.
This study examines the lived experiences of Black women with a BMI over 30 who
have had healthcare experiences outside of routine office visits and physicals. Participants in this
study are from various regions of the United States, of various ages, socioeconomic statuses, and
education levels, and does not restrict participation based on insurance type or lack thereof. The
criteria selected for participants is important to the study as it focuses on the intersectionality of
obese Black women, as research has shown that socioeconomic status and education do not
provide better outcomes for women of color as previously believed (Hossain, 2021).
Purpose of the Project and Research Questions
The purpose of this study is to examine the lived experiences of Black women in the
context of healthcare as it relates to weight and fatphobia. Additionally, this study examines how
these experiences and interactions influence how Black women navigate their health and
wellness. Finally, this study considers how the experiences of Black women in healthcare
settings can inform the future of healthcare equity. The research questions that guide this study
are as follows:
1. What have been the lived experiences of Black women with respect to medical care
and their weight?
2. How do Black women navigate their health and wellness as a result of their lived
experiences in healthcare settings?

5
Importance of the Study
While there is an abundance of existing literature on obesity among Black women, there
is a lack of literature on the healthcare inequities and mistreatment faced by Black women due to
their obesity. According to Collins’s (2000) Black feminist thought, social practices that include
neglect and mistreatment are justified based on the controlling images assigned to Black women
to dehumanize them, including jezebel, hoochie, mammy, matriarch, and welfare queen.
Anthropological texts dating back to 1878 compare Black women’s physical attributes to
animals, linking them to apes and orangutans, further dehumanizing Black women and
diminishing their importance. Society has historically used the likening of Black women to
animals to justify the rape of Black women, the exploitation of the bodies of Black women for
profit, and the overall lack of attention given to the bodies of Black women in healthcare settings
and beyond. This mindset continues to permeate society, leading to systemic inequities against
Black women (Collins, 2000).
This problem is important to address because of the high stakes of racism, both
healthcare-focused and otherwise, which can lead to lower life expectancy for Black women than
their White counterparts as well as strain on mental health as noted by Medical News Today
(Rees, 2020). According to biomarkers of aging, Black women are 7.5 years older than White
women biologically with stress and socioeconomic living conditions accounting for more than a
quarter of this difference in biological age (Chinn et al., 2021). Identifying, understanding, and
eradicating health inequities that plague Black women generation after generation will contribute
to closing this biological age gap. Failure to examine this inequity will result in a continued
increase in mortality rates and poor health outcomes for Black women, specifically those that
exist in bodies deemed obese, an added layer of discrimination to an already oppressed existence.

6
Overview of Theoretical Framework and Methodology
Black women who are deemed obese by inequitable medical standards receive unjust
treatment at the hands of healthcare professionals (Jett & Justin, 2022). Black feminist thought is
the theoretical framework used in this study to examine the lived experiences of Black women
who exist in bodies deemed obese based on the BMI scale in healthcare settings. Collins (2000)
created the seminal work on Black feminism in an effort to encourage self-definition amongst the
oppressed population of Black women to fuel resistance against systemic misogynoir. In
alignment with this effort, Black feminist thought emphasizes the thoughts, experiences, and
intersectionality of Black women by exploring commonality amongst members of this
demographic group, oppression, and resistance (Collins, 2000). Black feminist thought explores
the lived experiences of the Black woman through the exploration of controlling images, the
power of self-definition, sexual politics, love relationships, motherhood, and rethinking activism
(Collins, 2000).
Black feminist thought is a fitting theory for this study as this study aims to examine and
understand the lived experiences of Black women based on their intersectionality. This study will
be conducted utilizing a qualitative method, specifically narrative inquiry to provide space for
Black women of all socioeconomic statuses and education levels that currently have a BMI of at
least 30 to tell their stories in the way that they see fit to describe their experiences and how their
experiences have been shaped as a result of these experiences. In alignment with the criteria for
this study, Black feminist thought accentuates the centrality of Black women intellectuals in the
Black feminism movement and highlights Black women as intellectuals regardless of their
socioeconomic status or education level (Collins, 2000).

7
Definition of Terms
The following key terms and definitions will be utilized throughout this study and will
provide clarity for readers.
Body Mass Index (BMI) is defined as “A measure that relates body weight to height. BMI
is sometimes used to measure total body fat and whether a person is a healthy weight. Excess
body fat is linked to an increased risk of some diseases including heart disease and some cancers.
Also called body mass index” (NCI Dictionary of Cancer Terms, n.d.).
Fatphobia is “The implicit and explicit bias of overweight individuals that is rooted in a
sense of blame and presumed moral failing, also referred to as anti-fat” (Boston Medical Group,
2021).
Hoochie refers to “A sexually promiscuous young woman” (Merriam-Webster, n.d.).
Intersectionality is defined as “The complex, cumulative way in which the effects of
multiple forms of discrimination (such as racism, sexism, and classism) combine, overlap,
or intersect especially in the experiences of marginalized individuals or groups” (MerriamWebster, n.d.).
Jezebel is seen as “An impudent, shameless, or morally unrestrained woman” (MerriamWebster, n.d.).
Mammy refers to “A Black woman serving as a nurse to white children especially
formerly in the southern U.S.” (Merriam-Webster, n.d.).
Misogynoir is “The specific hatred, dislike, distrust, and prejudice directed toward Black
women (often used attributively” (Mysogynoir, n.d.).

8
Obesity is defined as “Overweight and obesity are defined as abnormal or excessive fat
accumulation that presents a risk to health. A body mass index (BMI) over 25 is considered
overweight, and over 30 is obese” (Health Topics, n.d.).
Thick(ness) is described as “simultaneously having a “flat stomach.” “snatched” or
“toned” waist, “plump” thighs, hops, and buttocks (Jett & Justin, 2022).
Organization of the Study
This dissertation follows a traditional five-chapter model. Chapter One provides an
overview of the problem of practice, introduction of the study, overview of the theoretical
framework aligned with the study, justification for the need for the study, and key terms and
definitions relevant to the research. Chapter Two explores the significant literature related to the
problem of practice as well as an overview of the accompanying conceptual framework. Chapter
Three details the research methodology for the study, including relevant information regarding
the design of the study, associated research questions, the researcher, and participants. Chapter
Four provides the findings of the study as well as themes that arose as a result of those findings.
Lastly, Chapter Five highlights the proposed recommendations based on the findings of the
study. These recommendations represent the conglomeration of all research presented in the
previous four chapters of this dissertation. The suggestions are intended to be shared with
healthcare organizations to eradicate healthcare inequity against Black women who exist in
obese bodies.

9
Chapter Two: Review of the Literature
The ability to receive equitable healthcare relies on the recognizance of inequities and the
dismantling of historical oppressive systems that have led to said healthcare practices. The World
Health Organization (World Health Organization, n.d.) defines health as “the state of complete
physical wellbeing and not just the absence of disease or infirmity.” Therefore, it is imperative to
address the oppressive systems and structures to provide access to equitable health outcomes for
marginalized groups, including Black women. Although the literature on the medical neglect of
fat Black women in healthcare settings is limited, this literature review aims to provide context to
the issue from various viewpoints. This literature review provides historical context on the BMI
scale, the intersection of fatphobia and Black women, common healthcare challenges of Black
women and how they exist across socioeconomic statuses, current industry-wide efforts to
eradicate biases, obese Black women in the media, and kinship amongst Black women relative to
healthcare. Additionally, this literature review will explore the tenets of Black feminist thought
as the conceptual framework that guides this study.
The Intersection of Fatphobia and Black Women
Black women who exist in bodies deemed obese by the BMI face distinctive challenges
related to their intersectionality. Fatness and Blackness have historically become extrinsically
linked, a connection that originated in the United States in response to the discovery of the
differences in body type between White and Black women. As noted by Strings (2019), prior to
the emergence of slavery, artists and writers described the ideal woman as plump and juicy and
should be more voluptuous than slim to meet beauty standards. At this time, thickness was
determined to be a sign of superior health and hygiene (Strings, 2019). As late as the early 1800s,

10
fat bodies were associated with positive attributes such as good health, kindness, and agreeability
(Segrave, 2008).
Obesity held a positive connotation when it existed among high-class White people
(Segrave, 2008). As slavery pervaded Black families, the physicality of Black women was
incorporated into the discourse on beauty standards causing an almost immediate shift in the
physical characteristics that were seen as desirable. However, the analysis of Black women’s
bodies determined that Black women often present as thicker than their White counterparts,
including thick hips and round behinds, a physique that was at the time considered a marker of
beauty and good health (Strings, 2019). Based on the belief that Black people are an inferior
group in every way, the standards for beauty amongst women quickly shifted to include thinness,
a small mouth, gentle features, and coral lips, all of which are in direct opposition to the
descriptions given of African slaves (Strings, 2019). Major publications began to publish work
that dismantled the positive view of humans existing in larger bodies, asserting that they
experience diminished intelligence and the ability to maintain their livelihood because of their
excess weight (Segrave, 2008).
Black women contend with medical neglect without factoring in obesity due to the wellknown myth that exists in the healthcare industry that medical professionals that Black women
are less likely to experience pain or are more likely to exaggerate their pain (Hossain, 2021).
According to Harrison (2021), when factoring in Blackness, femininity, as well as perceived
obesity, Black women who are fat according to healthcare standards, exist in a heightened state
of fear due to their intersectionality. Previously, when exploring the link between fatness,
Whiteness, and wealth, researchers gave little to no attention to the issue (Segrave, 2008).

11
However, in modern times, Black fat women face instances of medical violence and neglect due
to their body type in conjunction with existing anti-Blackness.
Healthcare Challenges of Black Women
Although fatphobia amongst Black women is not equitably researched or documented,
the overmedicalization and medical neglect faced by Black women in other healthcare contexts
is a well-known problem. Historically, Black women have been the subject of medical
exploitation, dating back to slavery, during which time they were often forcefully sterilized and
coerced into experimental birth control treatments (Campbell, 2021). Despite the legal, scientific,
and medical developments that have taken place over several decades, Black women continue to
suffer shorter life expectancies and higher rates of maternal mortality than women belonging to
other demographic groups (Chinn et al., 2021). The healthcare challenges encountered by Black
women do not end at those associated with perceived fatness. Healthcare inequity across the
intersection of Black women because of sexism and racism.
Healthcare disparities related to childbirth amongst women of color are well documented.
Although challenges link to genetics and comorbid conditions, even when adjusting for those
factors, Black women’s chances of maternal morbidity are double that of White women
(Chervenak et al., 2016). These challenges became highly publicized knowledge when worldclass athlete Serena Williams experienced near-fatal medical neglect at the hands of clinicians
during the birth of her first child when she alerted physicians to her discomfort and history of
blood clots and found herself ignored until she was short of breath and in danger of dying
(Campbell, 2021). Serena Williams’ experience highlights the obstetric violence often faced by
Black women regardless of their socioeconomic status or recognizability. Campbell (2021) also
contend that the medical violence faced by pregnant and laboring Black women takes place

12
irrespective of the patient’s consent due to the vulnerability of the childbirth experience.
Obstetric violence is a common issue in healthcare settings that impact Black women at alarming
rates due to their unique intersectionality, irrespective of socioeconomic status (Campbell, 2021).
Black women experience inadequate treatment at every stage of the human
immunodeficiency virus (HIV) testing, diagnosis, and treatment process. According to Getter
(2018), as of 2014, Black women made up the majority population of women living with HIV. In
addition to the disproportionate rates of HIV amongst Black women, Black women living with
HIV experience poorer health outcomes than women of any other demographic group (Geter et
al., 2018). According to Davis and Wyatt (2020), due to racism, sexism, and misogynoir, barriers
to testing and treatment of HIV plague Black communities, keeping the status quo of high rates
of infection amongst Black women in place. These barriers include a lack of access to HIV
testing and treatment in facilities that provide reproductive services, causing inconvenience and,
depending on the geographic location, an inability to receive services (Davis & Wyatt, 2020).
Although Black women continue to be disproportionately represented in HIV positive numbers,
health disparities continue to hinder their access to just and equitable care.
Healthcare providers often diagnose Black women with hypertension more often, in
comparison to White women, resulting in comorbid illnesses, many of which are life-threatening.
Black women are two to three times more likely to receive a diagnosis of hypertension than
White women at lower ages, leading to increased rates of cardiovascular disease and renal
disease. One of the contributing factors to the disparity in hypertension diagnoses between Black
women and White women is the experience of racism, including racism experienced in
healthcare settings, which increases stress levels contributing to hypertension (Cozier et al.,
2006). According to Abel and Efird (2013), Black women are less likely to be medication

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adherent when mistrust exists between healthcare physicians and patients, leading to poor
outcomes in managing hypertension. Historical mistreatment of Black people in the name of
medicine has created distrust that leads to poor medication adherence and in some cases overall
refusal of healthcare treatment in its entirety (Abel & Efird, 2013). Black women suffer various
healthcare challenges due to medical neglect, medical violence, and overall learned distrust of
the intentions of the healthcare system.
Healthcare Providers and Perceptions of Black Women
Clinicians in healthcare settings view and treat Black women differently than other
groups. Notably, without accounting for weight, Black women have a lower chance of treatment
due to distrust by healthcare clinicians when they express that they are experiencing pain
(Consumer Reports, 2019). According to the Association of American Medical Colleges (n.d.),
56.2% of active healthcare physicians in the United States are White, and studies have shown
that approximately half of those physicians believe a myth regarding the pain of Black patients,
often including the myth that Black people have fewer nerve endings and therefore do not
experience pain as often or as intensely as White patients (Hossain, 2021). Consequently, Black
women are receiving undertreatment and mistreatment at the hands of healthcare clinicians based
on their intersectionality between race and gender.
Black women make decisions about how to navigate their health and healthcare visits
response to their previous healthcare experiences. According to Abdou and Fingerhut (2014),
Black women report higher levels of anxiety in healthcare settings compared to women of other
ethnic backgrounds because of stereotype threat. Stereotype threat is a theory that suggests that
individuals that belong to a specific group may confirm negative stereotypes assigned to that
group leading to poor outcomes (Abdou & Fingerhut, 2014). Correspondingly, Black women are

14
less likely than women of other backgrounds to utilize healthcare options because of various
barriers to equitable treatment, including stereotype threat. Abdou and Fingerhut (2014)
concluded that based on the stereotype threat experienced by Black women, this population may
experience higher rates of stress-related disorders or choose to intentionally avoid healthcare
settings to avoid the anxiety associated with receiving judgment or confirming negative
stereotypes. The controlling images such as welfare queen, mammy, Jezebel, Black lady, and
matriarch, that Black women face permeate the healthcare experiences of all Black women, often
resulting in the perpetuating of degrading health-related habits and mistreatment in clinical
settings (Collins, 2000; Sacks, 2018).
Black women often do not receive adequate medical treatment due to disbelief by
healthcare clinicians. Hossain (2021) determined that in a 2014 survey of American women with
chronic pain diagnoses, 91% of the participants reported discrimination that they perceived to be
due to their gender, with half of the participants said that their pain was not real and only existed
in their minds. To add additional specificity to this inequity, Black patients are 40% less likely to
receive prescriptions for diagnoses that cause pain (Hossain, 2021). Although Black women are
not a monolithic group, as a demographic group, they experience a higher prevalence of
comorbid diseases, including but not limited to heart disease, diabetes, and stroke (Chinn et al.,
2021). These statistics do not account for Black women who are obese according to the BMI.
The layered intersectionality of fat Black women makes them especially susceptible to
discrimination, misdiagnosis, and mistreatment at the hands of healthcare clinicians.
Industry Efforts to Eradicate Bias in Healthcare
Eradicating biases, especially instances of implicit bias, has been an area of focus for
several years in the healthcare industry. Implicit biases create a discrepancy between the

15
healthcare providers' intention and obligation to care for all patients equally and the influence of
their associations of people with their identity or perceived negative characteristics (FitzGerald
& Hurst, 2017). Implicit biases can be attributed to various factors, but healthcare professionals
most often address them in relation to race, ethnicity, gender, sexuality, and ableism. These
biases can lead to health disparities and inequities among marginalized groups (Chin et al.,
2021).
The study of health disparities amongst marginalized populations is well documented but
has not led to sufficient research on methods to eradicate these disparities through the addressing
of bias (Belton, 2017). Chin et al. (2021) stated that the industry expects individuals to address
both explicit and implicit biases, and often combat them through instructional intervention that
focuses on understanding bias and its existence. While instructional intervention provides
context to the issue of biases in healthcare, without the examination of historical and systemic
issues that underly the exhibited discrimination and medical violence, the problems will persist
(Chin et al., 2021).
The study conducted by FitzGerald and Hurst (2017) found that implicit biases displayed
by healthcare clinicians are parallel to those displayed in the global general population. Biases
held by healthcare clinicians influence the delivery of care, health outcomes, and the diversity of
the workforce (Chin et al., 2021). Despite numerous studies on the presence of bias in healthcare
outcomes, there has been little progress in the discovery of interventions that consistently and
effectively reduce the presence of bias among clinicians (Belton, 2017). With minimal research
and few interventions related to overcoming healthcare biases and especially those related to
fatphobia and its intersection with racism, fat Black women continue to unnecessarily experience
potentially life-threatening healthcare experiences.

16
The Exclusionary Nature of the BMI
Historically, healthcare-related studies exclude Black women due to their perceived
unworthiness in the United States. As illustrated by Hossain (2021), the majority of what is
known about the human body is a result of the study of males, both human and animal, with
women and especially women of color being an afterthought. For centuries, the lack of research
and subsequent health disparities led to the belief that Black people were inherently genetically
flawed, leading to assumed and unsubstantiated susceptibility to illness (Hossain, 2021). Strings
(2019) highlighted prior to the twentieth century, scientific studies and reports emphasized the
inferiority of Black men and women while studies at the turn of the twentieth century focused
less on Black bodies overall. Eugenicists and physicians such as John Kellogg believed that
Black individuals were incapable of sustaining their lives and would soon become extinct if left
to care for themselves. As a result, they removed the inclusion of Black bodies from scientific
studies (Strings, 2019; Roberts, 1999).
An interest in a specific demographic group that excludes Black women of all
backgrounds led to the creation of the body mass index (BMI) screening tool. Adolphe Quetelet,
a statistician with an interest in human growth but no formal training in medicine generated the
body mass index (BMI) screening tool, a tool used to determine obesity in the healthcare setting
(Cox, 2020; Harrison, 2021). Quetelet built the BMI using the measurement of standard physical
features, with the standard being White men (Harrison, 2021). Multiple revisions of the BMI
have taken place over the course of its existence, most notably in 1998 when CNN reported that
millions of Americans became obese overnight based on a drastic change in the BMI standards
(Who’s fat, 1998). The variation in genetic makeup between Black and White bodies, according

17
to Gasperino (1996) coupled with the standards with which the BMI came to exist, presents a
distinct barrier to perceived health for Black women in healthcare settings.
Black women face exclusion in healthcare settings through a lack of consideration for the
genetic differences that exist between Black women and other demographic groups. Despite the
scientifically proven differences in Black bodies in comparison to White bodies that are the
standard for the BMI, medical professionals continue to measure Black individuals using the
standard BMI while Asian Americans have a BMI scale that accounts for their genetic
differences (Bender et al., 2014). This study asserted that Asian Americans often present with a
BMI lower than those of White individuals due to the difference in muscle mass and overall
physical build, which led to the World Health Organization (WHO) proposing a modified BMI
scale for those of Asian descent. According to Alexis (2021), Black people often have a higher
muscle mass and lower body fat percentage than other groups. However, their body composition
is not always considered when determining their health status, and they may be classified as
obese even when they are not. Notwithstanding, there is no BMI scale that aligns with the
differences in Black bodies in comparison to the scale that exists for Asian American
individuals.
Despite the exclusionary nature of the BMI, Black women view attractiveness, health,
and desirability in a way that is unique to their intersectionality. Black women view thickness as
a desirable body type and a principal component of their intersectionality and identity (Jett &
Justin, 2022). Generally, Black women do not view obesity as determined by the BMI to be an
indicator of poor health or laziness, as has been historically implied, instead seeing it as an
indication of their Black femininity and rejection of White centric beauty standards (Jett &
Justin, 2022; Strings, 2019). The declaration of thickness as a cultural norm amongst Black

18
women presents as resistance to the exclusionary nature of the BMI as well as the perception of
health and fitness based on a perceived link between whiteness and thinness (Jett & Justin, 2022;
Strings, 2019). Despite the negative stigma applied to obesity, often times Black women do not
subscribe to this thinking, combating negative imagery in both healthcare and media.
Fatphobia and Black Women in the Media
The media perpetuates the justification of fatphobia amongst Black women by
continuously judging and shaming them for existing in obese bodies, irrespective of their health.
Lizzo, a Grammy-winning entertainer has acted as a source of inspiration for plus-size Black
women across the world while simultaneously becoming a target for body shaming and fatphobia
for simply existing without shame. Lizzo dispels the longstanding belief that an obese body is a
punishment for laziness as she maintains a vegan diet, a strenuous exercise routine, and performs
high-energy shows on stages across the globe (Haberl, 2021). While Lizzo illustrates the evergrowing body of research studies that show that weight loss does not improve health markers and
that weight is not the driving factor for higher mortality rates amongst fat Black women, her
body type is consistently noted in the media and among peers as glorifying obesity and
promoting an unhealthy lifestyle (Cox, n.d.; Harrison, 2021). Despite the research that indicates
that higher mortality rates for obese individuals are due to mistreatment and misdiagnosis, the
media continues to perpetuate the negative stereotypes especially as it relates to Black women.
The reality television show, My 600-lb Life demonstrates the negative media attention
that Black women receive. My 600-lb Life airs on TLC and follows the lives of individuals who
weigh 600 pounds or more that are seeking assistance losing weight via weight loss surgery
(Justin, 2021). Although the show does not focus solely on Black women, the intersectionality of
being a fat Black woman contributes to historical stereotypes and controlling images that Black

19
women face. Justin outlines how Black women who struggle with obesity, often due to sexual
violence and other trauma previously experienced, expose their most vulnerable and
embarrassing moments, perpetuating stereotypes of laziness, poor parenting, and lack of selfcontrol. The transparency that reaches households across the nation furth reinforces beliefs that
being fat and Black and a woman indicate a moral failing or deviance that justify poor treatment
and judgement Justin, 2021). This imagery provides further inappropriate rationalization for the
discrimination and mistreatment of Black women.
Healthcare Inequity Across Socioeconomic Statuses
Socioeconomic status, education level, or region of the country do not restrict the
healthcare inequities faced by Black women. Serena Williams, an extremely successful and
wealthy Black athlete, brought heightened attention to the experiences of Black women in
healthcare settings when she had a near fatal birthing experience due to medical neglect
(Campbell, 2021). The medical neglect that threatens the lives of Black women extends beyond
childbirth challenges and beyond fame and notoriety. According to Hossain (2021), Dr. Susan
Moore, a Black female medical doctor, recorded and shared her experience of medical neglect in
an Indiana hospital where she sought treatment for COVID-19 via social media. Despite being a
medical doctor herself, Dr. Moore did not receive pain medication, received delayed
administration of medicine, and was discharged against her wishes, leading to her death due to
complications related to COVID-19 (Hossain, 2021).
Despite advanced levels of education among Black women, health disparities and
increased diagnosing of serious physical illnesses persist (Smith, 2021). According to the Center
for Disease Control and Prevention (CDC), Black women with college degrees experience a
higher mortality rate related to childbirth than those who are not college-educated (Hossain,

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2021). To further illustrate this inequity, both Serena Williams and Dr. Moore advocated for
themselves unsuccessfully despite their socioeconomic standing and medical knowledge
(Campbell, 2021; Hossain, 2021).
When accounting for socioeconomic and education level equivalencies, Black women
continue to experience poorer health outcomes than other demographic groups. In comparison to
White women, Black women with the same level of education receive lower wages and
experience higher rates of unemployment, impacting their socioeconomic standing (Smith,
2021). When Black women do reach equal levels of socioeconomic standing as their White
women counterparts, the association between physical wellness and socioeconomic status is
inconsistent (Turner et al., 2017). There is no definitive link between socioeconomic and
educational status and Black women's poor health outcomes.
Kinship Amongst Black Women
In response to the challenges faced due to their intersectionality, Black women have
historically found kinship amongst one another as a safe space. Slavery and its lasting effects,
mass incarceration, and other tools of White supremacy have historically separated Black
families in the United States. The separation of biological Black families has led to the formation
of Black kinship that extends beyond the biological family to include friends, neighbors,
godparents, and other members of the community in which a family resides (Wade, 2019).
Through kin-like relationships, Black women were introduced to the notion of kinship as early as
girlhood, often being mothered by older women who are not biologically related as a means of
protection and a source of wisdom (Field & Simmons, 2019). As the media, healthcare industry,
government industry, and other institutions portray Black women as a monolith of undesirability,

21
Black women have found community within familial and personal networks to counter these
stereotypes (Collins, 2000).
Kinship continues to be at the center of the healthcare experiences of Black women,
impacting how Black women navigate their care. Black individuals, regardless of socioeconomic
status are less likely than White individuals to trust physicians due to the history of the United
States exploiting and experimenting on Black bodies in the name of science and healthcare
(Corbie-Smith et al., 2002). Consequently, these experiences become embedded in families,
networks, and communities. According to the study conducted by Coe and Keller (1996), the
shared lived experiences of those in Black women’s trusted network override the beliefs and
suggestions of those outside of their network, including healthcare providers. Since Black
women view the experiences of their communities as trusted, this distrust for physicians due to
historic medical violence against Black women continues to influence Black women’s choices to
adhere to medical advice or seek alternative routes to care. Black women that are obese based on
the BMI scale face a unique set of challenges that may or may not be relatable to their kin.
Fat Black women consistently face challenges of access to clothing, hygiene products,
and safe avenues of dating that remain largely ignored by the general public leading to the
creation of online communities specific to the intersectionality of fatness, Blackness, and
womanhood (Cox, 2020). These communities foster a sense of knowing, creating a bank of
resources specific to healthcare, including lists of fat-positive healthcare providers as well as
verbal and non-verbal strategies to resist fatphobia in healthcare settings to receive equitable care
(Jamie & Kost, 2022). The emergence of social media and digital connection has created the
ability to expand kinship beyond those in one’s neighborhood, allowing for the resources,
support, and community to be shared on a much larger scale (Wade, 2019). The ability of fat

22
Black women to build kinship with individuals who share their intersectionality provides
potentially life-saving resources that may have otherwise been inaccessible.
Conceptual Framework
Black feminist thought outlines six tenets of Black feminism that served as the
conceptual framework for this study. According to the seminal work on Black feminism, Collins
(2000) identified the six tenets of Black feminist thought as controlling images, the power of
self-definition, sexual politics, love relationships, motherhood, and rethinking activism (Figure
1). These tenets provide context for the unique challenges faced by Black women due to their
intersectionality, including healthcare inequities.
Controlling Images
Controlling images refers to negative stereotypes assigned to Black women that aim to
justify and normalize the racist, sexist, and oppressive systems that Black women and other
historically marginalized groups navigate (Collins, 2000). The controlling images outlined by
Collins (2000) in Black feminist thought are mammy, matriarch, welfare queen, Jezebel, and
Black lady. As a result, there is a suppression of Black women's intellectuality, sexuality, and
wholeness with the use of these images (Collins, 2000).
Mammy describes the controlling image that sees Black women as the caretakers for
White children during slavery in the United States (Merriam-Webster, n.d.). According to this
image, Black women are obedient servants who seek to maintain order in their society by
teaching their children not to question or challenge White men's authority. Black women are
portrayed as inferior and should remain in domestic roles (Collins, 2000). Historically, society
expected White women to exhibit purity by concealing their sexuality. However, the mammy is
considered an asexual being whose sole role was to raise children and engage in physical labor

23
that was deemed beneath White women (Collins, 2000). This portrayal of the mammy image
frames the bodies of Black women as undesirable and uninteresting, perpetuating a long-standing
disregard for the health and wellness of Black bodies (Miles, 2019).
The image of the matriarch is an evolution of the previously discussed mammy image.
While the mammy represents the docile caretaker and mother figure for White children, the
matriarch represents the negative mother figure in Black households (Collins, 2000). This study
explored the blame faced by Black women for all family problems that exist in Black culture due
to their perceived role as matriarch. A 1965 report, The Negro Family: The Case for National
Action pointed to Black women as the cause for the deterioration of the Black family due to their
inability to fulfill their womanly duties, their aggressiveness, and their lack of femininity which
led to the emasculation of their husbands and subsequent abandonment by their husbands
(Moynihan, 1965). The Negro Family Report (1965) implied the matriarchal Black woman as the
root cause of the issues in the Black household that restricted Black families from advancing
during the Civil Rights era. The matriarch is an image that displays Black women as the
downfall of the Black family because of their inability to be womanly enough to meet the
standards of femininity set by White men and women.
According to societal expectations of Black women, single Black mothers often embody
the role of the matriarch. However, Black women intellectuals view single Black mothers
differently. Collins (2000) highlighted several Black women intellectuals who portray Black
women in their works as multi-dimensional and strong in the face of adversity. Narratives of
mammies and matriarchs were rarely found in works created by Black women in comparison to
those created by White writers and creators.

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The welfare queen continues the evolution of the controlling images that permeate Black
womanhood. In Black feminist thought, Collins (2000) described the inception of this image as a
response to Black women demanding access to social services and benefits that their White
counterparts already had access to, including welfare. According to Business Insider (2020),
Black families with access to social service benefits had an almost immediate impact on the
perception of said benefits. Politicians in the media, including the President of the United States,
Ronald Reagan, demonized social service benefits such as welfare. They also intensified the
restrictions and requirements needed to gain access to those benefits. In contrast to the media
insinuation that Black families and more specifically Black women, referred to by President
Ronald Reagan as welfare queens, were the primary recipients of welfare benefits, White
families are both historically and currently utilizing these benefits in more significant numbers
than any other demographic group (Ward, 2020). Despite the fact other demographic groups also
utilize benefits entitled to them by law, society stigmatizes Black women for using these services
to care for their families, even though they have every legal right to do so.
Much like the matriarch, the welfare queen controlling image focuses on negative
stereotypes of Black mothers. According to Collins (2000), society tends to view the matriarch as
overly aggressive while perceiving the welfare queen as lazy and content to avoid responsibility
by collecting government assistance through having more children to increase their benefit
amounts. In alignment with the welfare queen controlling image, society justifies stereotyping
Black people as lazy by blaming Black women for passing on poor work ethic to their children
(Collins, 2000). Adding to this stereotype-driven justification, medical fatphobia assumes that
fatness is a punishment for laziness, a trait already associated with Black people and especially

25
Black women, furthering the seemingly justified medical neglect of Black women who exist in
larger bodies (Gronning et al., 2012).
In contrast to the welfare queen, the Black lady controlling image does not focus on
motherhood but continues the narrative that Black women are to blame for the breakdown of the
Black family. The Black lady controlling image refers to Black women who are middle class and
have secured positions in society that lend themselves to respectability politics (Collins, 2000).
However, although seen as respectable, the Black lady archetype aligns with the perception of
the mammy. The value of the Black lady archetype focuses solely on her work ethic, but she is
still to blame for the division of the Black family due to her inability to focus on her husband or
partner due to her own ambitions (Collins, 2000). Furthermore, Collins (2000) notes that
although the Black lady archetype does not rely on the government for financial assistance,
affirmative action initiatives have charged them with taking jobs from more qualified White
men, challenging their sense of belonging. Overall, although the Black lady is the most socially
respectable version of the controlling images presented in Black feminist thought, those Black
women associated with this archetype still shoulder the burden of the division in the Black
family while also not receiving full acceptance in the academic and professional world regardless
of their credentials or experience.
The final controlling image, Jezebel, also referred to as hoochie, is quite distinct from the
previously outlined controlling images. However, it still connects to the other controlling images
through the justification of mistreatment of Black women. The Jezebel image implies that Black
women are sexually aggressive and animalistic, a perception that has justified sexual abuse
against them since the era of slavery (Collins, 2000). This image has evolved into the hoochie
image, a modern version of the Jezebel that focuses on sexual promiscuity amongst women

26
deemed “ghetto.” The Jezebel and hoochie controlling image not only portray Black women as
sexually promiscuous and aggressive but also masculinizes them by suggesting that their sexual
desires are similar to those of Black men, who are often perceived as animalistic in their
sexuality (Collins, 2000). The Jezebel controlling image dehumanizes the physical body of Black
women, contributing to the mistreatment and misdiagnosing of Black women in healthcare
contexts.
Self-Definition
Black women combat the controlling images through kinship and self-definition.
Historically, Black women have felt both highly visible through the scrutiny faced in conjunction
with controlling images as well as invisible due to the dehumanizing effect of racism (Lorde,
1984). Collins (2000) explained that to combat the negative images portrayed in the media and
entertainment industry, Black women build community and network amongst each other to share
experiences and combat these narratives. The safe spaces created amongst Black women allow
for identifying, creating, and affirming positive identities, fostering a space of understanding that
can only exist amongst those that share an individual’s intersectionality (Collins, 2000). This
kinship is visible amongst Black women who face fatphobia in healthcare as they create
communities to share experiences and resources to navigate their experiences and receive the
care that is their human right (Jamie & Kost, 2022).
Sexual Politics
As noted in discussing the controlling images that permeate the perception of Black
women, the conversation regarding the sexuality of Black women only exists to justify their
mistreatment and abuse. According to Collins (2000), society frequently uses Black women's
identities as a benchmark for the mistreatment of other groups, rather than exploring their

27
identities. As a result, Black women's stories are often told for them, rather than by them. In the
past, writers have compared Black women to animals sexually, accusing them not only of
engaging in sexual acts with apes but also attributing the creation of HIV/AIDS to these animals.
The widespread belief that Black women are sexually promiscuous and aggressive provides a
further excuse for healthcare providers to prejudge Black women as promiscuous, animalistic,
and unworthy of care.
Love Relationships
The romantic relationships between Black men and Black women are an integral
component of Black feminism. According to Collins (2000), historically, there has been a
division between Black men and women, in part due to slavery and more recently, due to the
tensions between the two groups resulting from thoughts, behaviors, and actions around race and
gender. Black women implicate Black men in abandoning the mission to protect all Black
women, including centering their own narratives over those of the Black family (Collins, 2000).
The lack of love and support from the demographic group nearest Black women furthers the
invisibility of Black women, allowing for their neglect and oppression to go unchecked.
One of the major components of one’s health and wellness is the existence of a support
system of loved ones. Familial involvement in the care of an individual diagnosed with chronic
illnesses has proven to reduce readmission rates, reduce anxiety levels, and increase overall
wellness for those individuals (Deek et al., 2016). The perceived abandonment of Black women
by Black men in loving relationships hinders the progress of health and wellness for Black
women.

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Motherhood
As conveyed by the controlling images assigned to Black women, Black motherhood has
been a highly criticized domain in Black families. Due to the historic division of Black families
dating back to slavery, Black motherhood is critical to the existence of Black households beyond
the biological relationship between a mother and child. Collins (2000) studied the existence of
othermothers in Black communities. The term othermothers refers to the presence of nonbiological mother figures that participate in the care and upbringing of Black children. These
women-centered networks often include aunts, grandmothers, sisters, cousins, and even
neighbors. Othermothers provide biological mothers support by offering childcare for free or at a
discounted price, rendering support for unprepared mothers, and in some cases, informally
adopting children as needed (Collins, 2000). The presence of othermothers in Black communities
breeds generations of activism and compassionate work, including healthcare-related positions,
amongst Black girls and young women as they are raised to mother others.
Rethinking Activism
Activism amongst Black women often equates to survival in the face of oppression. As
noted by Collins (2000), activism for Black women in the United States has two major
dimensions, the struggle for group survival and the struggle for institutional transformation. The
first dimension, the struggle for group survival requires that Black women occupy spaces of
influence to amplify Black feminine voices and experiences. This method is the most common
method of achieving the goal of group survival because it does not present the challenge of direct
confrontation which can be dangerous for women of color. The second dimension, the struggle
for institutional transformation, challenges the policies and organizational norms of
organizations and institutions that are oppressive in nature to the detriment of Black women.

29
These strategies both typically require Black women to assimilate to fit into the spaces that they
are attempting to occupy as well as build allyship with other groups to lobby for and influence
change (Collins, 2000). As Black women continue to survive amid oppression, advocate for
themselves and others, and influence change on an organizational level, the health of Black
women also calls for advocacy. The survival of Black women depends on it.
Figure 1
Conceptual Framework

30
Conclusion
Black women experience varied challenges in healthcare settings that are specific to their
intersectionality. The historical mistreatment of Black human bodies, dating back to the
emergence of slavery, has caused these challenges. This mistreatment along with the controlling
images assigned to Black women by society as outlined in Black feminist thought continue to
perpetuate the negative perceptions of Black women by healthcare providers regardless of
socioeconomic and education status. Black women who have a BMI that categorizes them as
obese encounter compounded challenges because of fatphobia. The impact of these challenges
extends beyond healthcare experiences to negatively affect their overall quality of life. Despite
the existence of medical fatphobia, Black women actively leverage their personal networks to
combat these challenges. The creation of these personal networks is in a bid to achieve and
maintain positive health outcomes.

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Chapter Three: Methodology
The purpose of this study is to examine the lived experiences of Black women in the
context of healthcare as it relates to weight and fatphobia. Additionally, this study examines how
these experiences and interactions influence how Black women navigate their health and
wellness. To answer the research questions in this study, I conducted narrative-focused
interviews and subsequent document analysis of the transcripts of narratives of Black women
with various socioeconomic backgrounds and education levels that are obese according to their
BMI.
Research Questions
The research questions that guide this study are as follows:
1. What have been the lived experiences of Black women with respect to medical
care and their weight?
2. How do Black women navigate their health and wellness as a result of their lived
experiences in healthcare settings?
Overview of Design
This research study is a qualitative study, utilizing narrative inquiry to interview
participants. Narrative inquiry focuses on participant stories as the primary source of qualitative
data (Creswell & Creswell, 2018). Participant identities are withheld in this study by the use of
pseudonyms in place of their names to maintain participant anonymity. Additionally, participants
have disclosed demographic information including age, sex, occupation, and region of residence.
The narrative inquiry approach provides participants with the autonomy to share their
experiences with little to no restriction through the answering of one to two guided questions.
Analysis and coding of these stories will highlight patterns, similarities, and differences between

32
the experiences of participants. This data examines the health inequities experienced by Black
women related to fatphobia through the answering of the posed research questions.
Research Setting
Interviews for this study were conducted via Zoom to accommodate the various regions
in which the participants reside. Participants in this study are current and former patients in
various healthcare settings across the United States. Demographically, all participants were
Black women above the age of 18 residing in the United States with a BMI of 30 or above,
indicating obesity according to healthcare BMI standards. The selection of the participants
focuses on answering the posed research questions. The exploration of the lived healthcarerelated experiences and subsequent decisions made regarding one's healthcare because of these
experiences in relation to fatphobia require the participation of the demographic. To analyze
findings and provide industry-level recommendations to progress in eradicating medical
inequities, participants need to represent various regions of the United States, diverse
socioeconomic statuses, and different age groups.
The Researcher
Positionality plays a crucial role in shaping one’s perspectives and experiences in life.
Personally, my positionality fits into four categories that significantly impact how I view the
world. These include my gender, ethnicity, the evolution of my socioeconomic status over time,
my physical attributes, and my present career. As a Black woman deemed obese based on the
BMI working in the healthcare industry, a strong relationship exists between me, as the
researcher, the study, and the participants. I have first-hand patient-level experience facing
medical neglect due to fatphobia and anti-Blackness. Inherently, my personal experiences and
positionality leave room for potential biases in the study.

33
Narrative inquiry is the appropriate research method because it lessens the presence of
bias by allowing participants to tell their stories with a few guiding questions and minimal
prompting and interruption from the researcher. The standardization and consistency of the
questions will reduce the potential for bias by keeping the interviews from following a direction
that reflects my thoughts and beliefs as an individual. Finally, as a healthcare employee, it is
important to consider my influence and biases as a researcher. While I do work in the healthcare
industry, I do not have direct contact with former patients at any point. I am not in any way
responsible for or involved in the medical care of any of the participants in this study, allowing
participants to speak openly and without consequence or exposure to potential medical
retaliation.
Data Sources
This study uses narrative inquiry to collect data from participants through interviews.
Interview questions align with both the conceptual framework and research questions to ensure
the gathering of the most pertinent data. After facilitating the narrative-focused interviews, I
transcribed the interviews to review the stories shared. The analysis of the narrative-based
interviews aims to extract common units or themes from each story to identify differences and
commonalities in the experiences of the participants (Merriam & Tisdell, 2016).
Narrative Inquiry Interviews
Narrative inquiry is a qualitative research method that focuses on the stories of
participants related to a mutual lived experience used to construct findings in a research study
(Johnson & Thacker Darrow, 2023). By analyzing the stories of the participants, the researcher
identifies common challenges and themes in alignment with the proposed research questions and
conceptual framework (Jones, 2017). Prior to conducting the interviews, the participants received

34
information on the study, thus setting expectations for storytelling, a less-known form of
interview style. Prior to beginning the interview, participants provided their demographic
information. This information includes their current professional title, level of education, and
place of residence. The interview then guided participants to share their healthcare journey
beginning with their first exposure to the BMI. Following the completion of each interview, a
transcription of the interview took place.
Participants
Convenience sampling is the method of participant recruitment for this study.
Convenience sampling, a form of purposeful sampling, factors in availability, time, money, and
location to select participants that are most convenient to the researcher while also meeting the
criteria for the study (Merriam & Tisdell, 2016). Convenience sampling is the appropriate
method for this study due to the sensitivity of the subject of obesity and fatphobia. Despite the
various body positivity movements, the term fat generally remains offensive and off-putting.
Additionally, it could be harmful to assume obesity if individuals have not chosen to disclose
their BMI or express interest in participating in the study. Recruiting participants who belong to
the personal network of the researcher and employing network sampling by asking those
participants to refer additional potential participants is the least harmful way to select
participants.
The participants for this study are Black women of all ages with BMI scores of at least 30
who have received healthcare in the United States. Participants have a range of socioeconomic
and educational backgrounds as well as a range of health-related challenges and histories. There
are four participants in this study. This number of participants is based on the narrative inquiry

35
data collection method. Narrative inquiry requires multiple interviews for each participant,
allowing for the capture of each participant's full story.
Instrumentation
I conducted structured narrative-focused interviews composed of 13 questions with
additional prompts to probe further as needed to obtain participant stories directly related to the
study’s research questions. The analysis of narratives focuses on deriving meaning from the
stories of participants to extract meaning related to the subject matter and draw patterns and
similarities between participants (Merriam & Tisdell, 2016). The interview protocol (Appendix
A) includes the interview introduction, request for verbal consent, questions, and prompts that
focus on personal stories related to fatphobia, healthcare, and weight-related stigma. All
interview questions included in the interview protocol focus on guiding participants to share
stories, lived experiences, and perceptions regarding BMI, how healthcare providers talk to and
diagnose them based on their BMI, and how kinship with other Black women shapes their
healthcare experiences and navigation. Preparation of the previously mentioned interview
protocol will allow for a reduced bias and an efficient data collection process.
Data Collection Procedures
Data collection for this study took place using recorded Zoom interviews. I supplemented
the Zoom recording with the use of transcription software for later review and coding. The
interview took place in two interview sessions per participant of approximately 60 minutes per
session. This strategy allowed participants to tell their stories without interruption, as narrative
inquiry prescribes. Following each interview session, I reviewed and edited the generated
transcript as needed, gathered notes, and recorded findings. Although transcribing is a timeconsuming task, it provides the researcher with a greater understanding of the data through

36
exposure as well as an opportunity to take additional notes on patterns and findings the
researcher may not have made note of during the actual interview session (Merriam & Tisdell,
2016).
Data Analysis
The data analysis conducted for this study examines the narrative-focused interview
transcripts for patterns in the stories of lived experiences of Black women told by the
participants. A strength of narrative inquiry data collection is the flexibility of the data analysis
process (Merriam & Tisdell, 2016). I examined each interview transcript following the interview
to code the data utilizing predetermined categories. As prescribed by Merriam and Tisdell
(2016), analytic coding suggests that the researcher interprets, and clusters together common
themes found in the interview transcript. For successful data analysis, categories must answer the
research questions, be exhaustive, be mutually exclusive, be as sensitive to the data as possible,
and be conceptually congruent (Merriam & Tisdell, 2016). Following the creation of categories
for this study, I used the previously selected categories to code each additional transcript.
Credibility and Trustworthiness
To ensure the credibility and trustworthiness of the data and study overall, there was the
implementation of an interviewee transcripts review (ITR). According to Rowlands (2021), ITR
refers to the process of providing revised transcripts to the participants for their review. ITR is
recognized as one of the most crucial methods to assess the quality of qualitative research.
ITR in this study involves requesting that participants review initial findings following
their interview to confirm that their experiences and stories are well documented and accurate.
Providing participants with the opportunity to review the transcripts also acts as an additional
layer of informed consent, allowing interviewees to verify their anonymity in the study

37
(Rowlands, 2021). The use of ITR, along with my understanding and addressing of positionality
and potential biases, contribute to both the credibility and trustworthiness of the data and study.
Ethics
The sensitivity of the topic of fatphobia and its race-related implications highlight the
need for ethical consideration in this study. Due to internalized fatphobia stemming from societal
standards and norms, weight and weight-related stigma are often taboo subjects amongst women.
As the researcher, I did not directly request for any individual to participate in the study as the
assumption of obesity has the potential to be offensive and harmful to individuals. All
participation in this study was voluntary and sourced through open-ended personal network
inquiries. All participant identities are confidential in the findings of the study, and interviews
take place with the informed consent and permission of participants. The use of narrative inquiry
allowed participants to tell their stories as they see fit, slightly minimizing the potential
sensitivity to specific questions or topics.
Relational ethics refers to the consideration of the researcher’s positionality as well as
their relationship to participants in a study (Merriam & Tisdell, 2016). Based on the networkbased method of recruiting participants, I, as the researcher, was explicit in sharing expectations
and building trust in the interviews. Furthermore, my personal experiences were not included in
the participant interview protocol so that participants did not feel led to share anything outside of
their authentic experiences and stories.

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Chapter Four: Findings
This study examines the lived healthcare experiences of Black women deemed obese by
the BMI and how those experiences shape their decision-making as it relates to health and
wellness. Black feminist thought is the theoretical and conceptual framework that provides
context to the problem of practice. Chapter Four will explore the participants included in this
study and examine the findings of the narrative interviews. The research questions that this study
aims to answer are as follows:
1. What have been the lived experiences of Black women with respect to medical care
and their weight?
2. How do Black women navigate their health and wellness as a result of their lived
experiences in healthcare settings?
Participants
Participants for this study were four self-identified Black women who self-reported a
BMI over 30. Age, socioeconomic status, and education were not factors in recruitment, and
participants varied in their education levels, ages, and professional experiences. All participants
reside in the United States and have had multiple healthcare visits and experiences. Due to the
narrative inquiry method of the study, only four participants participated in the interviews. Table
1 provides a list of participants, their pseudonyms, the state they reside in, and their highest level
of education achieved.
Table 1
Participant Demographics
Pseudonym State of Residence Highest Level of Education
Achieved
Amber Texas Associate’s Degree

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Pseudonym State of Residence Highest Level of Education
Achieved
Blair Georgia High School Diploma
Cassandra Texas High School Diploma
Delores New Jersey Master’s Degree
Amber is a 54-year-old healthcare information technology professional residing in the
Dallas, Texas area. Born and raised in Flint, Michigan, Amber is the youngest of five children
raised by a single mother. While she grew up in a single parent household, her father was
consistently present, with both parents creating a loving upbringing for Amber. Amber raised a
daughter as a single mother before moving to California and then Texas to elevate her career.
Blair is a 34-year-old education specialist residing in the Atlanta, Georgia area. Blair is
the oldest of a large blended family, growing up with her mother, brother, and step-father in the
home. She has lived in the metro Atlanta area since she was a young child after relocating from
the Palm Beach, Florida area.
Cassandra is a 31-year-old analyst in the home improvement industry residing in the
Houston, Texas area. Cassandra is the oldest of two children in her family, where she grew up
with both parents in the home in Detroit, Michigan. In search of a new life experience, Cassandra
relocated to Texas in 2020.
Delores is a mid-30s first generation Nigerian-American educational equity professional
residing in the New Jersey area. Born and raised in New Jersey, Delores is the second-born
daughter, having grown up with her sister and both parents in the household. Delores attended
undergraduate with a focus in theatre management before shifting to a degree in Africana
Studies.

40
Findings Research Question One
This study examines the lived experiences of Black women deemed obese based on the
BMI. The participants in this study shared stories of weight-related interactions from childhood
that continue to impact them as adults. The themes that arose during these interviews were
community and familial influences and the impact of controlling images on self-definition.
Community and familial influences explored the way participants define themselves and those
around them as a result of the words and actions of their immediate family and the community
they belong to. The impact of controlling images and self-definition examined how participants
view themselves because of their experiences and controlling images in the media and on social
media. These themes connect to those presented in the literature review for this study and align
with answering research question one regarding the lived experiences of Black women with
respect to their weight and medical care.
Community and Familial Influences
The words and actions of an individual’s family and immediate community influence
their perceptions of themselves and the world around them. With no direct prompting, each
participant reported the influence of their family members on the way they view themselves.
“I’m second born, so I have an older sister who was always smaller than me, so there was no
passing down of clothing from her to me; it didn’t happen,” Delores shared. Delores also
discussed joint healthcare visits with her sister, where she experienced comparison to her sister
in conversations about weight and BMI as early as 8-years-old. Additional comments from her
parents regarding her weight made her especially self-conscious during healthcare visits. At 13,
when healthcare providers commented on her weight, stating that she was too heavy to carry or
move before a necessary surgery, Delores disclosed feeling embarrassed, particularly in front of

41
her parents, who often commented on her weight. Delores divulged examples of her
conversations with her parents about her weight. “It’s just always something about, ‘Oh, you
know, maybe you shouldn't. Are you losing weight? Are you gaining more weight?’”
While Delores reported differences in her body type in comparison to her family, Blair
described a different family dynamic of similarity in body structure. She recounted consistently
being taller and larger than her classmates in school growing up due to her parents being both tall
and overweight, according to the scale. Blair’s perception of fatness continued to evolve as she
grew older and found herself defending her family members against the misconceptions of
others:
I think when I was younger, it definitely hurt my feelings a little bit, because being from
a larger family, like my grandparents were average size but then I have aunts and uncles
and family members that are larger, and it's just like, I just felt like I always had to take
up for them and advocate for them. And it hurt my feelings because it's just like the
people that I love are larger, and y’all are essentially talking about the people that in my
life that I love the most, and it just really used to bother me.
Cassandra shared a different perspective on similarities in body structure within her
family and how they influenced her perception of her body.
It’s definitely kind of deep rooted because I know like my mom has had issues with her
weight and growing up, I've seen her cry because she can't fit something or seen her cry
because she has to go find something last minute to wear and she can't find it and then
she would start talking about how much she's unhappy with the way that she looks. And I
think for me, like that made me so sad.

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As a result of Cassandra’s familial experiences, weight loss became a major focus of her life as a
pre-teen. “I had to work harder to keep myself in shape. I think I started really working out when
I was like 12 or 13. I started doing like Pilates DVDs and I did Tae Bo over my aunt’s house,”
Cassandra reported. Cassandra’s experience with the BMI scale as a teenager seemingly
validated her concern with her weight, which began with the perception of weight perpetuated by
her family. The participants in this study shared tales of varying familial and community
influences on their perception of weight and how those influences, coupled with their healthcare
experiences have impacted the way that they view themselves.
Self-Definition
Prior experiences, healthcare and otherwise, greatly impact the way that the participants
view and define themselves. Amber shared the story of her experience with healthcare and, more
specifically, the BMI, starting in the early 1990s, in her early 20s. “That was my first experience,
just being told that I’m overweight when I didn’t feel like I was overweight. I felt like I looked
good,” Amber stated when asked about her first experience with the BMI. Following this
experience, Amber reported viewing herself differently and believing that her body was
something that needed to be changed or fixed. This mindset has defined the way that she dates,
approaches interactions, and even the way that she attends social events. Over the next several
years, Amber continued to encounter physicians who placed great importance on her weight and
BMI. As a result of these encounters, Amber describes her current approach to discussing weight
with her healthcare professionals,
I think for me. I try to, I guess, maybe meet it head-on before they bring it up, because
sometimes it makes me feel bad if they bring it up. So, I tell her, ‘Okay, I've been having

43
his back pain, like I guess, primary visit, I started exercising, so I'm losing a little weight
but like it's still hurting.’ So, I guess I try to bring it up before they do.
Cassandra shared a similar shift in how she viewed herself following her first experience
with the BMI. Before her first BMI experience in a healthcare setting, Cassandra reported being
very critical of herself. When she saw an obesity diagnosis on her patient portal, Cassandra was
shocked and confused. She shared,
It was actually very jarring because I'm somebody who was already extremely hard on
myself about how I look and how much I weighed. It was also kind of confusing because
even though I was hard on myself about how much I weighed, when I looked at myself
and I looked at other people, I didn't I didn't see that I was obese. I didn't feel that way. I
didn’t feel like there was anything wrong with my weight. I didn't feel like it was enough
to be inputted on medical notes because of course I don't remember what I went to the
doctor for, but you know they have those notes. But it’s just like what does that have to
do with anything that I ever even went to the doctor for? So it's like you kind of go in and
weigh yourself and get your height. And I didn't realize that they were using that, you
know, to classify me with anything.
Cassandra’s obesity diagnosis, coupled with the fear of inheriting genetics that would make her
feel bad about her body, increased her criticality about her weight. She details examining herself
in multiple mirrors, sharing excessive photographs with friends, and canceling plans at the last
minute based on anxiety associated with how she views her body. Additionally, Cassandra
shared how weight defines her existence as she sees it as a contributing factor in how people
treat her, professionally and personally.

44
Delores disclosed having a love-hate relationship with her weight since she was a child.
She discusses being thick since birth and hearing comments about her weight growing up. “So
weight has always been an interesting dynamic for me. I wouldn't say that I completely was
against certain things with weight, but I was always conscious of it. Because, there are always
comments,” she recalled. Delores shared a story about retrieving a medical record from her
childhood for her master’s program admission; seeing her weight at the age of 6, she recognized
that weight has always been an important factor in how she views herself and how others view
her.
As a result of Delores’ experiences, healthcare, and otherwise, she views her weight as
inseparable from her existence overall, seeing it as a defining characteristic of who she is as a
woman. “I don’t separate myself from my weight, or I don’t think I can. So every interaction I
feel is weight conscious.” Delores shared how the BMI, in particular, disregards ethnicity and
impacts how individuals, especially Black women, think about and view themselves.
Blair described feelings of confusion and inadequacy following her first experience
discussing weight with a healthcare professional.
You know, I wasn't unhealthy in a sense, but to the doctor based off of the metrics, you
know I was, but I was active. I played basketball when I was younger, like I was always
outside, like, I never watched TV. I was doing stuff. But that's when I was like, oh, this is
a thing and you become conscious of that. So then you try to start to wear different things
and like look different ways. And I had to ask my mom, ‘is something wrong with me,
because I'm bigger than all the other kids’ and that becomes a factor of her trying to
reaffirm me when I didn't need that before I went to the doctor type of thing.

45
These feelings of insecurity about her weight led to Blair viewing herself as larger than she was
at certain times in her life and currently wishing she could return to that size. She reported that
she has since learned to accept her body as is, with the understanding that she can change it at
any time if she so desires to. The participants in this study have found themselves shaped by their
perceptions and experiences relating to weight, resulting in an altered self-definition.
Controlling Images
Stereotypical images, also referred to as controlling images, assigned to Black women,
such as the jezebel and mammy archetypes, dehumanize the physical body of Black women. This
dehumanization contributes to the mistreatment and misdiagnosing of Black women in
healthcare contexts. The participants in this study shared their perceptions of the portrayal of fat
Black women in the media, including social media, and how those portrayals have impacted their
perceptions of themselves and the world.
Cassandra reported being a frequent social media user and the various negative posts,
comments, and reactions that she sees regarding fat Black women. She relayed the acceptance of
fat Black women if they have a certain body type.
Let’s say you are overweight, but you still have like a natural hourglass body. That body
is going to be much more acceptable than somebody who could weigh the same amount as
you, they be the same height as you, but their body type is different.
During the conversation, Cassandra brought up the unfair judgment of overweight Black
women's eating habits. She noted how society tends to celebrate thinner women for the same
eating habits that earn harsh criticism for their overweight counterparts. Additionally, Cassandra
pointed out the popularity of Mukbang videos on YouTube and Twitter, a Korean-style video
where the host(s) eat large amounts of food while interacting with their audience. Often, thinner

46
individuals who participate in these videos go viral, while overweight individuals doing the same
thing receive negative comments and criticism. Cassandra shares the harsh reality of feeling that
as a fat Black woman, every post and every action is criticized by the general public. When
asked about her online experience, she shared,
But it definitely makes me hyperaware that I'm not gonna have the same experience. I'm
hyperaware of any photo that I take, any way I record myself, anything that's uploaded of
me because I want to make sure that I look presentable. I want to make sure that I don't
look sloppy. Like I wanna make sure that any picture taken of me is a great angle and that
I look my absolute best because I know how you can be chopped up online. Like it could
be as simple as you getting in a small debate with Twitter with someone and they're
gonna pull up a picture of you. I make sure that if somebody pulls up a picture of me, that
I'm looking good in every single one so there's nothing that you can say. There's also
certain things I'm not gonna be saying all the time like saying how hungry I am all the
time. That’s not something I'm ever going to say because I already have this certain body
type. I don't ever wanna also come across like this, like all stereotypical, of course you
hungry all the time. I'm just I'm very hyperaware of how you can be treated online and I
try to protect my online experience as best as I can.
When prompted to share a specific instance of the experiences of fat Black women in the
media, Cassandra shared a specific story about pop star, Lizzo, and the criticism she garners
online because of her weight. She detailed the ridicule and shame that Lizzo regularly receives in
the media and on social media for wearing clothes deemed sexy although her thinner peers do
not receive the same criticism. “When you’re a bigger person, you know that society does not
like you. Society does not fuck with you,” Cassandra explained, detailing her experiences as a fat

47
Black woman that frequents social media. Cassandra reported a negative experience as it relates
to body image as a fat Black woman in the media as well as on social media.
Amber contributed to the discussion of stereotypes and societal expectations by speaking
of the expectation for women to have a specific body type. “You look at television and social
media, and it’s all perfect bodies. So you think of yourself as kind of a monster, like an outsider.
You don’t meet the standards of the societal norm that they put out there.” She described the
negative feelings that she experienced as a result of these expectations, which were only
exacerbated by the poor treatment she received related to her weight in healthcare settings. She
describes eventually coming to terms with her body while also striving to be healthy at any
weight.
My weight is what it is. I am currently on a journey to lose a little weight, but it’s not
because I want to fit into society, it’s because I want to be healthy. I have diabetes in my
family, cancer runs in my family, hypertension runs in my family, kidney failure, liver
failure so I look out for those so I want to be as healthy as I can. I want to have the
energy and the stamina and to be able to say I’m healthy. Right now, I’m on a weight loss
journey but it’s for myself.
Amber goes on to describe the microscope that she feels fat Black women live under on
social media. “It’s like you shouldn’t be happy or have anything if you’re overweight.” She
details viral videos of fat Black women eating, working out, or in their swimsuits content
creators post to ridicule them. According to Amber, these videos, and the treatment of celebrities
like Lizzo and Gabourey Sidibe work together to make it difficult for Black women to feel
comfortable in their bodies. The stereotypes faced by Black women deemed obese by the BMI

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and healthcare industry impact the way that these women define themselves as well as how they
navigate the world overall, including healthcare settings.
Discussion Research Question One
Three themes emerged from the narrative interviews related to participants' lived
experiences with respect to their weight and healthcare experiences. The themes that emerged
from the study findings were familial and community influences, self-definition, and controlling
images. While the participants shared varied stories and experiences, common patterns surfaced
from all participants.
The first theme, familial and community influences, focused on the participants’
experiences during their formative years. While each participant described a different family
dynamic, all four participants viewed the body types and perceptions of their family as pertinent
to the way they thought about their own bodies and the way they navigated conversations with
healthcare professionals who diagnosed them with obesity based on their BMIs.
The second theme, self-definition, centered how the participants view themselves related
to their weight. The participants in this study reported distinct shifts in their perceptions of
themselves after being made to feel abnormal in their bodies due to healthcare experiences. The
way that they defined themselves because of their interactions, in most cases, led to the inability
to distinguish their weight from their existence.
The third theme, controlling images, concentrated on the stereotypes assigned to Black
women by society, and in this study, specific to fat Black women in the media and on social
media platforms. Participants recalled several instances of fat shaming and ridicule assigned to
fat Black women in the media as well as on social media. Being privy to this negative perception

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of fat Black women has had an adverse impact on the participants, causing them to be
hyperaware of their bodies and feel like outsiders in their everyday interactions.
In the media and in healthcare settings, Black women deemed obese based on their BMI
are viewed as unhealthy and lazy and are often ignored as a result of this perception. The
participants shared their lived experiences in their homes, healthcare settings, and their day-today lives, how weight impacted their interactions, and how they defined themselves. These
experiences pervade every area of their lives and influence how they view and navigate the
world and their health and wellness.
Findings Research Question Two
This study not only examined the lived experiences of Black women in the context of
healthcare and weight but also how those experiences influence how they navigate healthcare
based on their experiences. The themes explored related to Research Question 2 are the impact of
fatphobia on decision making, the power of kinship, and their ideas and strategies for rethinking
activism. The participants in this study shared how their previous experiences and concept of self
have influenced and continues to influence how they manage their health and wellness today.
Additionally, participants noted that the presence of kinship with other Black women aided in
their decisions and strategies for obtaining proper healthcare. Finally, participants shared their
imagined ideal interactions with healthcare professionals, painting a picture of the gap that
currently exists between their current experiences and their perception of an equitable and
inclusive healthcare experience for fat Black women. These themes connect to those presented in
the literature review for this study and align with answering Research Question 2, which aims to
identify how Black women navigate their healthcare based on their lived experiences.

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The Impact of Fatphobia on Decision-Making
The participants in this study shared several experiences with fatphobia, healthcare, and
otherwise. This study explored how participant experiences have shaped their definition of self
and perception of the world. As a result of these experiences, each participant has strategies that
they employ to navigate their health and wellness and everyday lives.
Health and Wellness Decisions
Amber described her current focus on her health, stating several health-related diseases
and disorders that run in her family that she is aware of and would like to avoid. As a result of
this knowledge, she desires to be healthy at any weight. According to Amber, as a young woman,
she felt very self-conscious about herself, defining herself by comparing her body to those in the
media and seeing herself as an oddity. Amber has become comfortable in her body at her current
age, minimizing the influence of the negative comments of healthcare professionals, the media,
and social media. When asked about the impact of weight on how she views and defines herself,
Amber stated, “I think, at this point, I have outgrown that. I feel like I don’t care. My weight is
what it is.”
Cassandra reported how her experiences as a fat Black woman have impacted how she
navigates healthcare today. During past healthcare appointments, Cassandra described physicians
seeming disappointed to find that her lab results were normal despite her being overweight
according to her BMI.
It’s like they seem disappointed when they send you to go get blood work done and
you're normal. It seems like they're disappointed because then they're like, ‘Well, how's
that? That can't be.’ Like, that's how it seems. And I don't understand. And I've had that
happen twice. I've had that happen twice with telehealth doctors. They were non-black

51
doctors as well and I don't know if it was just them looking at me because that's all they
have to go off of, you know, on a telehealth visit. But they told me that I need to have
blood work done specifically because of my weight and then when it comes back normal,
it's like, well, now we're back where we started. I still need help.
Cassandra described feeling disheartened during appointments with healthcare professionals who
did not take into account her genetic makeup when assessing and discussing weight with her.
When asked to share more about this experience, Cassandra shared, “I feel like the BMI scale is
just not realistic for Black people. I'm not trying to go against science and say it’s different
because we're Black, but I feel like it should be.” In response to this experience, Cassandra has
vowed to select Black doctors whenever possible in an effort to be cared for by someone who
understands and respects her body.
Cassandra’s experiences with healthcare providers have also influenced her to
preemptively provide details about her weight, eating habits, and exercise habits before a
healthcare professional can bring it up. She shared,
It's definitely hard, but I try to tell doctors ahead of time. I feel like it's a way for me to
like keep them from judging me. I will be like, ‘I am doing something’ so that they don't
have to tell me themselves.
Blair divulged similar sentiments regarding choosing doctors who share her
intersectionality. “Typically, I try to stay within the realm of having Black providers. Because,
you know, I feel like they can relate a little bit more to the experience,” Blair declared. When
unable to find a Black woman provider, she focused on finding a female provider close to her
age, hoping that they would be sensitive to her body type and overall identity. Blair relayed her
recent experience searching for a new primary care physician. She consulted with other plus-

52
sized Black women and read reviews before deciding on a physician, taking every precaution to
have a safe and equitable healthcare experience.
Delores disclosed a visit to an obstetrician-gynecologist who suggested weight loss
without exploring any causes when Delores expressed issues with her menstrual cycle.
Following this visit, she expressed relief at finding a physician who did not immediately point to
weight when Delores shared a healthcare concern. She stated, “It was very refreshing to have
conversations with the doctor where you could be vulnerable.”
As a result of her healthcare experiences, Delores shared a two-pronged approach to her
wellness, including vocalizing her healthcare concerns when under clinicians' care and exploring
natural remedies when available. Delores asserted, “I do think there’s always been a holistic side
to medicine that a lot of people embrace, and I think there’s always a balance between the two.”
The study participants shared various strategies they employ in their pursuit of equitable
healthcare. While their strategies did not always align, the common thread amongst all four
participants was that fatphobia in healthcare settings and otherwise greatly impacted the way
they navigate their health and wellness.
Personal Decisions
Cassandra shared experiencing fatphobia in not only her medical decision making but
also her personal decision making. Even when embarking on a fitness journey, Cassandra
detailed having to input her height and weight to calculate her BMI as an indicator of health or
lack thereof. This experience has resulted in challenges navigating her overall wellness, given
the discrepancy between how she feels in her body and what the BMI says is an appropriate
weight for her body.

53
Delores told several stories of her experiences with fatphobia, both personal and
professional. When asked for a few examples of how her weight impacts her everyday life,
Delores shared,
I've went on a vacation to do horseback riding, and they're like, ‘Oh, you're over the
weight limit,’ and I'm like, ‘Well, I know horses to tug quite a big load. Secondly, why
isn't this advertised before I purchased my ticket? for me to understand that this is.’ And
I'm like, we're in another country, so I'm not gonna get as stern and be able to advocate in
ways that I might wanna be able to advocate. But, like, it affects every single thing you
do. Even when simple things like people are getting on the elevator, and people are
crowded in and they're like, ‘Oh, what's the weight limit?’ And people are doing fake
math to try and see if we're okay. It's just little things like that that you're usually more
self-conscious of because you know what your weight is, and other people may not, but
they don't know how that affects you or how you perceive where you should be in that
moment.
Delores went on to share discomfort sharing her size for shirts purchased for her team at work,
once again calling to attention her weight. The impact of weight impacts every facet of the
participants' lives in this study, a seemingly inescapable piece of their identities that must
requires consideration in every situation and interaction.
Kinship
Kinship is a historical theme amongst Black women. The participants in this study
identified kinship as a major influence in how they navigate their health and wellness. Delores
told of a strong community of women with whom she discusses health and wellness and how
they support one another in their healthcare journeys. Delores has found support,

54
recommendations for healthcare providers, and understanding through a Nigerian Muslim friend
group at her mosque.
When Delores needed a new obstetrician-gynecologist, it was a woman in her group who
provided her with a recommendation. When she struggled with her eczema and received only
suggestions of weight loss from her providers, it was this community of women that provided
alternatives. Delores shared, “It’s beneficial to just have those people around who understand or
have similar enough experiences as you to share what their tactics are and what worked for
them.”
Delores’ intention to have children in the future has also led to healthcare conversations
with other Black women about birthing plans. These women have made recommendations for
birthing centers, doulas, and other suggestions to combat the widespread mistreatment and
fatalities of Black mothers and babies during labor and delivery. While these recommendations
are not the sole factor in determining how Delores makes her healthcare decisions, the kinship
that she shares with other Black women is a significant factor in her decision making.
Blair also reported having conversations with friends about the fears of childbirth as a fat
Black woman. Her conversations with the Black women in her life about childbirth have taught
her the importance of being vocal and selecting a healthcare provider that does not discriminate
against her based on her appearance. Blair revealed,
Even with like child birthing, like a lot of the people that I know have had children later
in life. So there's what they call the geriatric pregnancy. So there's that aspect of it on top
of being a black woman. And speaking with you learning to have to like advocate for
yourself and say, “Hey, if you're not gonna do it, I'm gonna find somebody else whose

55
gonna do it” and sharing those experiences so that it doesn't happen with other people in
our circle.
According to the participants of this study, the kinship developed amongst Black women acts as
a support group, a safe space for discussing challenges and experiences, and a hub for finding
and sharing resources and recommendations. The participants in this study expressed using
kinship as a tool in their journey toward activism to combat oppressive systems and medical
inequity. Kinship has historically been and continues to be a trusted space for sharing wisdom,
guidance, and support with those who share intersectionality.
Rethinking Activism
The participants in this study have used their experiences, communities, and knowledge
to survive in the face of healthcare inequity attributed to their intersectionality of being fat Black
women. The ability to survive despite these challenges is a form of activism, according to Black
feminist thought (Collins, 2000). In addition to survival, activism takes the form of being vocal
with healthcare providers and refusing to settle for subpar healthcare experiences.
Amber described her ideal healthcare interaction as one where she would be patiently
listened to, respected, and not overmedicated to force rapid weight loss without addressing her
actual concerns. She also values a provider who does not invalidate her knowledge and research.
Activism for Amber looks like speaking up and demanding that she be heard when working with
clinicians. When asked how she would feel leaving her ideal healthcare visit, Amber responded,
“I would feel heard. I would feel seen. I would feel respected.”
Delores detailed a similar ideal healthcare experience, emphasizing seeing a physician
who would take their time during their appointment, allowing time for true communication of

56
her ailments and time to find the best resolution. Delores also expressed a desire for a private
experience when having her vitals taken, specifically her weight.
The weigh-in process won't be as dramatic. I feel like every time you go, they’re like,
‘Oh step up on the scale here,’ and it's usually in a public hallway. I don't know if that, at
least for me, like when I go to places, it's not in private at times. It's just like, ‘Oh step on
the scale right here real quick.’ And then they'll say it out loud, cause they're trying to
remember it to write on the chart, but you don't know who's listening or who I want to
know my business or stuff like that. So, a discrete way to take your weight.
Most of all, Delores stressed the need for a humanistic approach to care.
Blair focused her healthcare experience desires on the overall experience, including the
office space and clinical staff. She described an inviting office space, a diverse staff that greets
patients warmly, and an easy check-in process that keeps the patient at ease. Blair expressed
similar sentiments with other participants regarding the need to be heard in their clinician
interactions and to have their issues addressed. She described,
Somebody who is an active listener, not only listening but listening with the plan to want
to help me with whatever I'm coming in for; and somebody who is empathetic to you
know what I may be feeling. They don't have to necessarily sympathize, but just, have a
heart to where you understand what I'm going through and this is how I'm gonna help you
get through it. I know a lot of healthcare providers see a lot of people, but at the same
time give me a personalized experiences so that I would want to come back.
Cassandra expressed her ideal healthcare experience as one where her weight would not
be the focus of the visit. In her ideal visit with a clinician, she would be viewed as more than a
number on the scale and would be treated for the ailments that she expresses. Cassandra would

57
ideally have the space to discuss weight at her own discretion and would feel comfortable and
safe to do so. When asked about her ideal healthcare visit, Cassandra divulged,
Not having to get weighed at the beginning. I wish that I could take that out of every
appointment because I have never gone to the doctor because I have a weight problem.
I've gone to the doctor cause I don’t feel good; I hurt myself, my head hurts, you know,
my stomach hurts. I wanna just walk in and they ask me what I feel like my issues are
and I tell them exactly what the issue is. Now I would say even after that, if they say, ‘Is
there anything else you want to talk about?’ but that being completely open, I may say,
‘I'm struggling to lose weight.’ I might just go to you that way because it seems more
like, we actually addressed what you came here for. I would be more willing to have an
appointment like that because it's not coming from a place of judgment. Yes, someone
could look at you, and they could assume what you weigh, but I just feel like when you
go to the doctor and that's the first thing they do, they're going off of that. Even if they are
not bringing it up to you, I think that that's in the back of their minds, depending on what
you're saying is wrong. You know like, ‘Oh, I've just been tired lately.’ It's like, ‘Well, do
you get out the bed? Because according to your height and weight, it doesn't seem like
you're moving around much.’
While each participant has shared various experiences in healthcare settings, each of them see
their ability to speak up and select providers who listen to and respect them as a form of activism
in an oppressive industry. “I think it is still insane how you are treated when you are a bigger
person. I truly hope that somehow this can help. That’s my hope,” Cassandra stated, implying
that even her participation in this study is an intended form of activism. This study revealed the
various forms of activism that the interviewees participate in on a daily basis, including but not

58
limited to seeking a healthcare experience where they feel safe and cared for, speaking up for
themselves, and speaking up for others when possible. While activism presents differently for
each participant, the underlying theme found in this study was a push for equitable and
compassionate care from healthcare providers.
Discussion Research Question Two
Three themes for Research Question 2 emerged from the narrative interviews conducted
for this study. The impact of fatphobia revealed the ways in which the lived experiences of each
participant challenged the way they view themselves as well as how they navigate their health
and wellness. Kinship explored the relationships between the participants and other Black
women and how those relationships affect healthcare-related decisions. Rethinking activism
detailed each participant’s ideal interaction healthcare interaction, an exploration of the
healthcare they seek.
Participants disclosed the way that their experiences with fatphobia impacted their
healthcare journey. While some participants selected doctors who shared their intersectionality in
the hopes that their healthcare provider could relate to their challenges, other participants attested
to the practice of seeking natural remedies to alleviate ailments. All the participants in this study,
despite their different experiences, shared a common belief that their experiences as fat Black
women impacted the way they maneuver through the world, including how they navigate
healthcare.
Kinship was a common theme amongst the participants in this study. The presence of a
community of Black women of a similar demographic proved to provide guidance and resources
to better navigate their healthcare. Kinship not only provided resources and recommendations for
natural remedies and clinicians but also emotional support and encouragement. The existence of

59
these supportive networks along with the impact of fatphobia worked together to help
participants make the most informed decisions for optimal health and wellness.
Finally, rethinking activism was a common theme in the interviews conducted for this
study. The participants shared common ideals for equitable and safe healthcare experiences that,
if implemented, could change the trajectory of health and wellness for Black women deemed
obese based on their BMI. The participants in this study define activism as survival in the face of
fatphobia, kinship with other Black women, and advocacy for themselves and others.
Summary
Several themes emerged from the findings of this study in the form of narrative
interviews with the four participants, Amber, Blair, Cassandra, and Delores. When exploring the
research questions, which focused on the lived experiences of fat Black women and how those
experiences influence how they navigate healthcare, the participants shared stories of success
and seemingly insurmountable challenges. These stories have shaped this study, providing
invaluable insight into the problems with healthcare as it relates to the intersection of weight,
race, and gender, as well as painting a picture of a healthcare environment that provided
equitable care for Black women despite their weight.
Each participant shared stories of familial and community influence and how those in
their family and friend groups impacted how they perceived themselves and the bodies of those
around them. At various ages, all four participants were exposed to the BMI, a scale that neglects
to recognize the genetic makeup of Black women in comparison to other demographic groups.
Their exposure to the BMI in healthcare settings, combined with the controlling images in the
media and on social media, influenced how participants viewed and defined themselves. The

60
participants shared how they use kinship and their own version of advocacy to survive despite
fatphobia.

61
Chapter Five: Recommendations
The purpose of this study was to explore the lived healthcare experiences of Black
women deemed obese according to their BMI and how these experiences impact how Black
women navigate their health and wellness as a result. This study provided insight into the factors
that most impact the healthcare experiences and perceptions of fat Black women, leading to the
following recommendations: retirement of the BMI as an indicator of health, changes in
weighing practices during office visits, the implementation of a Health at Every Size (HAES)
approach amongst clinicians, and speaking up as advocacy amongst Black female patients. These
recommendations, while not exhaustive, will move in the direction of health equity and the
eradication of fatphobia in healthcare settings.
Recommendation 1: Retirement of the BMI
The BMI, a tool originally created for non-healthcare-related purposes, is exclusionary,
leading to inequitable assessment of the bodies of Black women. Retiring the BMI would reduce
the prejudicial practice of basing health on weight, leading to equitable care. Healthcare
clinicians often use the BMI as an indicator of health rather than doing the necessary assessments
and tests. Multiple revisions of the BMI, originally created without considering diverse body
types, have altered the standard for assessing health (Who's Fat, 1998). The inconsistent standard
has made it challenging for individuals to meet the criteria. Participants in this study explained
how the BMI rarely, if ever, aligns with their optimal health. Reaching an optimal BMI range
often required an unhealthy amount of weight loss from participants due to physical and genetic
differences based on race and ethnicity (Alexis, 2021).
Providing care without the assistance of the BMI will reduce the underdiagnosing and
medical neglect of Black women, as they will receive treatment based on their ailments rather

62
than their weight. Participants reported several instances of healthcare clinicians ignoring their
reports of illness or concern in lieu of assuming poor health based on their weight. The
elimination of the BMI as a measure of health will allow for a more holistic approach to
healthcare for Black women. Healthcare providers can focus on addressing the specific health
concerns and needs of individuals, rather than relying on a one-size-fits-all metric. This
personalized approach will lead to better health outcomes and a more inclusive healthcare
system.
Additionally, by moving away from the BMI as a measure of health, healthcare providers
can prioritize promoting body positivity and acceptance. Shifting the perspective enables the
creation of a safe and supportive environment for Black women, eliminating the stigma and
judgment based solely on their weight. Emphasizing body diversity and focusing on overall wellbeing rather than weight alone can contribute to a more compassionate and empowering
healthcare experience for Black women.
To promote equitable healthcare for Black women, the Body Mass Index (BMI) should
be retired as a measure of health. Instead, healthcare institutions and providers should adopt
alternative methods of assessing health that consider the diverse body types of Black women. To
achieve this, institutions and providers should prioritize education and raise awareness about the
limitations and biases of the BMI, and train professionals on alternative methods of assessing
health. Healthcare policies and guidelines will require revision to remove reliance on the BMI as
a sole indicator and instead adopt a comprehensive and individualized approach that considers
medical history, lifestyle, and specific health concerns. Research and data collection should
include a diverse range of body types and demographics, leading to the development of more
inclusive and accurate health assessment tools. Lastly, healthcare providers should actively

63
engage and listen to the experiences and perspectives of Black women, involving them in
decision-making processes for a patient-centered and culturally sensitive approach.
Recommendation 2: Weighing Practice Changes
Current weighing practices during healthcare visits cause discomfort amongst Black
women deemed obese based on the BMI and deter them from seeking care, regardless of their
need. In most healthcare settings, clinicians weigh patients in the back office, behind the front
desk, where patients, front desk staff, and clinicians are within earshot. After stepping on the
scale, the documenting staff member will often announce the patient’s weight aloud as they
document it in the patient chart. Given the stigma that fat Black women face consistently in
healthcare settings as well as in the media, the current weighing practices during healthcare visits
can make patients feel uncomfortable and exposed. Stress reportedly causes health challenges
and barriers for Black women due to stereotype threat. This stress often leads to avoidance of
healthcare settings to reduce anxiety (Abdou & Fingerhut, 2014). The participants in this study
described feeling uncomfortable during the weighing process at office visits. They expressed a
desire for a more private space to have their vitals taken.
The specific recommendations for weighing practices in healthcare settings include a
confidential weighing area, as-needed weighing based on appointment type, lack of verbal
weight disclosure to patients, and exclusion of weight on all post-visit documentation provided to
the patient. Providing a confidential weighing area would allow patients to protect their privacy
from other patients and clinicians who do not belong to their care team. In healthcare settings,
only clinicians who are providing care for a patient have access to view a patient’s electronic
medical record to abide by the Health Insurance Portability and Accountability Act (HIPAA).
Ideally, this confidentiality would extend to patient vitals, including but not limited to weight.

64
As-needed weighing based on appointment type ensures that clinicians weigh patients
only when it is necessary for their specific healthcare needs. As-needed weighing will minimize
any unnecessary anxiety or distress that may be associated with weighing. This approach also
allows healthcare providers to prioritize patient comfort and focus on addressing their care
regardless of their weight.
The lack of verbal weight disclosure to patients further protects patient privacy and
avoids potential embarrassment or discomfort. The lack of verbal weight disclosure to patients is
a crucial practice to maintain patient confidentiality and privacy. Instead of announcing the
weight aloud, healthcare providers can communicate the results discreetly through secure and
private channels, such as electronic medical records or patient portals. Discrete communication
of vitals, including weight, ensures that sensitive information remains confidential in the
healthcare setting.
Excluding weight from all post-visit documentation given to patients helps prevent
unnecessary anxiety and distress stemming from internalized fatphobia. This exclusion can help
avoid the development of unhealthy eating habits and eating disorders. Weight and all other visit
information are available in the patient portal and accessible to the patient at any time at their
discretion.
These recommendations aim to prioritize patient privacy and dignity while also ensuring
that healthcare providers have access to necessary information for patient care. By implementing
these practices, healthcare settings can create a respectful and confidential environment for
patients during the weighing process, promoting a positive and patient-centered experience.

65
Recommendation 3: Health at Every Size (HAES) Practices
Implementing Health at Every Size (HEAS) principles in healthcare organizations will
encourage inclusion and fair treatment for all patients, despite their weight and BMI. HAES is a
framework for size diversity and health that focuses on holistic health for all individuals
(Association for Size Diversity and Health, n.d.). According to the Association for Size Diversity
and Health, the principles for Health at Every Size include weight inclusivity, health
enhancement, eating for well-being, respectful care, and life-enhancing movement. These
principles promote equitable treatment for all patients, a current desire expressed by participants
in this study.
According to the Association for Size Diversity and Health (n.d.), weight inclusivity
describes the acceptance of the diversity of body shapes without idolizing a specific body type.
HEAS endorses health policies that work towards improving equitable access to information and
resources to improve overall wellness. Eating for well-being encourages intuitive eating based on
individual needs, rather than restrictive eating focused on weight control. Respectful care
acknowledges and works to combat clinician biases in healthcare settings to reduce weight
stigma and fatphobia. Life-enhancing movement encourages physical activity that aligns with
enjoyment and mental, physical, and emotional wellness rather than punishment for an
undesirable body (Health at Every Size Principles, n.d.).
One of the key benefits of implementing the Health at Every Size principles is that it
promotes a shift in focus from weight to overall health and well-being. By embracing weight
inclusivity, healthcare organizations can create a more inclusive and accepting environment for
patients of all body sizes. Inclusiveness in a healthcare environment can lead to improved patient

66
satisfaction and better health outcomes for individuals who may have previously experienced
weight stigma and discrimination in healthcare settings.
Health at Every Size (HAES) principles implementation in healthcare organizations
requires comprehensive training and education for all clinicians and staff. This training and
education include raising awareness about weight bias and fatphobia and promoting policies that
prioritize health enhancement over weight-focused approaches. Collaboration with community
organizations is also crucial to ensure patient and clinician access to resources that support
holistic health. By embracing the principles of HAES, healthcare organizations can create a
culture of inclusivity, respect, and equitable care, leading to improved patient satisfaction and
better health outcomes for individuals of all body sizes.
Recommendation 4: Speaking Up as Advocacy
Clearly communicating expectations and needs when speaking with a healthcare provider
is a form of advocacy and activism for Black women. According to Black Feminist Thought
(Collins, 2000), one of the major dimensions of activism for Black women is challenging
oppressive policies and norms within organizations and industries. In this study, multiple
participants emphasized the importance of speaking up for their health and wellness needs to
overcome fatphobic treatment and medical neglect.
To promote equitable treatment for fat Black women, this study proposes several
recommendations for speaking up. The first recommendation is to request documentation of
healthcare-related conversations, particularly those that result in clinicians refusing to treat or
test. If a patient asks for a specific test, treatment, or medication and the healthcare provider
suggests weight loss instead, it is advisable that patients ask for this to be documented in their
progress note and made available for them to review in their online portal. This documentation

67
holds the clinician accountable if the patient feels that their medical needs are disregarded due to
fatphobia.
Furthermore, if healthcare providers bring up weight when discussing an unrelated issue,
patients should redirect the conversation back to their chief complaint or reason for the visit.
Another recommendation is to bring a trusted advocate or support person to healthcare
appointments. This individual can ensure that the clinicians hear and address the patient's
concerns, while also providing emotional support during potentially challenging interactions.
Another important recommendation for speaking up as advocacy is to educate oneself about
healthcare rights and resources. By understanding their rights as patients and the resources
available to them, Black women can better advocate for equitable treatment and challenge
fatphobic practices. This can include researching patient rights, seeking out support groups or
organizations that focus on health advocacy for Black women, and staying informed about
current research and initiatives aimed at addressing healthcare disparities. Empowering oneself
with knowledge can be a powerful tool in advocating for better healthcare experiences.
To summarize, advocating for oneself is imperative for Black women to combat
fatphobia and medical neglect. By seeking records of medical discussions, steering conversations
towards their primary concerns, bringing a reliable advocate or companion to appointments, and
becoming informed about healthcare rights and options, Black women can assert their needs and
advance equitable treatment. Through these measures, they can exercise agency in navigating the
healthcare system, challenge oppressive practices, and advocate for more positive healthcare
encounters.

68
Limitations and Delimitations
Limitations are potential weaknesses of the study that are outside of the control of the
researcher. In conducting this study, there were limitations based on the context as well as the
choices and comfortability of the participants. Due to the sensitive nature of the study,
participants may have felt uncomfortable answering some questions truthfully, leading to
erroneous findings. Researcher bias and positionality present additional limitations as they can
influence the tone of the interview as well as the interpretation of the findings. I addressed and
accounted for the limitations in the interview protocol and selection of participants.
Delimitations are the boundaries put in place to manage the limitations of a study. The
delimitations of this study included the multiple sessions of interviews for each participant to
build rapport and reinforce comfortability in sharing their stories truthfully. Additionally, the use
of narrative inquiry as the data collection method is a delimitation to the study as it focuses on
storytelling with very little guidance or input by the researcher, reducing bias, and the potential
for leading the participant. The combination of limitations and delimitations works to provide a
credible and trustworthy study.
Recommendations for Future Research
The intersection between fatphobia, gender, and race is one that leaves fat Black women
feeling unheard, unseen, and unimportant. Fatphobia in healthcare settings specific to Black
women currently has very little published research. To combat the challenges faced by Black
women deemed obese by the BMI, this topic could benefit from research related to specific
specialties within healthcare, such as obstetrics, endocrinology, cardiology, surgery, and others,
to provide additional data from which to make recommendations. This study revealed an
assumed lack of inclusion of body types in diversity training aimed at educating healthcare

69
professionals. Research focused on diversity and inclusion training and how this includes or
excludes body types and weight would be beneficial to improve outcomes across all patient
populations.
Conclusion
Black women are dying at disproportionate rates in comparison to other demographic
groups due to the impact of fatphobia. Fatphobia in healthcare settings can lead to poor outcomes
for patients, especially for Black women who face medical neglect due to their intersectionality
as Black, female, and having a high BMI. This study has highlighted the challenges faced by
Black women related to their weight and BMI when accessing healthcare. The Black women in
this study expressed feeling unheard, stressed, and dismissed when seeking care from healthcare
professionals.
This research and future studies on this topic are crucial for the well-being and existence
of Black women. To fail to address fatphobia in and out of healthcare settings is to fail to
acknowledge the value of the lives of Black women. Without intervention and change, as
recommended in this study, healthcare outcomes for Black women with a BMI deemed obese
will continue to be subpar, leading to higher mortality rates and lower life expectancy, further
oppressing Black women. Identifying, understanding, and eradicating health inequities that
plague Black women generation after generation will encourage improved physical, mental, and
emotional wellness for this demographic. The lives of Black women depend on the
acknowledgement and eradication of this life-threatening issue.

70
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Appendix A: Interview Protocol
Introduction to the Interview:
Thank you so much for agreeing to participate in my study focusing on the lived experiences of
Black women that are obese according to the BMI scale in healthcare settings. I appreciate your
willingness and your time. I anticipate this interview will take one to two hours, depending on
how you tell your story during this time. Is that okay?
This interview and all subsequent transcripts are for research purposes only, and any notes that
I take or audio that I record are for the purposes of including your lived experiences that you
choose to share with me in the research documentation.
Do I have your permission to conduct and record this interview for use in this research study?
Lastly, what questions do you have before we begin?
Table 2
Interview Protocol
Interview Questions Potential Probes RQ
Addressed
Key Concept
Addressed
1. Tell me about yourself. What do you do
professionally?
What is your highest level
of education achieved?
What region of the United
States do you reside in?
Have you always lived in
that general region?
1 SelfDefinition

77
2. Tell me about your first
experience with the BMI.
How old were you?
What was your BMI at that
time (if you recall)?
How did that make you
feel?
1 SelfDefinition
3. Tell me how weight influences
how you view yourself.
What are your thoughts
when you look in the
mirror?
2 SelfDefinition
4. Describe how the media and
social media talk about fat Black
women.
How does this make you
feel?
Tell me about a specific
instance if you can think of
one.
1 Controlling
Images
5. Tell me about a discussion that
you have had with other Black
women about healthcare and
weight.
What is your connection to
this person/group of people?
1 SelfDefinition
6. How have the discussions that
you have heard amongst other
Black women influenced your
healthcare experiences?
How does that make you
feel?
1, 2 SelfDefinition

78
7. Tell me about your routine
healthcare experiences.
This could include physical
exams, immunizations, or
blood work.
1 SelfDefinition
8. Tell me about your
experiences with healthcare
providers outside of your routine
visits.
How many doctors have
you seen outside of your
routine visits?
Can you tell me how that
experience made you feel?
1, 2 Rethinking
activism
9. How have these experiences
impacted how you navigate
healthcare?
Can you tell me about the
connection between your
experiences and this
decision?
2 Rethinking
activism
10. What strategies do you
currently employ to ensure that
you receive adequate healthcare?
How effective is this
strategy?
2 Rethinking
activism
11. Tell me about a time that
your weight impacted your social
or day to day life.
Tell me more.
Describe your feelings in
that moment.
1 Controlling
images
12. Tell me about a time that
your weight was an important
How did that make you
feel?
1 Controlling
images

79
factor in an interaction (of any
kind).
13. Describe your ideal
interaction with a healthcare
professional.
How would they speak to
you?
How would you feel leaving
that interaction?
1, 2, 3 Rethinking
activism
Conclusion to the Interview:
Is there anything that you would like to share that I did not ask about in this interview? Do I
have your permission to reach out if I would like any additional clarification as I review our
interview?
Thank you so much for your time. If you have any additional thoughts to share beyond this
interview, please do not hesitate to reach out at any point. Your story is so important and I am
honored to have the opportunity to hear it and use it in my research in an attempt to further the
progression of Black women in every way.

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Asset Metadata

Creator Mabry, Brandi Nikkale (author)

Core Title Weight for care: the impact of fatphobia on Black women in healthcare settings

School Rossier School of Education

Degree Doctor of Education

Degree Program Organizational Change and Leadership (On Line)

Degree Conferral Date 2024-05

Publication Date 03/21/2024

Defense Date 02/06/2024

Publisher Los Angeles, California (original), University of Southern California (original), University of Southern California. Libraries (digital)

Tag Black feminism,black women,equity,fatphobia,healthcare,OAI-PMH Harvest

Format theses (aat)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Datta, Monique (committee chair), Jones, Kacee (committee member), Ott, Maria (committee member)

Creator Email bmabry@usc.edu,brandinikkale@gmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-oUC113857443

Unique identifier UC113857443

Identifier etd-MabryBrand-12707.pdf (filename)

Legacy Identifier etd-MabryBrand-12707

Document Type Dissertation

Format theses (aat)

Rights Mabry, Brandi Nikkale

Internet Media Type application/pdf

Type texts

Source 20240325-usctheses-batch-1130 (batch), University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the author, as the original true and official version of the work, but does not grant the reader permission to use the work if the desired use is covered by copyright. It is the author, as rights holder, who must provide use permission if such use is covered by copyright.

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA

Repository Email cisadmin@lib.usc.edu