Evaluation of Surgeons' Perspectives and Perceived Readiness to Adopt Minimally Invasive Breast Surgery in a Low- and Middle-Income Setting.

Weight stigma occurs when individuals are mistreated or discriminated against because of their body shape or weight. Approximately half of adults report experiencing weight stigma in their lifetime [], with people in larger bodies reporting the highest rates of weight‐based teasing and maltreatment []. Similar to other forms of social stigma, weight stigma is considered a psychophysically stressful experience, with prior research demonstrating increases in negative affect [], acute inflammation biomarkers [], and salivary cortisol levels [, ] following exposures to weight stigma. Experiences of weight stigma can activate stress pathways and prompt metabolic, emotional, and behavioral changes that increase vulnerability to developing adverse health and well‐being outcomes [, ]. Additionally, individuals who have experienced weight stigmatization may also delay recommended healthcare screenings, postpone or avoid necessary care, or switch providers frequently due to felt stigma and fears of encountering future stigmatization [, , ]. Prior research suggests that weight stigma increases one's risk of developing obesity and obesity‐related morbidities and mortality, highlighting the potential deleterious effects []. These findings raise concerns about the impact of weight stigma among individuals pre‐ and post‐metabolic bariatric surgery (MBS) given the higher weight status of patients seeking MBS. MBS is considered the most effective intervention for reducing weight and related comorbidities among persons with obesity (BMI ≥ 35 kg/m or BMI of 30–34.9 kg/m with comorbidities) []. For many, MBS results in improvements in physical health conditions, such as type 2 diabetes, hypertension, dyslipidemia, and musculoskeletal pain, in addition to long‐term weight loss and improved functional mobility [, ]. Common reasons patients seek MBS include physical complaints, mobility impairments, health concerns, challenges engaging in daily activities (e.g., walking, playing with grandchildren), and improve body image concerns [, , ]. Another reason for considering MBS is the goal of minimizing experiences of weight‐related stigma [, , ]. Interestingly, despite the well‐documented health benefits of MBS, individuals report ongoing and uniquely challenging stigmatizing experiences following surgery, including beliefs from others that having MBS is the “easy way out” []. For those who continue to experience weight stigma, current evidence suggests that health benefits of MBS could be compromised by weight stigmatization given that experiencing weight‐based mistreatment is associated with greater disordered eating behavior (e.g., night eating, binge eating), poorer body image, and higher depression and anxiety levels among individuals who have had MBS []. A systematic review by Bennett and colleagues [] summarized studies that examined weight stigma among patients undergoing MBS; most studies were cross‐sectional (pre‐ post‐MBS) with only two longitudinal studies included, revealing a significant gap in the literature to date. Their review found that experienced and internalized weight stigma was associated with psychological, behavioral, and physical health problems among individuals pursuing or having undergone MBS []. The present study expands on the work of Bennett and colleagues [] by updating and expanding the literature review, analyzing the change in patient experiences of weight stigmatization before and after MBS using data from a larger pool of longitudinal studies than was previously reported, and by investigating the predictive impact of presurgical weight stigmatization on postsurgical outcomes. Based on the results reported in Bennett and colleagues [], we hypothesized that weight‐based stigma would improve from pre‐to‐post MBS. To expand on previous results, we planned to examine moderators including demographic variables and surgery type. We also hypothesized that greater weight stigmatization pre‐MBS would predict poorer outcomes post‐MBS.