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Epidemiology and Population Health

The association between higher body weight and stigmatizing language documented in hospital birth admission notes

International Journal of Obesity (2026)Cite this article

Subjects

Abstract

Background

Weight stigma is pervasive in pregnancy care. However, there is limited research on how pregnant women with higher body weight experience stigma through language documented in electronic health records (EHR). The purpose of this study was to examine the association between higher body weight and stigmatizing language documented in the EHR during the hospital birth admission.

Methods

We used EHR data from women over 20 weeks of gestation admitted to two large metropolitan hospitals in the Northeast United States between 2017 and 2019. The primary exposure was higher body weight. We identified women with higher body weight with ICD-10 codes and keyword searches for terms associated with higher body weight in clinical notes. Study outcomes were the presence of any stigmatizing language and four subcategories of stigmatizing language documented in the clinical note. We employed logistic regression to calculate unadjusted and adjusted associations.

Results

After adjusting for covariates, women with higher body weight were more likely to have any stigmatizing language documented compared to women without higher body weight in birth hospitalization notes (adjusted odds ratio [aOR] = 1.10, 95% confidence interval [CI] = 1.01, 1.20). Women with higher body weight were also more likely to have language documented from the marginalized language/identities category (aOR = 1.38, 95% CI = 1.20, 1.59).

Discussion

Women with higher body weight experience stigma in clinical documentation. Findings support the need for clinician training in equitable documentation and the removal of stigmatizing terms from clinic documents and workflows to promote perinatal health equity.

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Data availability

The datasets analyzed during the current study are not publicly available due to patient privacy as this was a secondary analysis of electronic health records.

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Funding

Columbia University Data Science Institute Seed Funds and the Gordon and Betty Moore Foundation grant (GBMF9048) supported this project.

Author information

Author notes

  1. These authors contributed equally: Sarah E. Harkins, Arielle K. Hazi.

Authors and Affiliations

  1. Columbia University Irving Medical Center, Department of Obstetrics & Gynecology, New York, NY, USA

    Sarah E. Harkins

  2. Columbia University School of Nursing, New York, NY, USA

    Arielle K. Hazi, Ismael I. Hulchafo, Maxim Topaz & Veronica Barcelona

  3. University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC, USA

    Jihye Kim Scroggins

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  1. Sarah E. Harkins
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  2. Arielle K. Hazi
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Contributions

SEH: conceptualization, formal analysis, writing-original draft, writing-review and editing; AKH: conceptualization, formal analysis, writing-original draft, writing-review and editing. IIH: formal analysis, writing-original draft, writing-review and editing; JKS: interpretation of data, writing-review and editing; MT: conceptualization, formal analysis, writing-review and editing, supervision; VB: conceptualization, formal analysis, writing-original draft, writing-review and editing, supervision, funding acquisition.

Corresponding author

Correspondence to Sarah E. Harkins.

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The authors declare no competing interests.

Ethics approval and consent to participate

The study was approved by the Columbia University Irving Medical Center Institutional Review Board (IRB AAAT9870), and all the procedures adhered to ethical guidelines. Informed consent was exempt from this study as it was a secondary analysis of electronic health record data.

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Harkins, S.E., Hazi, A.K., Hulchafo, I.I. et al. The association between higher body weight and stigmatizing language documented in hospital birth admission notes. Int J Obes (2026). https://doi.org/10.1038/s41366-025-01965-5

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