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Epidemiology and Population Health

Sex differences in the influence of weight bias internalization on preferences for telehealth utilization among people with obesity

International Journal of Obesity (2025)Cite this article

Subjects

Abstract

Background

People with obesity (PWO) often experience weight bias, resulting in weight bias internalization (WBI) which may impact their preferences for healthcare engagement. We explored sex differences in self-reported WBI and its influence on telehealth utilization preferences among racially/ethnically diverse PWO who have completed metabolic and bariatric surgery (MBS).

Methods

A qualitative approach was used. The impact of WBI on telehealth utilization preferences was assessed through in-depth interviews. Interviews were thematically analyzed to explore sex differences in preferences between telehealth and in-person visits.

Results

Qualitative analysis (n = 24, 54% female) identified themes such as quality of care, convenience, discrimination in healthcare settings, and shame. WBI was not a primary determinant of how to receive care for both men and women. Their perception of the quality of care they would receive from either telehealth, or in-person visits was the main consideration.

Conclusion

This qualitative research suggests WBI may be common among men and women who have completed MBS, but WBI was not the main factor considered when PWO made decisions about using telehealth or in-person care. Future studies should further explore how WBI impacts healthcare engagement and preferences among PWO who have completed MBS across diverse settings.

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Fig. 1: Sampling frame and sample selection.
Fig. 2: Examples of interview questions and their alignment with the Socioecological Model.

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Data availability

The data generated and analyzed for this study, which are primarily qualitative interview transcripts, are not publicly available due to ethical restrictions concerning participant anonymity and confidentiality. However, the study's interview guides and supporting materials are provided in the Supplementary Information files. De-identified excerpts of the data are included in the published article to support the findings.

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Acknowledgements

We are grateful to the staff at UTSW Weight Wellness Clinic for their support at the study site, and we are thankful to the patients for their participation in this study.

Funding

This study is funded by a grant from the National Institutes of Minority Health and Health Disparities (3R01MD011686-05S2).

Author information

Authors and Affiliations

  1. Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, School of Public Health, Dallas, TX, USA

    Marianne O. Olaniran, Adejumoke Adewunmi & Marlyn A. Allicock

  2. Department of Epidemiology, University of Texas Health Science Center at Houston, School of Public Health, Dallas, TX, USA

    Sitapriya Neti & Dhatri Polavarapu

  3. Department of Epidemiology, Peter O’Donnell School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Jackson Francis, M. Sunil Mathew & Sarah E. Messiah

  4. Department of Internal Medicine, Division of Endocrinology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Jeffrey N. Schellinger & Jaime P. Almandoz

Authors
  1. Marianne O. Olaniran
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  2. Sitapriya Neti
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  3. Dhatri Polavarapu
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  4. Adejumoke Adewunmi
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  6. M. Sunil Mathew
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Contributions

MO conducted the qualitative data collection and analyses, and was involved with project administration, and writing—original draft, review and editing. SN, DP, AA, and JF assisted with all qualitative analyses, and writing. MM AND JS were involved in recruitment strategies and writing. MA was involved in supervision, and writing—review and editing. SM obtained funding for the research including study design, analysis of data, interpretation of results, and writing of the report, and she was involved in conceptualization, methodology, supervision, project administration, and review and editing of the manuscript. JA obtained funding for the research and led the study design, analysis of data, interpretation of results, and writing of the report. He was involved in conceptualization, methodology, supervision, project administration, and review and editing of the manuscript. All co-authors contributed substantially to the manuscript and approved the final submission.

Corresponding author

Correspondence to Marianne O. Olaniran.

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Competing interests

This study was conducted without any commercial or financial relationships that could be construed as a potential conflict of interest. However, JPA has received advisory or consulting fees and/or other support from AbbVie, Boehringer Ingelheim, Eli Lilly and Company, Nestlé, Novo Nordisk A/S and Wave Life Sciences.

Ethics approval and consent to participate

All methods were performed in accordance with the relevant guidelines and regulations. This qualitative study adhered to the Standards for Reporting Qualitative Research (SRQR) guidelines for reporting qualitative research. All study procedures were approved by the Institutional Review Board (IRB) of the Committee for the Protection of Human Subjects (CPHS) at The University of Texas Health Science Center at Houston on November 5, 2018. The approval reference number is IRB NUMBER: HSC-SPH-18-0850.

Informed consent

Participants were recruited following procedures approved by the IRB. Digital informed consent was obtained from all participants by clicking the embedded link within the initial communication, which directed them to a researcher-designed questionnaire where they provided consent and demographic information.

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Olaniran, M.O., Neti, S., Polavarapu, D. et al. Sex differences in the influence of weight bias internalization on preferences for telehealth utilization among people with obesity. Int J Obes (2025). https://doi.org/10.1038/s41366-025-01977-1

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