Weight stigma in healthcare is not only about what a clinician says. It is also a chair with arms that do not fit, a gown that comes in one size, a scanner that cannot take the patient, a waiting room TV show about how bad obesity is. A UK research team has now published how it built a checklist for exactly these environmental parts of stigma in NHS hospitals. The paper reports how the checklist was made and what 69 survey respondents and 18 interviewees thought of it. It does not report whether the checklist works.
The paper is “Addressing Weight Stigma in Healthcare Settings Using an Obesity Checklist: A Mixed-Method Development Study” by Giang T. Nguyen, Jade H. Thorne, Nicola Heslehurst and colleagues, published online on 17 June 2026 in Obesity Facts (open access). The paper uses the term “people living with obesity” (PLwO); I use it where I describe the study.
How the checklist was built
The work started with a checklist that Northumbria Healthcare NHS Foundation Trust had developed internally as a quality improvement project. The authors saw its local origin as a limit, so they extended it in three phases.
In phase 1 they searched Google Scholar for existing checklists and found four more: one from Alberta Health Services in Canada, one for ambulatory settings in the USA, one from Obesity Canada (adopted by the Association for the Study of Obesity on the Island of Ireland) and the European criteria for obesity specialist services. A convergence coding matrix compared the five sources for agreement, additions, contradictions and gaps. One example of a contradiction: the sources disagreed on equipment weight capacity. The wording was checked against international consensus statements on weight-related language.
In phase 2, healthcare professionals, researchers, people living with obesity and their carers or family members in the UK and Republic of Ireland gave feedback. Recruitment was by convenience sampling through professional and patient networks and social media. An online survey ran in February and March 2025, and interviews on Microsoft Teams followed from May to July 2025, lasting 25 to 65 minutes. Phase 3 revised the checklist and wrote implementation recommendations.
Who answered
69 people completed the survey. 56 of them answered the branch for professionals and researchers, 22 the branch for people living with obesity and carers or family members; some people held more than one role, so the role counts in the paper overlap and I report only these totals. 18 survey participants were interviewed. The average age was 47 in the survey and 48 in the interviews, 84 and 82 percent were women, and 82 and 83 percent lived in England. The authors call the group sizes “small and heterogeneous”.
The results
The checklist covers four areas: reading materials, furniture, equipment, and access and infrastructure. Examples from the paper: reading materials without stigmatising images or language, seating without arms as well as with, no visibly separate “bariatric” seating, appropriately sized gowns and blood pressure cuffs, and short distances to hospital departments.
Most reviewers saw little missing. Across the four areas, 75 to 85.7 percent of professionals and researchers said no important items were missing, and 93 to 100 percent said nothing should be removed.
Patients and carers were less uniform. Asked whether a checklist like this would have changed their own hospital experience, 59 percent said it would have made no difference for reading materials and for access. For equipment, 55 percent said more comfortable and 46 percent said no difference. For furniture it split evenly at 50 percent each. One person each said reading materials and access might have made it more uncomfortable. The qualitative data were more positive: participants described that suitable equipment and thoughtful language made them feel “normal” and respected.
The interviews describe the environment problem concretely. One interviewing professional, who runs obesity clinics, said appropriate tables and chairs are hard to find even there: “People are made to feel uncomfortable. People are made to feel unwelcome.” A professional described a patient with a bariatric chair whose relative of similar weight has to sit on a standard chair, making both uncomfortable. A patient described a one-size gown that had to be swapped for scrubs, so she “looked completely different from everybody else”.
Changes after feedback: the final checklist added items such as reading materials on the complexity of obesity, adjustable beds, dignity underwear, daily-living equipment and commodes.
Barriers named by participants: funding, space, outdated buildings and deep-rooted weight bias. As supports, they named management buy-in, training and education, endorsement and accreditation schemes. The paper ends with twenty recommendations. Examples: a named person responsible for checking compliance, accreditation, integration into regulatory frameworks such as CQC standards, and data collected before and after implementation.
Reading it carefully
The checklist is a development result, not an evaluated intervention. The paper covers stage 2 of a five-stage framework (content and design). Testing and validation, implementation and ongoing evaluation are still ahead. The authors say longitudinal studies are needed to evaluate real-world effectiveness and effects on patient experience and stigma. The conclusion that the checklist “could support hospitals” is therefore a hypothesis the study did not test.
The sample is small, recruited through networks and social media, and mostly English. The survey came before the interviews, which the authors say may have focused the interview discussion on the four domains. The branch for patients and carers had only 22 respondents, so the 59 and 55 percent figures rest on a handful of people. I would not read them as a ranking of what matters most.
The funder is Northumbria Healthcare NHS Foundation Trust, which also developed the original checklist; two of the authors developed it. The authors declare no conflicts of interest. That is worth knowing, not a finding against the paper.
The authors also state a limit of the checklist itself: participants stressed that staff behaviour and attitudes shaped dignity and safety, and the checklist does not address these. Training and cultural change have to come with it. For that side, see our article on the AIHTA training review and the Spanish survey of health professionals; this paper is about the physical and printed environment.
This article reports how one checklist was built and received. It does not evaluate any treatment or weight-related intervention.
Why it belongs here
Stigma research often measures attitudes. This paper looks at furniture, gowns and leaflets, and asks patients and staff what they would change. The answers are specific and checkable, which is what makes a checklist useful, and the paper is open that nobody has yet measured whether using it changes anything. For hospitals in the UK, the next step it names is validation. For Germany and the United States, the data do not speak: the sample was UK and Ireland, and the authors say transfer to other systems would need adaptation.
Source: Nguyen GT, Thorne JH, Goodlet S, Davies L, Combet Aspray E, Papamargaritis D, Miras AD, Le Brocq S, Cooke S, Harland J, Heslehurst N. “Addressing Weight Stigma in Healthcare Settings Using an Obesity Checklist: A Mixed-Method Development Study.” Obesity Facts, online ahead of print 17 June 2026, doi.org/10.1159/000552921 (PMC13432955). Full text read on 3 October 2026.