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Obesity stigma: A barrier to life-saving cancer screening services

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Published on 11 May 2022

Professor Yitka Graham
Professor Yitka Graham

A study has found that people living with obesity are failing to access vital cancer screening services due to fears of stigma and judgement surrounding their condition.

Healthcare researchers at the University of Sunderland set out to explore the impact of obesity and obesity stigma on the uptake of three main cancer-screening services: breast, cervical, and colorectal, from both the patients and healthcare professionals’ perspective, within community and general practice settings.

The study is the latest example of quality research taking place at the University of Sunderland. This week it was announced that over 70% of our published research has been rated as either world-leading or internationally excellent in the 2021 Research Excellence Framework (REF) results.

Analysing studies over the last 10-years, across Europe, Australia and the United States, the researchers found that many healthcare providers hold strong negative views and attitudes toward people with obesity who present in healthcare settings, with evidence that such viewpoints can influence perceptions about the patient, judgment, behavior toward the patients, and influence decision-making on treatment.

Several studies highlighted disparities in the population living with obesity; a study of breast screening participation in women aged 50–64 years found that both women, underweight or obese, had significantly higher levels of non-participation with mammography compared with normal weight women. Another study showed a decrease in cervical screening linked to increased body size. Meanwhile, men of a normal weight are more likely than men who are overweight or obese to have undergone colorectal screening.

What was apparent from the research was the evidence that the higher a woman's BMI was, the statistically less likely she was to engage and uptake with cancer screening services. Factors preventing screening included embarrassment, negative body image, and imaging with medical equipment.

The review argues that more research is now needed to improve the uptake of cancer screening services, and that more education is considered for health professionals around weight prejudice, which they say is often unconscious. They believe this may help increase the incidence of early diagnosis of potential cancers and improve health outcomes for people living with obesity. 

Lead researcher, Professor Yitka Graham, Head of the Helen McArdle Nursing and Care Research Institute, Health Services Research at the University of Sunderland, said: “Obesity is a known risk factor for the development of cancers, there is also an acknowledged stigma across society towards people living with obesity, which can influence health behaviors and deter seeking help, such as cancer screening. Healthcare professionals’ attitudes and views toward people living with obesity may also affect the patient–professional interface and treatment.”

Catherine Hayes, Professor of Health Professions Pedagogy and Scholarship in the University’s Faculty of Health Sciences and Wellbeing, added: “The review reveals the reality of living with barriers to cancer screening for people living with obesity, examining their personally held perceptions of screening processes and the practicalities of attending them. 

“In terms of our need to continually underpin medical and healthcare academic programmes with an evidenced based approach to tackling the stigma of obesity, the study will serve to highlight and illuminate significant issues for a reflexive approach to improving knowledge, skills and understanding of a complex and multi-faceted condition.”  

Professor Catherine Hayes

Kamal Mahawar, Consultant Bariatric Surgeon at South Tyneside and Sunderland NHS Foundation Trust, Visiting Professor and External Advisory Board Member of the Helen McArdle Nursing and Care Research Institute commented: “The findings of this review show that excess weight is a barrier to accessing cancer screening services for both sexes. The review highlighted the importance of healthcare professionals to understand the concerns and fears of people living with obesity when attending for cancer screening, whether perceived or real, for example, feeling stigmatized, and make every attempt to ensure that facilities are weight-friendly, from equipment, language used, and overall environment.”

Kamal Mahawar

Collaborator Dr Julie Cox, Consultant Radiologist at County Durham and Darlington NHS Foundation Trust, Visiting Professor and External Advisory Board Member of the Helen McArdle Nursing and Care Research Institute, said: “The review also identified that many healthcare professionals were not comfortable or experienced in undertaking screening procedures with people living with obesity, and that education on techniques for performing screening interventions with this population, along with learning how to deal with refusals and other barriers, and providing a supportive environment which is weight-friendly, is crucial.”

The research was funded by the Northern Cancer Alliance (NCA). 

Sheron Robson, NCA Programme Manager for the Early Diagnosis Workstream, said: “Understanding barriers to cancer screening is key to increasing uptake. If people living with obesity are worried about being stigmatised, they will be less likely to attend screening programmes. Screening leads to early diagnosis, which means better prognosis, and this review will inform future service development.”

Sheron Robson

Rates of obesity have tripled globally since 1975, and as of 2016, the World Health Organisation estimated there were 650 million people living with obesity. By 2030, the rates are predicted to increase to one in five women and one in seven men, meaning over one billion people across the globe will be living with obesity.

The study was carried out before the Covid-19 pandemic, and the wider impact of the pandemic on cancer screening services is currently in the early stages. The risks associated with obesity and related deaths in the context of Covid-19 and social distancing rules may be a further contributing factor to an already low uptake of screening services in the population living with obesity.

The research team included Professor Yitka Graham, Professor Catherine Hayes, Julie Cox, Kamal Mahawar, Ann Fox and Dr Heather Yemm. 

The full report: A systematic review of obesity as a barrier to accessing cancer screening services – appears in the latest publication of Obesity Science and Practice, click here.