Weight-Inclusive and Supportive Environments for healthcare Residents

Weight stigma (WS) is a persistent form of discrimination against people living with obesity that extends into healthcare, where it compromises the quality, safety and equity of care. Patients who anticipate or experience stigmatising treatment are more likely to delay or avoid medical visits, report poorer communication and lower trust, and encounter situations in which all health problems are automatically attributed to their weight, with detrimental consequences for health outcomes and inequalities. Research consistently shows that WS is present not only among practising healthcare professionals, but also among health sciences students and residents, whose clinical beliefs, attitudes and skills are still being shaped. Addressing WS in healthcare is therefore a public health and human-rights priority, and a key target for psychological intervention. This project aims to design, implement and evaluate a training intervention for healthcare residents, with the overarching goal of fostering stigma-free, person-centred clinical relationships in the management of obesity. The project is organised in three phases and adopts an innovative methodological approach grounded in mixed methods and psychologically informed frameworks, and guided by a systems perspective that considers the various actors involved in obesity care. Phase A uses a mixed-methods design to understand how WS is expressed, maintained and experienced in educational and clinical settings. A large online survey with health sciences students from public and private universities in Spain will assess explicit and implicit stigma, beliefs about the causes and controllability of obesity, and key psychological and sociodemographic correlates. Latent class and multivariable analyses will identify risk profiles and modifiable targets. In parallel, focus groups with patients, university educators and healthcare professionals, enriched by participatory methods such as Concept Mapping and Photovoice, will explore lived experiences of WS, communication barriers and opportunities for change. Building on these findings, Phase B will develop and feasibility-test WISER (Weight-Inclusive and Supportive Environments for healthcare Residents), a face-to-face group intervention co-designed with patients, clinicians and educators and grounded in Mentalization and Motivational Interviewing (MI). The programme aims to reduce stigma by enhancing empathy, reflective functioning, self-awareness of bias and MI-consistent communication skills. A single -arm pilot will examine feasibility, acceptability and preliminary changes in targeted psychological outcomes. Phase C will conduct a longitudinal, parallel-group, single-blind randomised controlled trial comparing WISER with usual training in a larger sample of residents. Primary outcomes will be explicit and implicit weight stigma; secondary outcomes will include beliefs about obesity, internalised stigma, empathy, reflective functioning, MI skills, self-efficacy and use of non-stigmatising language. Mixed-effects models will test intervention effects and explore psychological mediators and moderators. The project aims to generate knowledge that is directly useful for training, clinical practice and health policy, promoting more inclusive care environments and a view of health that goes beyond body weight. Results will be disseminated through training materials, curricular recommendations and community- oriented activities.