"I'm not just a large lady; I'm a large Black lady": Intersectional stigma and barriers to healthcare access among Black women.

Weight stigma in healthcare settings presents serious mental and physical health implications and contributes to disparities in healthcare access and outcomes. Using an intersectionality lens, this study examined how weight stigma experienced by large-bodied, low-income Black women in Missouri healthcare settings affects healthcare quality and access. We used qualitative design and in-depth interviews to collect data. Eligible participants identified as Black women (age ≥35) with BMI ≥30, low income (≤$60,000 for a family of four), Missouri residence, and English proficiency. 21 participants were included in the study using purposive and snowball sampling approaches. One 30-60-min semi-structured interview was completed per participant via Zoom/phone. Data analysis followed a thematic analysis. Six coders iteratively developed a codebook; intercoder reliability was strong (Cohen's κ = 0.85). Intersectional stigma was pervasive and multifaceted. Participants described (1) weight-first framing that overshadowed other diagnoses, leading to misattribution and missed care; (2) cultural insensitivity and non-inclusive environments (lack of appropriate fitting gowns/equipment, stigmatizing imagery); (3) communication failures and dismissal, producing feelings of being unheard or judged; and (4) heightened medical mistrust rooted in historical and ongoing racism, resulting in delays or avoidance of care. Contextual barriers in low-income neighborhoods (e.g., limited healthy food and safe exercise spaces) were seldom acknowledged in clinical encounters. These results demonstrate that weight stigma cannot be disentangled from race, gender, and socioeconomic status in Black women's healthcare. Interventions should include weight-inclusive, culturally responsive, bias-aware training; increased representation of Black providers; redesigning clinical environments for inclusivity; and workflow changes that prioritize holistic assessment beyond weight. Findings inform practice, policy (e.g., respectful-care quality metrics), and future research to co-design solutions with patients and clinicians.