The weight of society: a qualitative study on how social norms shape body size and weight ideals.

Background: Weight bias and stigma have transformed body weight from a purely biological attribute into a complex social phenomenon. Social and health scientists continue to critically examine how weight stigmatising discourses and biased perceptions shape attitudes, beliefs and everyday experiences. Studies show that socially mediated subjectivities profoundly affect women's health-related behaviours and decision-making. This study seeks to explore, from the standpoint of patients attending a gynaecological clinic, how weight bias and stigma influence women's perceptions of their own weight and body size and the healthcare decisions they make. Methods: This qualitative study was conducted in a Family Planning Outpatient Clinic in the southeastern region of Brazil. Interviews (n = 6) and focus groups (n = 2, six participants per group) with patients were conducted from February to November 2024. All participants identified as women, and the interviews and focus groups were analysed using a reflexive thematic analysis approach. Findings: The rationality of weight bias and stigma influences how women perceive their weight and body shape. This turns biological functions, such as eating and exercising, into social actions that respond to imposed norms that shape common sense about what is considered a healthy and desirable weight. Interpretation: Medical research and clinical practice often reduce health risk factors to poor personal choices or biological predispositions, while neglecting systemic drivers such as weight bias, stigma and fatphobic representations, medicalised discourses of weight, and neoliberal ideals equating thinness with moral virtue. The rationality behind the embodied realities of women navigating weight-based discrimination reveals how weight bias and stigma shape women's everyday life, social actions and healthcare decisions. Funding: São Paulo Research Foundation (FAPESP).