Background: Weight-related stigma is reported frequently by higher body-weight patients in healthcare settings. Bariatric surgery triggers profound weight loss. This weight loss may therefore alleviate patients' experiences of weight-related stigma within healthcare settings. In non-clinical settings, weight-related stigma is associated with weight-inducing eating patterns. Dietary adherence is a major challenge after bariatric surgery.Objectives: (1) Evaluate the relationship between weight-related stigma and post-surgical dietary adherence; (2) understand if weight loss reduces weight-related stigma, thereby improving post-surgical dietary adherence; and (3) explore provider and patient perspectives on adherence and stigma in healthcare settings.Design: This mixed methods study contrasts survey responses from 300 postoperative bariatric patients with ethnographic data based on interviews with 35 patients and extensive multi-year participant-observation within a clinic setting. The survey measured experiences of weight-related stigma, including from healthcare professionals, on the Interpersonal Sources of Weight Stigma scale and internalized stigma based on the Weight Bias Internalization Scale. Dietary adherence measures included patient self-reports, non-disordered eating patterns reported on the Disordered Eating after Bariatric Surgery scale, and food frequencies. Regression was used to assess the relationships among post-surgical stigma, dietary adherence, and weight loss. Qualitative analyses consisted of thematic analysis.Results: The quantitative data show that internalized stigma and general experiences of weight-related stigma predict worse dietary adherence, even after weight is lost. The qualitative data show patients did not generally recognize this connection, and health professionals explained it as poor patient compliance.Conclusion: Reducing perceptions of weight-related stigma in healthcare settings and weight bias internalization could enhance dietary adherence, regardless of time since patient's weight-loss surgery.

Living with extreme weight in the United States is associated with discrimination and self‐stigma, creating structural exclusions, embodied stress, and undermining health and wellbeing. Here we combine ethnographic interviews and surveys from those with experiences of living with extreme weight to better explain how this vulnerability is created and reinforced by public cues, both physical (e.g., seatbelts) and social (the reactions of strangers). “Misfitting” is a major theme in interviews, as is the need to plan and scan constantly while navigating too‐small public spaces. The most distressing events combine physical misfitting with unsympathetic reactions from strangers. Sensitivity to stigmatizing public cues reduces with weight loss, but does not disappear. This study explains one basic mechanism that underlies the creation of felt stigma related to weight even after weight loss: the lack of accommodation for size and the lack of empathy from others that characterize modern urban spaces.

Stigma - both weight-related and surgery-related - needs to be addressed at a larger level, in terms of policy and in clinical bariatric programmes.

Cultural notions equating greater morality and virtue with hard work and productive output are deeply embedded in American value systems. This is exemplified in how people understand and execute personal body projects, including efforts to become slim. Bariatric surgery is commonly viewed as a 'low-effort' means of losing weight, and individuals who opt for this surgery are often perceived to be 'cheating.' This extended ethnographic study within one bariatric program in the Southwestern United States shows how patients conscientiously perform this productivity. By prioritizing discourses that focus on their own hard work and the inherent value and necessity of their surgery, patients and practitioners alike contest the dominant public views of surgically-induced weight loss.

Burgeoning online environments offer completely new opportunities for ethnographic and other forms of qualitative research. Yet there are no clear standards for how we study online texts from an ethnographic perspective. In this article, we identify barriers to the application of traditional qualitative methods online, using the example of a systematic thematic analysis of weightloss blogs. These barriers include the influence of the technology structuring online content, the fluid nature of online texts such as blogs, and the highly connected and public nature of online identities, which may span multiple social media platforms. We discuss some potential approaches to addressing these challenges as preliminary steps toward developing a tool kit suited to ethical, high-quality online modes of ethnographic research.

Translation of social science-oriented obesity research for broader public good requires collaborative work across disciplines and fields, as well as between academics, professionals working in public health and medicine, policy makers, and other key stakeholders. Translation efforts must acknowledge and develop practical programs addressing the "obesity crisis," but also are compelled to question core assumptions upon which obesity-reduction interventions have thus far been based.

In recent years, there has been a florescence of cross-cultural research using ethnographic and qualitative data. This cutting-edge work confronts a range of significant methodological challenges, but has not yet addressed how thematic analysis can be modified for use in cross-cultural ethnography. Thematic analysis is widely used in qualitative and mixed-methods research, yet is not currently well-adapted to cross-cultural ethnographic designs. We build on existing thematic analysis techniques to discuss a method to inductively identify metathemes (defined here as themes that occur across cultures). Identifying metathemes in cross-cultural research is important because metathemes enable researchers to use systematic comparisons to identify significant patterns in cross-cultural datasets and to describe those patterns in rich, contextually-specific ways. We demonstrate this method with data from a collaborative cross-cultural ethnographic research project (exploring weight-related stigma) that used the same sampling frame, interview protocol, and analytic process in four cross-cultural research sites in Samoa, Paraguay, Japan, and the United States. Detecting metathemes that transcend data collected in different languages, cultures, and sites, we discuss the benefits and challenges of qualitative metatheme analysis.

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