Navigating Communication Challenges in Obesity and Pregnancy Care
Discussions about obesity in pregnancy present unique challenges, shaped by medical perspectives, personal experiences, weight stigma and societal narratives. When patients and clinicians approach these conversations from different standpoints, misunderstandings can arise, influencing both the quality of care and patient trust. Rachel Dadouch’s PhD research, recently published in PLOS ONE, delves into these communication dynamics, identifying key areas where perspectives diverge and how these differences impact patient care.
Conducted during her PhD at the University of Toronto’s Institute of Medical Science, Dadouch’s thesis explores the intricacies of clinical encounters involving obesity in pregnancy. Co-supervised by Janet Parsons, associate professor in the Department of Occupational Science & Occupational Therapy at the University of Toronto, and Rohan D’Souza, associate professor in the departments of Obstetrics & Gynecology and Health Research Methods, Evidence, and Impact (HEI), her research examined how patient-clinician communication influences care experiences and outcomes. She now continues this work as a Postdoctoral Fellow in the Department of Obstetrics & Gynecology at McMaster University, under D’Souza’s supervision, further investigating ways to enhance patient-centred communication in maternal healthcare.
Unpacking the Communication Divide
Dadouch’s research originated from the Core Outcome Set for Studies on Pregnant Patients (COSSOPP), where she observed a striking disconnect: clinicians and patients were speaking about obesity in vastly different ways, including their use of the term itself. During the qualitative phase of COSSOPP – where she explored an unrelated question about clinical trial outcomes – these differences became too pronounced to ignore. Clinicians frequently expressed uncertainty about how to approach weight-related discussions, while many patients reported feeling dismissed, uninformed, or stigmatized. These insights led her to investigate how communication breakdowns in obesity-in-pregnancy clinical encounters and how they influence healthcare experiences.
Through her research, Dadouch identified five central “narrative tensions” – fundamental points where perspectives diverge both between and within patient and clinician groups:

Obesity as a medical concern vs. neutrality or acceptance:Some view obesity as a significant health risk, while others accept it as part of one’s identity and do not necessarily see it as a medical issue requiring intervention.
Personal responsibility vs. external factors:While obesity is often framed as a result of lifestyle choices, others emphasize genetic, social, and environmental factors beyond an individual’s control.
Routine pregnancy vs. high-risk condition:Some view a pregnancy with obesity as a regular pregnancy, merely in a larger body, while others automatically think about it as a high-risk status.
Uncomplicated vs. challenging clinical encounters:Some see these discussions as routine, while others find them complex due to medical risks, communication uncertainties, and weight stigma, shaping both clinician and patient expectations.
Direct discussions vs. avoiding the topic:Some believe weight should be addressed openly, while others hesitate, uncertain about how to discuss it without causing distress. Study participants also vary – some seek transparency, while others prefer weight to be mentioned only when medically necessary.

Crucially, these tensions do not exist solely between clinicians and patients but also within each group. An individual’s personal history and past encounters with weight-related discussions shape their position within these tensions, influencing how clinical conversations unfold and whether both patient and clinician leave the interaction feeling understood and supported.
“Many patients shared experiences that reflected long-standing weight stigma in medical settings, some dating back to childhood,” said Dadouch. “These experiences shape their expectations and interactions with healthcare providers. My goal with this research is not to assign blame but to foster dialogue that bridges gaps in understanding and promotes more constructive conversations.”
Strengthening Patient-Clinician Dialogue
While Dadouch’s findings highlight the complexities of obesity-related discussions, they also serve as a foundation for developing more effective communication strategies. She emphasizes that the next phase of her research will focus on identifying tangible approaches clinicians can use to facilitate more open, compassionate, and productive discussions about weight. In the interim, she encourages healthcare providers to reflect on their own positioning within these five narrative tensions and to pay close attention to subtle conversational cues that reveal where their patients may stand. Recognizing these nuances can help mitigate miscommunication and foster greater understanding in clinical encounters.
Beyond individual healthcare interactions, Dadouch hopes her research will inform broader systemic change. “There is a growing sense of distrust in healthcare, and improving communication is one of the most immediate ways to rebuild that trust,” she notes. “Listening to patients and validating their concerns is not just an ethical obligation – it is a critical step toward fostering a more inclusive and effective healthcare system.”
By dissecting the complexities of these discussions, Dadouch’s research underscores the necessity of patient-centred communication strategies. Addressing these narrative tensions can help create a clinical environment where patients feel heard, clinicians feel better equipped to navigate sensitive topics, and ultimately, maternal health outcomes are improved.






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