Background
Obesity is highly stigmatized, especially for women, and therefore may negatively affect healthcare experiences. Past findings on the relationship between obesity and healthcare experiences are mixed, perhaps because few studies examine relationships by gender and obesity class.

Objective
To evaluate whether women and men with more severe obesity report worse healthcare experiences related to Veterans Health Administration (VA) care.

Methods
Healthcare experiences (self-management support, mental health assessments, office staff courtesy, communication with providers) and overall provider ratings were assessed with the 2014 VA Survey of Health Care Experiences of Patients. Using multiple regression (n=13,462 women, n=268,180 men), we assessed associations among obesity classes, healthcare experiences, and overall provider ratings, adjusting for sociodemographic, health, and primary care use characteristics.

Results
The largest differences in healthcare experiences between patients with and without obesity were in self-management support experiences, which were more favorable among women and men of all obesity classes. There were gender differences in associations between obesity and mental health assessments: for men, but not women, those in any obesity class gave higher ratings than those without obesity. For most other healthcare experiences and provider ratings, men with obesity gave slightly less favorable experiences than those without. There was no consistent pattern for women.

Conclusions
It is promising that VA patients with obesity report more self-management support, given the behavior change required for weight management. Lower healthcare experience and provider ratings among men with obesity suggest a need to further investigate possible obesity-related stigma in VA primary care.

Keywords: obesity, veteran, healthcare experience, gender difference