{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,5]],"date-time":"2026-07-05T09:26:31Z","timestamp":1783243591339,"version":"3.54.6"},"reference-count":81,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T00:00:00Z","timestamp":1739145600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Ontario Graduate Scholarship Program"},{"name":"University of Toronto Obstetrics and Gynaecology"},{"DOI":"10.13039\/501100020895","name":"Temerty Faculty of Medicine, University of Toronto","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100020895","id-type":"DOI","asserted-by":"publisher"}]},{"name":"University of Toronto, School of Graduate Studies"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>\n                    There are numerous biomedical and psychosocial challenges associated with obesity in pregnancy that impede communication between healthcare providers (HCPs) and patients. We conducted a narrative study informed by stigma theory to understand specific areas of communication breakdown in obesity-in-pregnancy clinical encounters. Sixteen patients and 19 HCPs participated in in-depth, semi-structured interviews. We explored how participants positioned obesity-in-pregnancy clinical encounters within their broader narratives. Employing narrative analysis, we identified five narrative tensions contributing to communication challenges: 1) obesity as\n                    <jats:italic>a detriment to health<\/jats:italic>\n                    versus\n                    <jats:italic>an acceptable biologic variation<\/jats:italic>\n                    ; 2)\n                    <jats:italic>obesity as the result of personal choice<\/jats:italic>\n                    versus\n                    <jats:italic>the result of uncontrollable circumstances<\/jats:italic>\n                    ; 3)\n                    <jats:italic>a regular pregnancy<\/jats:italic>\n                    versus\n                    <jats:italic>a high-risk diagnosis;<\/jats:italic>\n                    4)\n                    <jats:italic>a typical and problem-free clinical encounter v<\/jats:italic>\n                    ersus\n                    <jats:italic>a tremendously difficult clinical encounter<\/jats:italic>\n                    ; and 5)\n                    <jats:italic>talking openly about Body Mass Index (BMI) and related co-morbidities<\/jats:italic>\n                    versus\n                    <jats:italic>sidestepping the topic<\/jats:italic>\n                    . How participants positioned themselves relative to prevailing societal discourses regarding obesity in general influenced these tensions. These narrative tensions revealed specific areas where communication is vulnerable to breaking down during the obesity-in-pregnancy clinical encounter. Participants\u2019 (both HCPs and patients) past experiences of clinical encounters\u2013and the meanings they ascribe to them\u2013shape subsequent encounters, and our analysis illuminates the complexities of this interactive space. This research has implications for improving clinical practice and education.\n                  <\/jats:p>","DOI":"10.1371\/journal.pone.0318514","type":"journal-article","created":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T13:32:59Z","timestamp":1739194379000},"page":"e0318514","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Where is communication breaking down? Narrative tensions in obesity-in-pregnancy clinical encounters"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6910-6060","authenticated-orcid":true,"given":"Rachel","family":"Dadouch Enzel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarenna","family":"Lalani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rory","family":"Windrim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"Maxwell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Kingdom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4049-2017","authenticated-orcid":true,"given":"Rohan","family":"D\u2019Souza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet","family":"Parsons","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,2,10]]},"reference":[{"key":"pone.0318514.ref001","article-title":"Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults","author":"Collaboration NCDRF.","year":"2024","journal-title":"Lancet"},{"key":"pone.0318514.ref002","unstructured":"WHO. 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