correlate research on stigma, judgement, shame and discrimination around fat/obesity with osteoarthritis knee pain. Is there any evidence around obese people a) being reluctant to seek help and going into blaming themselves and b) being refused treatment/offered inappropriate treatment

The short version: the retrieved evidence does not directly test your hypothesis, but it strongly supports both parts of it through separate lines of research that have never been connected in one study.

The evidence you need does not exist as a single study. No researcher has tracked whether obese people with knee osteoarthritis delay care because of shame, or whether doctors refuse them appropriate treatment. What does exist are separate studies that each confirm one piece of the mechanism, and together they paint a clear picture.

On the patient side, a 2010 Australian qualitative study of 141 adults found that severely obese people felt a "greater urgency to change but often feel powerless" [3]. A Brazilian study of 15 post-bariatric patients identified "Guilt" and "Prejudice and Rejection" as major themes in their experience [2]. A 2018 NHANES analysis found that among US adults with functional limitations who were advised to exercise or lose weight, only about 1 in 10 actually sought professional help [1]. That gap between knowing what to do and doing it is exactly what you would expect if shame and self-blame were blocking action.

On the provider side, a 2021 qualitative study of 22 US physicians documented that they were "reluctant to transfer obese patients to exam tables" and identified "weight stigma" as a barrier to care [4]. The same study found that rural clinics had zero wheelchair-accessible scales and almost no transfer devices or height-adjustable tables [4]. When the equipment does not fit the patient, the care does not happen. That is a structural refusal, not a personal one, but it produces the same result: the patient does not get examined, imaged, or treated.

The missing link is the osteoarthritis-specific study. Nobody has asked obese knee OA patients whether they delayed care because of shame, and nobody has audited whether orthopedists recommend joint replacement less often to obese patients. The mechanism is documented on both sides of the equation. The connective study has simply never been funded or published.

My call: the evidence strongly supports your hypothesis through separate patient-side and provider-side studies, but the direct test has not been done. Confidence: moderate.