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Background Weight stigma (WS) negatively impacts health outcomes and experiences for people living with obesity (PLwO), in healthcare settings. This study aimed to refine a WS environment and equipment checklist developed by Northumbria Healthcare NHS Foundation Trust (NHCT), enhancing its applicability across NHS hospital environments.Methods Using a converging coding matrix, 4 existing checklists were integrated with the NHCT checklist, structured around key domains: reading materials, furniture, equipment, access and infrastructure. A mixed-methods online survey and a qualitative study were conducted to gathered feedback and further refine/finalise the checklist. Results from the survey and interviews were used to make revisions and finalise the integrated checklist.Results 69 people completed the online survey (51 Health Care Professionals (HCPs), 8 researchers, PLwO, and 4 Carer/Family member (C/FM)); 18 survey respondents were interviewed (8 PLwO, 8 HCPs, 2 HCPs+PLwO). Participants viewed the checklist as comprehensive, with no amends. Implementation challenges were noted such as furniture, equipment and access, largely due to financial constraints, limited space, outdated infrastructure, and availability of equipment. Training, education, and accreditation were identified as key facilitators, while weight bias and discriminatory attitudes among HCPs were major barriers. PLwO and C/FM felt equipment improvements would most enhance their experiences, whereas reading materials and access factors were less influential. 5 qualitative themes were developed: practical content, clear and inclusive wording, influence of environment and staff attitudes on dignity and outcomes, role of inclusivity in patient and family experiences, barriers and enablers to implementation, including funding, leadership support, and policy endorsement.Conclusion This study supports the WS checklist as a practical resource to guide NHS trusts in creating more obesity-inclusive environments. Findings suggest a clear, practical, inclusive checklist could help hospitals reduce weight stigma and improve care experiences for PLwO. Respondents valued the checklist but noted that implementation requires funding, structural changes, and staff training.