Navigating Weight Stigma at the Doctor’s Office

If you are a person who is considered “overweight” or “obese” by the BMI, chances are you are a person who has experienced weight stigma. Weight stigma shows up in many ways from sinister comments to making less money due to one’s size to being unable to fit on public transit. Weight stigma shows up when people are not able to shop at department stores for clothing that will fit them or when someone is constantly subjected to unsolicited diet advice and comments on their food. This sort of treatment is rampant, hurtful, and problematic.

Weight stigma goes beyond unkind strangers at the grocery store. It is a problem built into the medical system. In fact, patients can simply be denied medical care based on nothing but the size of their body.

Fatphobia has its roots in sexism, racism, and ablism, making it problematic on multiple levels. Asher Firestone argues that weight stigma is taking all these other forms of oppression and making them more palatable (Firestone, 2022). Aubrey Gordon put it this way: the increase in weight stigma “has allowed disdain and bigotry aimed at poor people and people of color to persist uninterrupted and simply renamed (Gordon, 2020).” In other words, we are just undergoing a large “rebranding.” Firestone states:

“The project of sexism and racism to link fatness with laziness and unhealthiness harms everyone, but especially fat people. Rooted in disablism, fat people are treated as deficient and at fault for negative outcomes they may experience due to their bodies (such as health, bullying, or social isolation), rather than the environments that create these conditions. When people’s value is determined by the ‘productivity’ of their bodies, ‘health’ becomes a dangerous measure of one’s morals. The entire medical system is a nightmare to navigate for fat people, who are denied access to life-saving medicines and surgeries because doctors insist they will feel better if they just lose weight. The stigma is so pervasive that fat people are more likely to be denied jobs or convicted in a trial (Firestone, 2022).”

When fat people go to the doctor they are often not believed when they describe their symptoms, or the symptoms are attributed to the size of their body and nothing else. Patients are gaslit into believing they are the cause of their poor health and into distrusting their body cues. They are often denied diagnostic tests or are unable to participate in those tests as the equipment needed for the tests is not size inclusive. Then patients are blamed for not fitting, when in fact, weight stigma in healthcare has led to equipment that won’t treat all of their patients. Your body isn’t the problem.

Read more about weight stigma here.

The Problem with Weight Loss Interventions

Being told to “just lose weight” and you will be healed is dismissive and unrealistic. In my work I have yet to meet a fat person who has not tried all of the diets, plans, pills, and exercise programs available. None of these people meet the “lazy” stereotype they are often saddled with by their healthcare providers (and others).

The trouble with telling someone to “just lose weight” is that for most of the population sustainable weight loss is not possible. In addition, the research is pretty clear: correlation does not equal causation. There is no causal evidence showing the link between higher body weight and disease or premature death (O’Hara, 2006; O’Hara, 2018, Hunger, 2020).

Here are a few more facts:

• “BMI is not supported by empirical evidence as a measure of an individual’s health (Nuttall, 2015).”
• “There is considerable evidence that the focus on weight and weight loss is linked to diminished health (Tylka, 2014).”
• “Dieting causes long-term weight gain in 95-98% of participants (Tribole, 2017).”
• “1 in 4 dieters progresses to a clinical eating disorder (Brooks, 2022).” That number is likely higher as many people in larger bodies never get diagnosed despite 98% of people with an eating disorder not being in “underweight” bodies (Sonneville, 2018).
• Healthcare focused on weight intensifies stigma and leads to increased internalization of shame, and worsening health outcomes (Brown, 2002; Phelan, 2015; Rubino, 2020; Wu, 2018).
• “Weight stigma has been shown to pose a greater risk to your health than what you eat (Harrison, 2019).”

Weight-Inclusive Paradigm Shift

We need a shift in how we function in healthcare. Patients deserve to be seen as a person, not as a number on a scale. We need a paradigm shift.

With a weight inclusive model of healthcare patients are treated as a whole person and not as a number on the BMI chart. There is curiosity about symptoms rather than the assumption all symptoms are due to weight. Patients will be heard and believed when they explain their lifestyle. When we stop assuming that fat is a behavior people choose then we can start to treat the whole person.

Unfortunately, we have a long way to go before we get to this point. So below are some supports to help you advocate for the doctor in the meantime:

Advocating at the Doctor’s Office

You shouldn’t have to advocate for equitable care when seeking medical attention. It is important we preface everything with that. Your body is not the problem, our healthcare system is. This blog post should not exist. There should be no need to prepare yourself and to have to fight for fair treatment at the doctor’s office, but here we are.

Weight-inclusive doctor

Finding a weight-inclusive or Health at Every Size (HAES) aligned doctor can make your experience with healthcare much easier. These providers are too few and can be far between. Directories are cropping up to help you locate a good provider (see links below).

Asking around to friends, family, and even on social media for recommendations for providers that people have had good experiences with is another great way to find a provider who will treat you with dignity. Facebook groups can be a good resource to find local providers.

Try finding a provider here:

• Fat Friend Healthcare Providers by Country/State: https://fatfriendlydocs.com
• Fat Friendly Fertility Specialists: https://nicolasalmon.co.uk/fat-positive-fertility-clinics-high-bmi/
• ASDAH’s HAES Directory: https://asdah.org/haes-professional/
• BARE resource for size-friendly providers: https://barehealth.co

If you are still struggling to find a provider listed you are welcome to call local clinics and ask if they have any providers who are HAES aligned or would be willing to provide you with HAES aligned care (more on this below).

Lastly, you can utilize telehealth where you will not need to worry about not having proper fitting medical equipment and furniture. Obviously, not every condition can be effectively treated through telehealth, but it could be a good resource or a good jumping off point to access care.

Understand Your Rights – Advocating for HAES Aligned Care

When it comes to healthcare it is important to remember you have rights. You should be treated with dignity and be given informed consent for all care. However, when sitting on an exam table we often feel vulnerable and as if there is a definite power dynamic that may make us feel like we have to take whatever the provider gives us. This is not the case.

In reality, you are the customer and are paying the doctor. You would never pay a plumber to tell you your water lines have issues because you are too fat and need to lose weight. You have the right to seek another provider.

That being said, sometimes access to healthcare leaves people with very few options. When that happens it is important to learn to advocate for yourself. For example:

• You do not need to be weighed at the doctor’s office unless it is necessary for proper medication dosing. If that is the case you can ask not to be told your weight.
• It may be necessary to ask for the proper sized vaccine needle to ensure that you are properly vaccinated.
• If improperly sized medical equipment is being used and is causing you distress/pain, you can ask them to stop. You can take back consent.
• Often patients are blamed for their bodies and told their health conditions are their fault. You can ask the provider if people in small bodies get this condition and if so, how do they treat it in those cases? Ask for the same treatment, if that is withheld, ask the provider to record in your chart that you were denied those treatments.
• Take a straight-sized friend with you to the doctor. Many people find that having a loved one with a small body in the room when receiving treatment improves the experience as providers tend to keep their weight bias to a minimum.

Below are some card you can print out to take the doctor. One is for you to help with language when meeting with a doctor. One card is for the doctor informing them how you would like to be treated when in their office.

Click here to download a printable version.

Other Resources

• If you would like more support to help you advocate at the doctor Dr. Asher Larmie teaches courses to empower you to combat weight stigma (there are also many other helpful resources on Dr. Larmie’s website: https://www.fatdoctor.co.uk/unshrinkable/
• This podcast is an excellent listen to help you prepare for your next healthcare visit: https://open.spotify.com/episode/1cOqGerEaRM3rBSaBdqJmL
• Find more helpful information and inspiring stories on combatting weight stigma here: https://danceswithfat.org/2017/09/24/advocating-at-the-doctors-office-say-something-sunday/
• HAES health sheets have tons of resources: https://haeshealthsheets.com/resources/
• One of my favorite podcasts debunks many diet/wellness culture myths and I find it helpful to listen to voices who fight back in the face of weight stigma: https://www.maintenancephase.com/

Conclusion

The more of us that band together to fight weight stigma the more we can see a change in the healthcare system. It is unfortunate that we are forced to fight for dignity and equal care and it can be exhausting. Know that you are not alone in this fight.

If you have other helpful resources please share by sending a message, we will update this post with your best resources, advice tips, and tricks!

Resources:

• Alberga AS, Edache IY, Forhan M, Russell-Mayhew S. Weight bias and health care utilization: a scoping review. Prim Health Care Res Dev. 2019 Jul 22;20:e116. doi: 10.1017/S1463423619000227. PMID: 32800008; PMCID: PMC6650789.
• Brooks S, Severson A. How to Raise an Intuitive Eater. New York, NY, St. Martin’s Essentials, 2022.
• Brown A, Flint SW, Batterham RL. Pervasiveness, impact and implications of weight stigma. EClinicalMedicine. (2022) 47:101408. doi: 10.1016/j.eclinm.2022.101408
• https://cswd.org/denial-of-insurance
• Firestone, Asher. “The Systems of Oppression Behind Fatphobia.” Medium. 2022.
• Gordon, A. What We Don’t Talk About When We Talk About Fat. Boston: Beacon Press. 2020.
• Harrison, Christy. “Anti-Diet.” Little Brown Spark, 2019.
• Hunger, JM, Smith JP, Tomiyama AJ. An evidence-based rationale for adopting weight-inclusive health policy. Soc Issues Policy Rev. (2020) 14:73-107, doi: 10.1111/sipr.12062
• Mauldin K, May M, Clifford D. The consequences of a weight-centric approach to healthcare: A case for a paradigm shift in how clinicians address body weight. Nutr Clin Pract. 2022 Dec;37(6):1291-1306. doi: 10.1002/ncp.10885. Epub 2022 Jul 12. PMID: 35819360.
• McEntee ML, Philip SR, Phelan SM. Dismantling weight stigma in eating disorder treatment: Next steps for the field. Front Psychiatry. 2023 Apr 11;14:1157594. doi: 10.3389/fpsyt.2023.1157594. PMID: 37113547; PMCID: PMC10126256.
• Nuttall FQ. Body Mass Index: Obesity, BMI, and Health: A Critical Review. Nutr Today. 2015 May;50(3):117-128. doi: 10.1097/NT.0000000000000092. Epub 2015 Apr 7. PMID: 27340299; PMCID: PMC4890841.
• O’Hara L, Gregg J. The war on obesity: a social determinant of health. Health Promot J Austr. 2006 Dec;17(3):260-3. doi: 10.1071/he06260. PMID: 17176244.
• O’Hara, L., & Taylor, J. (2018). What’s Wrong With the ‘War on Obesity?’ A Narrative Review of the Weight-Centered Health Paradigm and Development of the 3C Framework to Build Critical Competency for a Paradigm Shift. SAGE Open, 8(2). https://doi.org/10.1177/2158244018772888
• Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griffin JM, van Ryn M. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev. (2015) 16:319–26. doi: 10.1111/obr.12266
• Rubino F, Puhl RM, Cummings DE, Eckel RH, Ryan DH, Mechanick JI, et al. Joint international consensus statement for ending stigma of obesity. Nat Med. (2020) 26:485–97. doi: 10.1038/s41591-020-0803-x
• Sonneville, K. R., & Lipson, S. K. (2018). Disparities in eating disorder diagnosis and treatment according to weight status, race/ethnicity, socioeconomic background, and sex among college students. International Journal of Eating Disorders, 51(6), 518–526. https://doi.org/10.1002/eat.22846
• Tylka TL, Annunziato RA, Burgard D, Daníelsdóttir S, Shuman E, Davis C, Calogero RM. The weight-inclusive versus weight-normative approach to health: evaluating the evidence for prioritizing well-being over weight loss. J Obes. 2014;2014:983495. doi: 10.1155/2014/983495. Epub 2014 Jul 23. PMID: 25147734; PMCID: PMC4132299.
• Tribole E, Resch E. The Intuitive Eating Workbook. Oakland, CA, New Harbinger Publication, Inc., 2017.
• Wu YK, Berry DC. Impact of weight stigma on physiological and psychological health outcomes for overweight and obese adults: A systematic review. J Adv Nurs. (2018) 74:1030–42. doi: 10.1111/jan.13511