Written by: Kait Vanderlaan, LCSW
Going to the doctor can be stressful for anyone, but an additional layer is added for patients in a larger body. Unfortunately, weight stigma is rampant in the medical community and frequently shows up even if a doctor has good intentions. Weight stigma is defined as discrimination based on a person’s weight or size. In a medical setting, this can look like the (false) belief that a person’s health issues are because of their weight and that losing weight will instantly solve all health problems. All too often, fat patients are not listened to and are told that they simply need to lose weight and that their health issues are due to their weight. No matter what the presenting symptom is, it is often blamed on body size, and we are told time and time again that we would not have this ailment if we just lost weight. While this is completely untrue, it is also extremely stressful to always have things blamed on weight, never feel listened to, and never get other solutions from a health care provider. This experience of weight stigma in health care can lead to increased stress, poor health outcomes, or avoidance of health care altogether.
First and foremost, it is important to note that health is extremely complex and cannot simply be deduced to a person’s weight. There are so many things that influence someone's health including but not limited to socioeconomic status, access to food and food insecurity, physical environment, education, mental health, adverse childhood experiences and trauma, genetics, and community and family support. Weight tells us absolutely nothing about a person’s health. There are plenty of ways to enhance health such as joyful movement, reducing stress, prioritizing sleep, getting enough rest and down time, eating regularly, medication, therapy, prioritizing sleep, socializing, and getting preventive medical care. It is possible to be healthy at any body size and to pursue health without changing your weight.
Often doctors will recommend losing weight and dieting as a solution, without also talking about the harm associated with intentional weight loss. A doctor who only recommends weight loss or dieting is just plain lazy, in my opinion. Health looks different for everyone, and if you don’t feel comfortable with your provider, seek out a different provider if you are able to. Additionally, most physicians have very little nutrition training and are not actually qualified to give nutrition advice. If you are looking for support with nutrition, I highly recommend working with an anti-diet, Health at Every Size (HAES), and/or weight-inclusive Registered Dietitian. Connect with our RDs HERE.
Most medical appointments start with the dreaded weigh-in, followed by comments about BMI and the “need to lose weight.” This is an extremely stressful way to start an appointment as it often evokes feelings of shame and stress. As a patient, you have the right to decline any medical procedure or vitals check, including being weighed. Weight is actually very rarely medically necessary, despite the fact that it is so common at medical appointments. Typically the only time your weight is needed is for precise medication such as anesthesia or chemotherapy. Otherwise, it is totally fine to skip it! Feeling anxious about declining it? Go to your appointment prepared with a notecard or a response of what you want to say. Typically, I say, “actually, I prefer not to be weighed today.” Other options:
“You can write patient declined.”
“Being weighed is triggering to me, and I would feel more comfortable not stepping on a scale.”
“My weight is not relevant to today’s appointment, and I would like to focus on other aspects of my health today.”
“Weight is not an indicator of health, so I am going to skip this part.”
“If taking my weight today is medically necessary, can you explain why so I can give informed consent?”
“If taking my weight is medically necessary to figure out a medication dose, please take a blind weight and do not tell me the number.”
Doctors are often viewed as authority figures and what they say goes. However, this could not be further from the truth! You are the expert of your own body. and your medical providers work for you. You are a customer paying for a service, and you have the right to receive compassionate, respectful, ethical, and evidenced-based treatment just like everyone else. Yes, medical providers are extremely knowledgeable about health care, but they do not know everything. You do not have to do anything that you are not comfortable with and have the right to decline any aspect of suggested care.
One of the best pieces of advice that I have received is to view doctors as consultants in your care. You are going to them for help and support around a certain issue, and they are there to offer advice. You are allowed to ask questions, seek a second opinion, or decline what is suggested. Take what works for you and leave the rest behind. People of all sizes have health ailments, and there are so many ways to improve symptoms without weight loss. I know that not everyone feels comfortable speaking up during a medical appointment. Remember, you have a right to be involved in your medical care. If you have a medical provider who is insisting that weight loss is the only solution, you are allowed to question and challenge them. Examples of questions you can come prepared with:
“What advice would you give to a thin person who is struggling with this issue?”
“I hear that you are suggesting weight loss. Can you share some research with me that shows this method of weight loss works for people long term?”
“I know we don’t have much time today, and I would like to use our time to focus on X, not weight loss. Are you able to do that?”
“I have some research about the dangers of dieting and the harm of weight stigma; would you like to see it?” (See below)
Unfortunately, sometimes patients are denied gender affirming surgery, joint replacement, or other surgeries due to arbitrary BMI limits. This topic is complex and deserves way more than a paragraph in this blog, but I think it’s too important not to at least name it. If you have been denied surgery because of your weight, I am SO sorry. It is absolutely crushing to be denied a surgery that could change your quality of life because of your weight. Research on this is growing, but often it is not that a procedure or surgery is unsafe for people in higher weight bodies, but that surgeons have no training on how to perform the surgery on larger bodies. Medical schools typically only practice on thin cadavers, and as a result many surgeons just don’t have the experience working with larger bodies. If a doctor tries to tell you that it’s unsafe to use anesthesia on higher-weight bodies, I call bullshit. Surgeons perform bariatric surgery with anesthesia all the time on higher weight bodies - so what’s the difference? The problem is not with your body, but with inexperienced surgeons. There ARE surgeons who do not have a BMI limit, though I know it is a privilege to be able to travel for surgery. If you want more information on the research around this, this is a wonderful collection of studies on weight and surgery: HAES surgery research - Dropbox
I hope that you feel empowered to advocate for your needs at your next medical appointment. Do whatever you need to do to prepare - wear comfortable clothing, bring a safe support person, write down your questions or needs ahead of time, take a few deep breaths, listen to music in the waiting room, or use any other coping skill that helps you feel safe. You are also allowed to leave at any time; you do not have to tolerate a bad provider. Moreover, remember that you do not owe anyone your health. Bodies are designed to fail, and struggling with health issues does not make a person unworthy or less than. Struggling with certain health issues is not a moral failing, despite narratives that exist in our society. There is not one health issue that only fat people struggle with. All humans experience health issues throughout their life. You too are human and deserve adequate and compassionate health care.
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Want more information? Check out these HAES Health Sheets (https://haeshealthsheets.com/) a “Health At Every Size®-Based Guides for Blame-Free, Shame-Free Explanations of Common Medical Conditions”
Research Studies:
The weight of stigma: cortisol reactivity to manipulated weight stigma
Weighed Down by Stigma: How Weight-Based Social Identity Threat Contributes to Weight Gain and Poor Health
Long-term Effects of Dieting: Is Weight Loss Related to Health?
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