Doctors Aren't Mean to Fat Patients, They're Just Nicer to Thin Ones

As a fat person, I've never been treated like complete shit at the doctor, although I've certainly gone in for a sore throat and been told to go on a diet (ugh, why wouldn't I stop eating so many strep-laced Ding Dongs!?). But I have had some uncomfortable experiences, and I know plenty of fat people who have had downright abusive and dangerous ones.

Though I've never been overtly traumatized by a healthcare professional, I sometimes wonder if I would have been treated better if I was thin. I've never been thin at the doctor. Maybe it's awesome! Maybe going to the doctor while thin is like that episode of Growing Pains when Chrissy goes to bed and then Jason and Maggie do pony-rides around the living room all night. I don't know! Fortunately, academia is making some significant strides into solving this mystery—measuring and documenting anti-fat bias in clinical situations. (No word yet re: secret ponies. But I've got my eye on you, thin people.)

It shouldn't be surprising or controversial at this point to hear that fat people, in general, get shitty medical care. Or, rather, that fat people have a harder time getting good medical care than thin people do. This is not new. Americans dislike and distrust fat people. Fatness is conflated with myriad moral failings: laziness, selfishness, ignorance, incompetence, whininess, lack of self-control, refusal to take responsibility for one's choices. When most Americans look, superficially, at a fat person, they assume (not necessarily deliberately!) that they know a lot of things about that person: what they eat, how much they move, how they feel about themselves, how "healthy" they are. Their size tells the whole story; no need to investigate further. And doctors—the people supposedly employed to investigate and solve fat people's health issues—are not exempt from those assumptions. Doctors don't exist outside of that system. Doctors are human beings, and absorb the same cultural norms and subtle biases as the rest of us. Doctors can be dicks, and that puts fat people's lives at risk.

A study last fall supported just that—about 2,300 doctors participated in a "Weight Implicit Association Test," which revealed that physicians hold the same strong anti-fat biases as the general public. But, as one of the study's authors noted, "We don't know if this affects how doctors behave clinically."

Jackpot! Now we do! A new study out of Johns Hopkins specifically examined doctors' clinical practices and found that most doctors aren't necessarily cruel to fat patients; but they measurably withhold the empathy and personal connection that they extend to thin ones. (Anecdotally, fat people are already very aware of how bias affects their doctors' clinical behavior. Read through the heartbreaking stories of anti-fat medical bias collected here if you're not convinced.)

Via the New York Times:

In conversations with patients of normal weight, the doctors offered simple comments to show concern — for example, “I’m glad you’re feeling better” to a woman who had experienced hot flashes. When a normal-weight patient had trouble getting an appointment with a specialist, her doctor shared her concerns. “I agree with you,” the doctor said. “That gets extremely frustrating when that happens.”

...And statements like these are no small thing. Studies show that patients are far more likely to follow a doctor’s advice and to have a better health outcome when they believe their doctor empathizes with their plight.

“When there is increased empathy by the doctor, patients are more likely to report they are satisfied with their care, and they are more likely to adhere to recommendations of physicians,” Dr. Gudzune said. “There is evidence to show that after visits with more empathy, patients have improved clinical outcomes, so patients with diabetes have better blood sugar control or cholesterol is better controlled.”

There's a massive, distracting misconception about bias (and this applies to discrimination against all marginalized groups, by the way)—that it's loud and ugly and direct. Sure, sometimes it is. Sometimes anti-fat bias is pointing and laughing at a fat person on the street, or telling a fat writer that she's too fat to get raped. But much more often, it's subtler. It's not the presence of hostility, it's the absence of care: a lack of compassion, of warmth, of representation, of generosity, of willingness to connect. A lack of things that are granted, without question, to other groups, and taken for granted by those groups. That deficit might not be violent or overt, it might be invisible, but it erodes people.

I don't know what it's like to be a thin person at the doctor. I don't know. And that's the point, really. I know that doctors are people, and plenty of them are wonderful (I personally love my doctor), and some doctors are fat, and some fat people get skillful, life-saving care. But many, many, many fat people don't—whether overtly or subtly. And just because you might not know what that feels like, or be able to perceive it, doesn't mean it's not real. Sometimes you just can't know someone else's experience; and it's especially difficult to perceive, in someone else's life, the absence of a boon you'd never even noticed in yours. This kind of invisible bias is more entrenched, harder to fight, less fashionable to complain about, and much more painful to recognize and address in oneself. But we have to.

Anti-fat bias in medicine is a devastating problem. Fat people are already reluctant to seek medical care, thanks to entrenched feelings of worthlessness (why take care of this thing I've been taught to hate?), lifetimes of conditioning never to show their bodies (wouldn't want to put the doctor through that), and the paralyzing cultural insistence that they're on the verge of death anyway (avoidance feels safer than potential confirmation). And then, when they do go, when they do put their trust in the hands of a supposedly caring, objective medical professional, they're met with the exact same disinterest and dehumanization and cheap myopia that they already get from every other angle. It blows a giant hole in the fallacy that anti-fat bias is really just "care" for fat people's "health." If you care about fat people's health, then you care about their mental health, their emotional health, and their access to the exact same level of health care that thin people enjoy. If you don't, then you don't care about fat people.