Doctors Are Shitty to Fat Patients

I’m a fat vegan — this leads to an endless array of good times at the doctor’s office. I’ve been told to eat more meat when I had an allergic reaction to strawberries; and I’ve been told to lose weight when I broke my middle finger (it was an unfortunate time to have a broken middle finger, LET ME TELL YOU). I’ve left doctor’s offices cursing, screaming, whimpering, and straight-up bawling, ala the little boy in Bridge to Terabithia. I had to audition three general practitioners and two OBGYNs to find medical care that didn’t involve prescriptions for Vitamin Steak and black market Phen/Fen. Seriously, I fucking hate going to the doctors.

Apparently, I’m not imagining the whole thing about doctors hating me — especially when it comes to weight. The researchers at Harvard’s Project Implicit conduct online tests to gain insight into our implicit biases. One of the tests focuses on our bias against fat people, and quite a few doctors have taken it. Unfortunately, they share the same strong anti-fat bias as most everyone else. Boo. According to a study in PLoS ONE:

More than 359,000 people took the project’s “Weight Implicit Association Test” online, and about 2,300 said they were doctors. Even though physicians are constantly reminded about their need to work with patients to maintain a healthy weight, they had the same strong anti-fat bias as the public.

“We don’t know if this affects how doctors behave clinically,” says Janice Sabin, an assistant professor in bioinformatics and medical education that the University of Washington in Seattle, who led the new study.

But other studies have shown that many doctors view obese patients as unattractive and difficult to work with, and that obese women get inappropriate comments about their weight from their doctor.

Janice Sabin might not be able to tell you, but any fat person who’s gone to their general practitioner with a head cold and been told to lose weight can. There are lots of larger folks who are terrified to visit their doctor with real problems — real problems that may or may not be related to weight — because they don’t want to be automatically be told to slim down before an examination is even conducted.

News flash, docs, fat people know they’re fat, they’re not confused. And since we’re constantly told that the obese monster is the #1 grim reaper, I’m pretty sure most fat people know what you think about their weight. And since many of the dangers of being fat are greatly exaggerated (if not completely fabricated), and since you’re a medical professional who should know better, your concern trolling is unnecessary. If a patient’s weight is a real hindrance or danger, then yes, let’s talk; but if you’re just telling them to lose weight because fat people gross you out, then kindly, shut the front door.

If your patient wants help losing weight I can guarantee that they’ll ask. Well, I can’t guarantee you, but wouldn’t you rather make your patient feel like they’re in a safe, caring space — one where they’re free to talk about anything, even their weight. If you start pressuring someone right away to lose pounds, the response will be an automatic shutdown — and maybe worse. Inducing shame, fear, disgust, and despair don’t exactly create a path to healthy behavior.

Going to the doctors is pretty loaded for most people, and when you know that you’re going to be judged because of how you look, it can be extremely unpleasant. It’s why so many fat people just don’t go at all — which is a big problem because it allows minor health issues to escalate. What’s easily treatable one month, can become very dangerous the next.

The prevalence of weight discrimination among Americans has increased by 66% over the past 10 years [7]. Overweight patients report being treated disrespectfully by health professionals because of their weight [8]. One study found that 53% of overweight and obese women reported receiving inappropriate comments about weight from their doctors [9]. Obese patients who report perceptions of weight discrimination avoid seeking routine preventive care such as cancer screenings [10], [11].

Awful! There are resouces to help larger people find physicians to talk to, like Mara Nesbitt’s How to Choose a Fat-friendly Doctor and other Medical Suggestions and various online and offline support communities, but it can be daunting at first. I don’t want to go to an OBGYN for a pap-smear and be told to lay off the donuts. Is my weight affecting my reproductive health? If it is, let’s have an honest discussion about why and how. If not, just scrape my cervix and let’s get my vagina out of your face.

Nesbitt has a great way for sussing out fat-friendly docs:

I ask the same questions of all of them:

“Do you think a person can be both fat and healthy?”

If they say no, or qualify it.. up to X number of pounds.. then I don’t give them my business. If they say yes, I proceed with:

“Are you comfortable touching a fat person?”

Most of us have experienced being diagnosed from across the room, as if the doctors fear they will catch fatness from us.

Then I ask whatever other questions I have: alternative therapies, office hours, etc. It is very rare that I get past the first question. They usually don’t think fat people can be healthy. I go on to the next doctor on the list.

I won’t waste my time, energy or my insurance company’s money with a doctor who won’t treat me with dignity and respect. If you belong to something like Kaiser, where you are assigned to a doctor, I’d recommend starting with the first one, expressing your needs for a non-judgemental physician with him/her, asking for their cooperation, and if they don’t want to work with you in that way, asking them for a referral to someone who will.

Word. Maybe doctors need to start looking at some pictures of diverse bodies? And educating themselves National Association to Advance Fat Acceptance’s patient’s bill of rights
? And just reading more about health, weight, and other things they should become familiar with, considering this country’s war on the obesity monster? Because, after all, isn’t the first part of the Hippocratic Oath to, “keep [patients] from harm and injustice”?

*Have you taken those tests at Project Implicit? The ones where you find out exactly how much of a racist homophobe your subconscious is? I love them — I’m addicted and won’t stop until I prefer gay people one hundred percent. I’m just testing a “strong preference” right now but I believe I can get to the point where an honorary rainbow flag sprouts out of my butt.

Implicit and Explicit Anti-Fat Bias among a Large Sample of Medical Doctors by BMI, Race/Ethnicity and Gender [PLoS ONE]
How Changing Visual Cues Can Affect Attitudes About Weight [NPR]