Kelly Neilson, MDA RD LD
I Think My Doctor Is Weight-Biased What Can I Do About It?
**Content warning: This post is about weight bias and stigma in healthcare. “Fat” will be used in a reclaimed, descriptive way, instead of in a derogatory way. The words obese and obesity are used sparingly because that is the language used in the research presented.
Weight stigma is all around us. It shows up in ads, on social media, in relationships, in the workplace — and yes — even in the healthcare setting. Its pervasiveness in the United States sends the message that it's acceptable to discriminate against people in large bodies.
Weight stigma, also called sizeism, is built on the belief that overweight individuals are lazy and eat too much. Many assume that if fat people could "eat less and exercise more" then they wouldn't be so fat.
These stereotypes lead to weight bias, or weight discrimination, and the unfair treatment of individuals who are perceived as being overweight.
But we know these beliefs aren’t based on facts.
Body size is complicated and involves more factors than the outdated “calories in/calories out” philosophy of diet culture. A person’s genetics, mental health, hormones, upbringing, and environment can contribute to their weight.
The oppressive standards of diet culture have oozed into the healthcare system. Without proper training and a conscious effort to acknowledge and change their implicit biases, healthcare providers can do harm to their patients.
So how can an individual address weight bias at their doctor’s office?
Weight Bias in Healthcare
The average time it takes to become a doctor is about 11 to 12 years. You’ll be shocked to learn that in that time, doctors don’t get much training in nutrition or eating disorders.
Most med students receive less than 20 hours of nutrition education, and maybe as little as one lecture per year of medical school.
With so little training in this area, and typically being taught using a weight-centric model, it’s no wonder that it’s common for doctors to have preconceived notions about people in large bodies. Many subscribe to the grossly inflated “health risks of being fat” mantra.
They forget the fact that a person’s HEALTH can affect their weight and large individuals can be “metabolically normal,” with a low risk of cardiovascular disease and other conditions commonly attributed to weight.
Scarier yet, some doctors and other healthcare practitioners believe frequent discussions involving shaming will encourage their patients to lose weight.
Needless to say, the shaming tactic doesn’t work and causes harm to patients.
Dietitian Christy Harrison talks about diet culture on her weekly podcast, “Food Psych.” She and her guests dive into the important topic of weight stigma in healthcare in episodes 119, 171, 207, and 248. “Food Psych” is available on major podcast apps.
I highly recommend her podcast to anyone who’s experienced weight bias and anyone who wants to be an agent of change.
Weight bias is far too prevalent in the healthcare system and individuals who experience it are less likely to seek care.
One study showed that 53% of women who would be categorized as “obese” have heard healthcare professionals make inappropriate comments about their weight.
And about 40% of healthcare professionals admit to having “negative reactions to patients with obesity.”
This same study found that 52% of women say their weight is a barrier to healthcare and that they’ll often delay or avoid preventative care. Not receiving appropriate care, whether because of avoidance or failure of the doctor to order testing, may be a possible reason why there are many disease states associated with large individuals.
Weight-biased practitioners can have significant negative impacts on a patient’s health and quality of life.
Discrimination and mistreatment can contribute to:
Decreased motivation to exercise
Eating disorders/disordered eating
And it could mean missing a life-saving diagnosis.
Biased providers are more likely to overlook the possibility of underlying conditions, focusing on weight as the cause of their patient’s symptoms.
This was the case with Ellen Maud Bennett who died at the age of 64 after being diagnosed with inoperable cancer. Doctors failed to provide diagnostic testing to get to the root cause of her symptoms. Instead, they told her to lose weight. Sadly, this is a common occurrence.
Addressing Weight Bias in the Medical Setting
If you believe you’ve experienced discrimination in the doctor’s office because of your weight, first and foremost, know that this is NOT ok.
You’re not alone. Caring and compassionate people are out there advocating for change.
It won’t happen overnight, so in the meantime, here are a few tips to help empower you to address bias at the doctor’s office.
Remember, YOU are your best advocate!
1. Knowledge is Power! Arm yourself with information before you head to your doctor’s office.
The Association for Size Diversity and Health maintains an educational blog to help raise awareness and combat weight bias. The organization is also the publisher of the HAES curriculum and offers a membership with additional benefits, such as resource sharing and community connections.
They offer a number of scholarships to ensure equity and inclusion.
If you don’t feel comfortable dropping the, “Hey, I think you’re weight biased,” bomb on your doctor, bring information about the HAES (health at every size) Principles.
Include the research showing that the HAES approach achieves better health benefits than diets and is sustainable.
This is a non-confrontational conversation starter that could open the dialogue for discussion around weight stigma.
“Hey doctor, I’ve been doing a lot of reading about the growing movement of the HAES approach, and it really makes sense to me. The research I’ve seen on the topic is compelling, and I’d like to explore this with you further.”
2.Write out what you want to say to your provider. Practice what you’re going to say at home so you’re comfortable speaking up.
Initiate a conversation with your provider. Let them know how you felt during your last visit. Doctors want to help their patients, that’s why they went into this field. Perhaps your doctors aren’t aware of the impact their words have had on your wellbeing.
Be sure to use language that doesn’t perpetuate the false narrative of “obesity is a disease.” For example, instead of saying “people experiencing obesity,” say “people in large bodies.”
Take charge of the conversation using appropriate terms and set an example for your provider.
You could start by saying, “During my last visit, I felt like the focus was more on my weight rather than trying to identify the cause of my symptoms. While I understand weight can affect my health, I also understand that my health can affect my weight. It’s common for medical conditions to go undiagnosed in people in large bodies. I know you want to help me so I can live my healthiest life. I’d like to have the appropriate diagnostic testing to rule out underlying conditions.”
Another conversation starter could be the “Don’t Weigh Me Cards.” The cards, created by Ginny Jones with More-Love.org, are a polite way of letting your doctor’s office know you only want to be weighed if it’s necessary for care and treatment and that your consent is needed to weigh you.
More-Love.org is an eating disorder advocacy group. Their “Don’t Weigh Me Cards” have been featured on CNN, NBS News, the TODAY, and more.
3.There’s strength in numbers. Take a friend or family member with you.
We often feel more comfortable and confident addressing conflict when we’re surrounded by support.
Ask a trusted friend or relative to go to the doctor with you. Explain that you’re needing to address this issue and would feel more comfortable if you had a support person with you.
Be sure to share resources with your support person so they understand the magnitude of the problem and can be an advocate for change as well.
Having a support person will not only help you feel more confident advocating for yourself, but it may also encourage the doctor to be more open to hearing your concerns.
4.If your efforts are fruitless, it’s ok to find another doctor.
Hopefully your healthcare provider is professional enough to recognize changes need to be made in the way they treat patients in large bodies.
Unfortunately, there are providers who aren’t going to see — or admit — their wrongdoings. It’s not your fault. And it’s not about you. If they choose not to recognize their biases, that’s on them.
Move on. Do your research and find a new provider.
Be sure to ask around, look at online reviews, and search for healthcare providers who don't subscribe to a weight-centric model. That’s a good indicator as to whether or not they’ll focus less on your weight and more on your health.
If you can’t find this information on their website or professional online directories, call their office and ask.
This is YOUR body, YOUR health, and YOUR life that you’re advocating for you. You deserve a medical provider who listens to your concerns, treats you with dignity and respect and provides quality care no matter your size.
I’ve listed several resources below to help you on your journey to empowerment and receiving better healthcare. If you’d like to talk to a dietitian who doesn’t subscribe to the diet culture and wants to put an end to weight stigma, get in touch! I’d love to talk to you.
Association for Size Diversity and Health
American Psychological Association
CBC News - Ellen Bennett Story