4 Questions to Ask Before Making Health Recommendations to Higher-Weight People

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A couple years ago I wrote a piece about what to think about before offering unsolicited advice to higher-weight friends/family/strangers about their health. Today’s piece extends from that. While it can apply to family/friends/randos at the drug store, this is intended for healthcare providers and other health/public health professionals and educators whether you are one yourself, or you want to share this with healthcare providers and educators you know.

I’ve written extensively about the research and ethical issues with recommending weight loss, including the old “eat less and exercise more” nonsense, but even for those recommending health-supporting behaviors, a lot of harm can be done.

If you are someone who gives health advice professionally, even if you are coming from a weight-neutral perspective and have the best of intentions, it’s important to know that you could absolutely do more harm than good (or do significant harm with absolutely no good.) In part 1 we’ll look at four questions to ask yourself before you start providing this information. In part 2, we’ll look at the harm it can cause if you don’t.

Before we start, I want to point out that the mistakes I’m about to discuss don’t come out of nowhere. In fact, a lot of education that is created for healthcare and public health professionals expressly teaches them to make these mistakes with higher-weight patients. If you, as a provider/educator are subjected to education like this, it’s a good opportunity to push back. You can do that individually based on your own power/privilege/leverage, and/or create an organization that increases your power/privilege/leverage.

Am I offering this information based on assumptions I’m making based on this person’s size?

If you assume the person needs whatever information you are about to offer around health because of their size, you are practicing stereotypes, not healthcare.

I once had a doctor tell me that “it will be so hard, but if you can do it it will change your life.” He then advised me to start walking 10 minutes a day. I was near the end of training for my first marathon.

A friend of mine who is a fat* vegan was once unsuccessful in getting her doctor to stop a lecture about the health benefits if she would just replace some of the meat she was eating with vegetables and plant-based protein… at an appointment she made for an injury to her thumb.

There are higher-weight and thin people with the exact same behaviors and knowledge about health, so if you assume that a higher-weight person doesn’t have knowledge about, or isn’t participating in some aspect of nutrition or physical activity, or other health-supporting behaviors you are coming from a place of weight stigma.

When this happens, in addition to changing your interaction with the patient, also make a note that you have some work to do to dismantle some implicit or explicit weight bias/stigma (While this can be difficult to face, and you may have to acknowledge the harm you have done, remember that, in a way, this is good news since if you aren’t aware of it, you can’t do the work to dismantle it and you are doing harm, however unintentionally.)

The only exception to this rule is if you are offering something (that the person has asked for/consented to, but we’ll get to that) that is specific to higher-weight people like options for accommodating durable medical equipment, mobility aids, clothes, health and fitness spaces, etc.

Do I know this person well enough to know this advice won’t harm them?

There are many ways that harm can be done, and we’ll dig into this in part 2, but some examples are:

Advising food restriction/increased activity to someone with a history of, or current, eating disorder

Recommending food and/or movement that is contraindicated by other diagnoses, sensitivities, or allergies

Recommending food and/or movement that is contraindicated by a health plan created by the patient and a provider/care team who knows them better than you do

The bottom line is that if you don’t have the full picture of this person’s health, you risk recommended something that could end up being harmful

Am I reasonably certain I know more about this subject than the person I’m about to advise?

This is an extension of the previous question. Just a week ago I had an eyeroll and a rage/laugh with a friend who is a higher-weight Registered Dietitian. She was at her first appointment with a new gynecologist and during the exam and apropos of nothing the doctor said “you know, fruits and vegetables are really nutrient dense, you should add some to your diet.”

There are obviously a LOT of things wildly wrong with this interaction, but under any circumstances just assuming a higher-weight person (or any person) hasn’t heard of/doesn’t know about/isn’t eating vegetables is ridiculous.

I hold a bunch of fitness certifications and specializations and I have since the 90’s. I cannot count the number of times a healthcare provider or fitness professional has given me either extremely basic information, or what I know to be misinformation about some aspect of physical fitness, assuming that I don’t know anything at all.

Honestly, this is a good question for any patient - are you reasonably certain that you are providing them with information that they don’t already have?

Do I have consent for this conversation?

If you’ve asked yourself the rest of the questions and you feel confident that you should move forward in giving advice to this patient, then you’re ready for this final step - which is to ask them for consent. This question is super important in general, and also because it can save you from doing harm if you made any miscalculations (however well-intentioned) in the previous questions:

Do you want to talk about…

Do you want some advice about…

Do you have questions about…

Do you want resources around…

Asking a question like this BEFORE you start doling out advice or suggesting resources can do wonders to avoid harm and build trust.

Of course, to do that, it’s imperative that the answer be respected. If you ask the person if they want to talk about something, and they say no, then the answer is no. If you’ll see this person again, you can ask “is it something you want me to bring up later?” (and then, again, respect the answer and chart it/make a note so you remember.)

If you are in a situation where you are required to have conversations about things with patients (including and especially if these requirements are driven by the patient’s size) then this question can check that box without forcing the patient into a potentially harmful conversation to which they do not consent.

In part 2 we’ll look at why asking questions like these is so important.

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*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings’ Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison’s Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.