Alternatives to Common Weight Stigma-Based Phrases in Healthcare

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I often get asked about practical things that practitioners can do to help decrease weight stigma. Below are some things that practitioners commonly say are rooted in weight stigma, as well as alternatives.

Instead of  “You are too big for the MRI machine”

Say: “I am so sorry that the MRI wasn’t built to accommodate you, let’s look at other options for getting the information we need”

While it may not be your fault, it’s bad enough that fat people aren’t always accommodated (by diagnostic tools, beds, best practices, pharmaceuticals etc.) so you definitely want to avoid blaming the patient for the lack of accommodation. Always make it clear that there is nothing wrong with the patient, apologize for the lack of accommodation and help them search for solutions.

Instead of: You are required to weigh-in

Say: The rumor that insurance requires you to weigh-in is almost never true, and a weigh-in is almost never medically necessary you have the right to refuse weigh-in

Or: We do need to get your weight for [legitimate, medically necessary reason] We don’t have to tell you your weight and we only care about [legitimate, medically necessary thing]

Patients have a right of informed consent/refusal of routine weigh-ins. It’s fairly rare that a weigh-in is medically necessary, and even rarer that you have to disclose/discuss weight with the patient. For some people, being weighed is no big deal. For others (including and especially fat people who have been weight-shamed in previous healthcare experiences and/or dealing with/recovering from eating disorders) it’s so stressful that they would rather not go to the doctor than be weighed. Insisting on a weigh-in that isn’t medically necessary can cause delayed care or disengagement from care. If it’s actually medically necessary (the patient’s care can literally not proceed safely without it it) then explain that, explain the options, and be clear that you don’t actually care about their weight, only the reason that causes the medical necessity.

Instead of: This blood pressure cuff is too small but let’s try it anyway

Try: A too-small cuff gives a too high reading, let’s get the correct cuff size for you.

Or: Make sure you have the correct size to begin with.

I covered this in a two-part series, you can check it out here!

Instead of: It’s too dangerous to give you [surgery you need] at your weight, I recommend weight loss surgery

Try: If we can give you weight loss surgery, then we can give you [surgery you actually need.]

Patients shouldn’t be forced to have a dangerous, essentially experimental surgery that takes a healthy organ and puts it into a disease state in order to have a surgery that they actually need/want. If your patient is being refused a surgery they need and being referred to weight loss surgery, help them advocate to get their surgery. If you are the person creating this barrier to care and making this referral, consider whether you can give the patient the actual care they need now, or refer them to someone who can. Remember that fat people shouldn’t only be allowed to get surgery if their needs and outcomes are the same as thin people. Surgeries for fat patients should be judged on the needs/wants of the patient with rigorous informed consent and shared decision-making - with the understanding that many of the issues with surgery on fat patients are created by research, tools, and best practices that were created for thin bodies.

Instead of: You should lose weight for that [health issue/diagnosis]

Try: There are weight-neutral options to support your health

The truth is that weight loss isn’t an ethical, evidence-based intervention for anything – prescribing it sets patients up for weight cycling that is independently linked to harm.

You can find diagnosis-specific, weight-neutral healthcare guides for many common diagnoses here.

You can find a guide to weight-neutral, non-restrictive blood sugar management here.

You can find a guide to weight-neutral, non-restrictive blood pressure management here.

Instead of: Fat patients are such a challenge.

Try: The way that fat patients are stigmatized and unaccommodated in the healthcare system is unconscionable, I’m going to do whatever I can to give those patients a great experience and excellent care.

All patients should be able to expect and receive compassionate, ethical, evidence-based care. Scrupulously avoid blaming your fat patients for the difficulties that are caused by weight stigma, lack of access, and the failure of healthcare to accomodate the diversity of body sizes that exist in the world.

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More research and resources:
https://haeshealthsheets.com/resources/

*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.