Fight Weight Stigma - Not Higher-Weight Patients

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On Saturday I posted a piece helping patients navigate weight stigma in healthcare, today I want to offer some support to healthcare providers to avoid creating weight stigma.

Recently the American Medical Association Journal of Ethics re-posted my July appearance on their podcast discussing how to fight BMI-Based denials of care to their Facebook page.

The comments included the usual general weight stigma and misinformation about weight and health that I’m sadly accustomed to seeing. But for me, some of the comments from people who claimed to be healthcare providers were the worst. People who care for patients for a living freely and publicly espousing their hatred for working with higher-weight patients. Their typical justification/excuse was that working with higher-weight patients (either now or in the past) is more difficult because these patients are more difficult to move. Interestingly, one person started out complaining about how higher-weight patients “couldnt turn themselves over in bed” then after having knee surgery herself found that “I was surprised at how difficult it was to turn over in bed. My BMI was 24.8 at the time.” Sadly, rather than having an epiphany about her mistake in making assumptions about weight being the cause of things or higher-weight people not deserving care, she concludes that since these things are difficult for thin people post-surgery, higher-weight people shouldn’t have access to surgery.

While I’m aware of the research that shows that healthcare providers harbor a significant amount of weight stigma, it’s always difficult to be reminded of how freely some of them are willing to share their weight stigma and use their authority as healthcare providers to try to convince anyone and everyone within hearing/reading distance that higher-weight people should be denied care and treated poorly.

I understand how this happens and I want to be clear that it’s not entirely the fault of healthcare providers. The world is full of weight stigma, medical education is full of weight stigma - including in some cases the idea that there is no need to get better at caring for higher-weight people as long as the belief holds (without evidence) that all higher-weight people could be/could have been thinner people. It’s sad and harmful, but not surprising if healthcare providers internalize that and then externalize it on Facebook. Then there’s the fact that those who are trying to profit from owning healthcare facilities do so by reducing staffing such that there are too few nurses, CNAs and other providers to properly care for patients who aren’t the easiest possible case for whatever reason. They also cut costs by not having (or not having adequate numbers of) beds, lifts, bedside commodes, etc. that are properly sized and weight-rated for higher-weight people.

These practices harm healthcare providers, including sometimes causing physical harm, but they harm higher-weight patients exponentially more. They create everything from contentious relationships with healthcare providers to patient disengagement (which leads to, among other things, missed preventative screenings, missed early detection, and more advanced healthcare issues, and suboptimal management of chronic conditions,) poor surgical outcomes, and lack of safety all of which lead to patient harm up to and including death due to substandard care and/or lack of care.

Weight stigma leads to these conversations becoming providers against higher-weight patients, but it doesn’t have to be that way.

It can be providers on the same team with their higher-weight patients and against weight stigma. It can be providers finding ways to use any power, privilege, and leverage they personally have to request, push, and lobby for the things they need to take care of higher-weight patients. It can be providers and patients pushing the healthcare system to put patients (and providers) before profits with proper procurement and staffing to make sure that patients of all sizes can be properly cared for in ways that are safe for patients and providers. It can be providers helping other providers who are struggling with weight stigma. It can be providers making it absolutely clear that there is nothing wrong with higher-weight patients and that those patient deserve excellent care without shame, stigma, bullying, or oppression. It can be providers making it clear that weight stigma is the problem, not higher-weight patients.

Full change will take time, of course, but we must remember that over that time patients and providers are being harmed so, in the meantime, providers can create an immediate change for themselves and their higher-weight patients by properly blaming and complaining about the healthcare system for not accommodating higher-weight patients and never blaming and complaining about higher-weight patients for existing.

I have a piece here about how to start.

I have a piece here about how to talk to colleagues about weight stigma.

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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 Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.