Getting the Healthcare That Thin People Get

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I just wrote about bias and stigma held by healthcare providers and the healthcare system itself. Today I want to write about what it would mean for higher weight patients to get the same care that thin patients would get. As always, I want to point out that weight stigma (medical and otherwise) becomes our problem, but it is not our fault and it shouldn’t be happening.

One of the strategies that I commonly recommend to people who are dealing with a healthcare practitioner who is trying to prescribe weight loss is asking “How do you treat this issue in thin people?” Over the years that I’ve been teaching this, I’ve heard from hundreds of people who were able to use this question to move past their healthcare practitioner’s obsession with weight loss to get evidence-based care (of course it isn’t foolproof, sometimes the HCP is simply unable to get beyond their weight stigma, but of course that’s never the fault of the patient who shouldn’t have to be doing this work in the first place.)

In truth, there are many instances in which it’s impossible for a fat person to get the care that a thin person would get because the healthcare system is, in very many ways, created FOR thin people. It may seem like a subtle distinction, but in fact it needs to be fixed and fixing it requires a major paradigm shift at every level of healthcare. And, while this piece will look specifically at fat experience, of course fat people aren’t the only ones – people of color, trans and non-binary people, and women are a few of the groups who aren’t adequately and fully accommodated by the healthcare system. I’ll also point out that all of the inequalities below do the most harm to those of the highest weights and those with multiple marginalizations. Today I’ll look at three facets of the healthcare system: Research, spaces, and training.

Research

Let’s begin with the research. When thin people take a medication, or are put on a ventilator, or undergo a medical procedure, they can assume that the research that supports this intervention included people their size. Often this same research makes no attempt to include or even understand how the medications, tools, or best practices that are created could be best designed/used for higher weight people (despite the fact that we keep hearing about how many fat people are in society.) For example, fat patients are often perceived to have higher surgical risks, but that is not necessarily supported by research and, even if it was, it’s not typically followed up by research to figure out how we could lower that risk. Rather, those patients are often simply denied care that they need for life/quality of life.

The research isn’t asking simple questions like: Should the dosage be increased by weight? Is this pill ineffective after a certain weight (like Plan B which starts to lose effectiveness at 165 pounds and becomes completely ineffective at 176 pounds.) Does this process for using ventilators work as well for fat bodies? More importantly, If not, what does? The fact that they so commonly don’t even bother to consider fat people in health research is a serious type of structural oppression. Even worse, when the tools, pharmaceuticals, and best practices that are developed from this research don’t work as well on fat bodies, the fat bodies get blamed rather than their exclusion from the research. Research needs to be far more inclusive. And research needs to be undertaken specifically to understand the needs of higher weight patients.

Spaces

When thin people go to their healthcare practitioner they can expect that chairs, gowns, blood pressure cuffs, surgical tables, and tools etc. are made to accommodate them. They don’t have to worry that if the two armless chairs are already taken up (perhaps by someone who doesn’t actually need them) they won’t have a place to sit down. Thin patients don’t have to worry that there won’t be room for them to navigate the space, or that immoveable arms on the electric patient chair will make it unusable for them, or that the scale for the medically necessary weigh-in for anesthesia won’t accommodate them. They don’t worry that they will be assured that the MRI will accommodate them, only to arrive and find out that it won’t.

In order to truly get the healthcare that thin people get, fat people would need to (and should!) be able to similarly assume that they will be fully accommodated. The good news is that often the things that accommodate higher weight patients will also work for thinner ones - a doorway that fits an extra wide wheelchair will also fit a standard wheelchair, a waiting room where most chairs are armless or loveseats (while still including some chairs with arms for those who need them) means that most of the chairs can accommodate people of all sizes rather than just a couple, a scale that will weigh the heaviest people will also weight lighter people etc.

Medical School Training

Medical school training is steeped in fatphobia, so much so that it will be a full piece of its own in the future. For now, I’ll just include one obvious example (warning, that this one’s a bit graphic,) those responsible for handling cadavers for medical schools often don’t accept larger bodies, which means that future doctors (including surgeons) don’t practice on fat bodies. In addition to the obvious issue with lack of experience, it also sets up thin bodies as “normal” which leads those future doctors to conceptualize the differences in working with fat bodies as inconveniences that are the fault of fat patients. This, in turn, drives weight stigma and a healthcare system where fat people are refused routine surgeries that they need for life/quality of life but then referred weight loss surgeries. Facilities and surgeons who are unwilling to repair our joints or give us gender affirming care, often proactively try to convince us to undergo dangerous surgeries to mutilate our digestive systems so that we can become the thin patients they are used to from gross anatomy (and, as I mentioned above, are the patients who are included in the research.) Over the years I’ve heard any number of excuses/justifications for not including higher weight cadavers, but none are truly valid. Past exclusion does not justify current or future exclusion– it’s a problem that needs to be solved and the first step is admitting the problem, not trying to justify it.

At the absolute least, fat people deserve care that is based on research that includes fat patients, with equipment that was made to accommodate fat patients, from doctors who were educated on how to work with fat patients, and are not entrenched in weight stigma. It’s really not that much to ask.

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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.