How Do I Talk To A Colleague About Their Weight Stigma?

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I received this question from an anonymous reader who is an RN, and it’s a question I’ve received in various shapes and forms from a number of providers:

I feel like I’m surrounded by weight stigma all day long - negative body talk in front of (sometimes to and at!) patients, diet talk amongst the staff (sometimes also in front of patients) jokes at high weight patient’s expense behind the scenes …you get the idea. I want to say something but I’m not clear how. Do you have any ideas on what to say to a colleague who is engaging in weight stigma, especially in front of the patients?

This is a great question, a common question, and a tricky question. The approach to these conversations can be impacted by power and privilege imbalances, the cultures of the people involved or the workplace in general, the relationships between the people involved and more.

That said, I think that there are a few main options (with plenty of variations). In this piece I’ll look at different options for dealing with colleagues more or less directly, with the understanding that sometimes the best option may be utilizing HR or the chain of command to file a report/get assistance.

1. Say something directly

A colleague says something fatphobic. You point it out to them. You could say something like “That’s weight stigma. We don’t do that here.” Or “I used to say things like that too, but now I know how hurtful weight stigma is.” If you have resources offer them. ie: we had a training about this, you can find it on the employee portal or there is a piece about weight stigma here.

2. Talk through the patient:

This can be an option to support the patient directly and educate a colleague indirectly. (You might choose to follow up with the colleague with something direct at a later time.) ie: a colleague tells patient “You are too big for the MRI” you say to the patient “actually, you are fine, the MRI is too small!” (it can help to deliver this in a light-hearted way/with a smile to help keep the patient from being uncomfortable.) Don’t underestimate the power of a gesture, even a mall one. I talk to patients all the time who remember a small, kind thing a practitioner said to them when they were experiencing weight stigma 10 years ago.

3. Make a generalized statement

This can be helpful if you want/need to avoid confrontation (though it is not a guarantee.) ie: colleagues are engaging in diet talk/negative body talk/weight. You say “I wish we lived in a world where we could just appreciate the diversity of body sizes” or “I always wonder if patients trust us less when they hear us making jokes about body size?”  

4. Talk to the colleague later

In this case, I think it can be helpful to use the “I used to”/third party verification framework. For example: I noticed back there that you told that patient to cut down on snacks while you took their blood pressure. I used to do that too (you can say this even if you didn’t, just to soften the statement) but I [attended a training, read a paper etc.] and learned that saying stuff like that is generally based on our stereotypes about higher-weight patients, and it can make the patients so uncomfortable that they don’t come back, plus they may be dealing with an eating disorder we don’t know about. [offer to share resources if you have them]

5. Share Resources

Send information about this to colleagues, see if you can bring in a trainer for a lunch and learn, grand rounds, CME day etc. Consider different/multiple methods. Often it takes repeated messages to get through to folks. Just be careful not to recommend or host a diet industry seminar in disguise – here are some ways you can tell.

Have other suggestions? I would love for you to leave them in the comments!

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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.