How Medical Research Fails Higher-Weight Patients

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There are many aspects of weight stigma within the healthcare system that harm higher-weight people. I wrote about many of them here. 

There is a lot of focus on reducing poor treatment of higher-weight people - for example changing the language we use. There is talk of accommodating higher-weight people, whether it’s an armless chair in the waiting room, or properly sized blood pressure cuffs and imaging practices. There is discussion of not blaming higher-weight people for healthcare’s failings. 

These are all important things and they deserve the conversations that are happening and much more. But there is an issue that underpins these, and many more, harms that the healthcare system does to higher-weight people.

Research. Or a lack thereof. 

The truth is that most of modern medicine, including best practices, pharmacotherapies, surgical tools and techniques, pre-, peri-, and post-operative protocols, essentially the entire healthcare system, was created using research that either specifically excluded higher-weight people or vastly under-represented them. 

In just one example, a few months ago I gave a talk at an anesthesiology conference. In researching for this talk I came upon a paper called “General Anesthetic Care of Obese Patients Undergoing Surgery: A Review of Current Anesthetic Considerations and Recent Advances” from 2023 which stated:

Additionally, the impact of ob*sity on drug pharmacokinetics and pharmacodynamics remains an important knowledge gap. Ob*se patients often exhibit altered drug distribution, clearance, and response to anesthesia, which can have significant implications for drug dosing and titration. Yet, ob*se patients are not included in most clinical trials for anesthetic agents, and as a result, there are limited guidelines on the appropriate size descriptors, such as total body weight versus ideal body weight, in pharmacokinetic and pharmacodynamic studies.

Per Grogan and Preuss,

Pharmacokinetics (PK) is the study of how the body interacts with administered substances for the entire duration of exposure (medications for the sake of this article). This is closely related to but distinctly different from pharmacodynamics, which examines the drug’s effect on the body more closely. This field generally examines these four main parameters: absorption, distribution, metabolism, and excretion (ADME)

Possessing an understanding of these processes allows practitioners the flexibility to prescribe and administer medications that will provide the greatest benefit at the lowest risk and allow them to make adjustments as necessary, given the varied physiology and lifestyles of patients.

I’m not an anesthesiologist, but that sounds important to me. Now, the first journal “devoted chiefly to the science of Anesthesia and Anesthetics” was published in 1891. Higher-weight people existed in 1891 so, at this point, the research has been failing us for all 133 years of its existence. This has left anesthesiologists without adequate information to create guidelines and protocols for higher-weight people because higher-weight people are “not included in most clinical trials for anesthetic agents.”

Horrifyingly, this does NOT set the field of anesthesiology apart from the most of the rest of medicine.

I want to point out that there is a deeper level here as well. The idea that higher-weight people’s responses are “altered” suggests that thinner people are “normal” and higher-weight people are at best abnormal/an aberration whose healthcare should be created/assessed based on that of thinner people.  This is the view that got us here in the first place. In truth, higher-weight people have always existed, will always exist, and deserve to be treated equally in research and not assessed based on a comparison to thin people’s healthcare and/or included only in research that seeks to shrink/eradicate us through weight loss.

To be clear, there’s still the issue that even when we HAVE research (like for longer vaccine needle length) the best practices aren’t always followed which is another example of healthcare failing higher-weight people that also needs to be talked about and solved.

Still, the response to this lack of information should be (should have been, really - it’s been an issue since at least the late 1800’s) a widespread call that research must include higher-weight people at the rate that they exist in the world moving forward and that research must be undertaken to fill in the gaps that exist because of historical exclusion. (And, of course, higher-weight people are not the only people who have been excluded, marginalized groups including but not limited to People of Color, cis-women, trans and nonbinary people and, especially, those with multiple marginalized identities face this issue as well).

Tragically, what ends up happening is that this lack of research is used to refuse to provide healthcare to higher-weight people (as we see in BMI-based denials in which healthcare is held hostage for a weight loss ransom) and/or to blame the negative outcomes that stem from the lack of research and everything that flows from it, on higher-weight bodies (aka “ob*sity”) rather than the failures of the healthcare system to include and accommodate higher-weight people.

People of all sizes deserve healthcare that is based on research that includes them and a healthcare system that affirms their existence. Healthcare and medical research have a long way to go to give higher-weight patients this most basic of experiences. 

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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.