Physician Demonstrates Medical Weight Stigma and Bias

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I have written before about the various types of weight stigma that can impact healthcare including implicit weight stigma and bias (wherein people have negative beliefs and stereotypes about fat people and  are acting on them unconsciously) and explicit bias (wherein people are fully aware that they have negative beliefs and stereotypes about fat people and are acting on them). Today we have a doctor who seemed to be going out of their way to demonstrate textbook explicit bias.

Tigress Osborn is a long-time fat activist, the current Executive Director of NAAFA, and one of my personal heroes in the movement. She shared a comment with me that she received in response to a feature that was written about her for the Smith College Alumnae Quarterly.  This doctor saw the feature, then took to the internet to find the NAAFA website and submitted this comment via the form. Tigress gave me permission to write about it here.

Content Warning: The comment is steeped in weight stigma. If you skip the parts in italics you’ll get my commentary without the doctor’s anti-fat bias. I’ll leave you with a reminder that you deserve excellent, weight-stigma free healthcare and if you aren’t receiving that, even if it becomes your problem it’s absolutely not your fault and you deserve better.

I’ll copy the entire comment and then I’ll break it down bit by bit:

I read the article in the Smith Alumnae Quarterly featuring Tigress Osborne. As a retired physician, I have a different perspective on fat people. Tigress and Lizzo would not have fit in my ophthalmology examination chair. If they had needed eye surgery, the pressure from fat would make it high risk. In fact all surgery is high risk for fat people. Morbid ob*sity leads to diabetes, fatty liver and hypertension. Life expectancy is shortened by 10-15 years according to some studies. Fat people should not be discriminated against any more than patients with epilepsy, acne or cancer, but being fat is not something to celebrate. I pity fat people.

Ok, let’s break this down:

I read the article in the Smith Alumnae Quarterly featuring Tigress Osborne.

She begins by misspelling Tigress’s last name, which appears in the article 13 times. Certainly, she could be using a screen reader, but I would suggest that if you are going to make the effort to, without being asked, tell someone that you think that their personal existence, which they celebrate, is something that you pity, you should also make the effort to spell their name correctly.

As a retired physician, I have a different perspective on fat people.

And here’s the root of the problem. The fact that this person thinks that whether or not fat people should receive equal treatment and basic human rights is a matter of “perspective” is, in and of itself, pure, dehumanizing weight stigma. To quote Tigress from the article:

“Anti-fatness destroys lives. It’s as serious as that. It upholds racism, sexism, and ableism. It destroys people’s mental health and economic stability. It tries to shut people out of society, and it tries to force us to be something many of us simply cannot, or will not, be. Fat people exist in every identity group. If we don’t work together to fix all injustice, any success we have in moving toward equity is undone by the reality that anti-fat discrimination limits people’s lives. All forms of oppression are interconnected. We need to support each other’s causes.”

To call what this doctor is saying a “perspective” is just an attempt to rebrand pure bigotry.

Tigress and Lizzo would not have fit in my ophthalmology examination chair.

This is a core mistake that many healthcare providers make– believing that if medical equipment doesn’t accommodate fat patients, then the problem is fat patients existing. The solution here is for this doctor to have a bigger chair, not for fat people to cease to exist, or be unable to get healthcare. (I wrote about this in detail here.)

If they had needed eye surgery, the pressure from fat would make it high risk.

I’m not going to do a deep dive into this today but for a quick review:

We know that in other surgeries these risks are often greatly exaggerated, or are calculated by leaving out research that doesn’t demonstrate a higher risk. Often they fail to control for confounding variables and use “risk factor” in very lazy (and harmful) ways when it comes to higher-weight people.

Even if it were true, the solution would be to get better at performing these surgeries on fat people. There is research, for example, on the use of the reverse Trendelenburg position (tilting the patient so that their head is higher than their feet) to reduce risk and improve outcomes in some eye surgeries.

The problem is that when a healthcare professional is busy looking for an excuse to justify their weight bias rather than looking for ways to best care for fat patients, the HCP feels vindicated and their fat patients are harmed.

In fact all surgery is high risk for fat people.

False.

For starters, the fact that this doctor throws around “high risk” like it’s a single definition that applies to every surgery makes me question their knowledge base. The concept of “high risk” shifts based on various factors including the type of surgery.

If she just means “at higher risk than thin people having the same surgery” that is still false as a blanket statement. And, again, to any extent that it is true, the solution is not to blame fat people for unequal treatment or to say that if fat patients don’t have the same outcome as thin patients then they don’t deserve care. The solution is getting better at performing these surgeries on higher-weight people, including getting better at managing and mitigating risks before, during, and after surgery.

If she is talking about anesthesia risk, the risk of anesthesia to higher-weight patients is both complex and controversial (I literally just talked about this at a conference for anesthesiologists,) beyond which these patients are often referred to…weight loss surgery (which also uses anesthesia) again calling these risk designations and their use into question.

Morbid ob*sity leads to diabetes, fatty liver and hypertension.

False.

First of all, even among those who support (often for-profit) the concept of “ob*sity” (pathologizing bodies based on size rather than symptomatology) the term “morbid ob*sity” is discouraged because even they know it’s offensive (and it was made up by two doctors in the 1960’s who were trying to get insurance reimbursements for weight loss surgeries, so not so much scientific as marketing language.)

The term refers to people with a BMI of 40 or higher, many of whom don’t have these health issues. While there is a correlation between being higher-weight and these health issues, there is also a correlation between weight stigma and these health issues, and between weight cycling and these health issues.

Beyond which, the idea that if people have health issues then they don’t deserve equal rights and to celebrate their existence is completely rooted in stigma and completely wrong.

Fat people have the right to live without shame, stigma, bullying, or oppression. It doesn’t matter why we are fat, it doesn’t matter if there are “health impacts” of being fat, it doesn’t matter if we could or want to become thin. Fat people have the right to live without discrimination and celebrate our bodies and lives. Period.

Life expectancy is shortened by 10-15 years according to some studies.

Some. Studies. I’m working on a piece about these studies. The short story is that their methodology, including and especially controlling for confounding variables, would be laughable if the questionable conclusions they draw weren’t used to harm people (as they are here.) And, again, even if being fat did shorten our life spans, fat people would still deserve equal treatment and to celebrate our existence.  

Fat people should not be discriminated against any more than patients with epilepsy, acne or cancer

While this could be read as suggesting that this doctor believes that there are some number of people with epilepsy, acne, or cancer who should be discriminated against, and that fat people should face equal, but not greater, discrimination, I’m going to give this person the (wholly unearned) benefit of the doubt and suggest that they are saying that people with epilepsy, cancer, and acne (all actual diagnoses with shared symptomatology) and fat people (a body size, without shared symptomatology) shouldn’t be discriminated against. And that’s correct.  

but being fat is not something to celebrate

Translation – I think I should get to dictate how other people feel about themselves for some reason. I don’t like fat people, so I don’t think fat people should like themselves. If I see a fat person liking themselves I will track them down on the internet to try to ruin that for them…you know…as a doctor…for their health.

I could agree with the doctor here, but then we’d both be wrong.

I pity fat people.

Translation: I think I’m better than fat people.

Again, I’ll take a hard pass on joining this person in their weight-stigma driven superiority complex.

I feel bad for any fat person who has ever or will ever have to interact with this person. Especially those who showed up for healthcare and got…this… instead. On the bright side, this person is retired and thus no longer able to harm patients. If you are a physician, I implore you to see this person as a cautionary tale and exactly the kind of doctor you NEVER want to be.

I’m going to finish this up with the brilliant words of Tigress from the article:

“The world should be prepared for the continued acceleration of the audacity of fat people. Do we dare assert that we are entitled to all that is good in life without having to lose weight to get it? Oh, yes, we do! We are only going to get louder about our rights and more unapologetic about our bodies.”

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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.