Reader Question - How Do I Get a Fatphobic Doctor To Help Me?

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I received the following question from reader Briana:

I've seen two cardiologists. They both opened with bariatric surgery and were shocked when I pushed back. Neither had blood pressure cuffs that fit and yet both prescribed bp meds and taking my bp (even though they have no evidence of high bp and they had no recommendations for home cuffs that would fit to the point of being sarcastic and mean). They also were super fatphobic in other ways. One told me that the reason I suddenly was having breathing problems after a hospitalization for high heart rate that it was "my confidence was shot" when in fact it was walking pneumonia. He absolutely refused to believe me.

What the efffff do you say to get a doc to really take you seriously? I've had some luck with primary care docs, but the cardiologist are so deep into fatphobia that they aren't treating me at all and in fact are causing harm in an ongoing way.

Do I say something? Do I escalate? Who to? How do I get results in changing a dr's behavior? Especially when there are limited or no options.

First of all, this is absolutely unconscionable behavior, and it is especially harmful in situations where the patient has few options for providers. It shouldn’t happen, fat people should not have to fight for ethical, evidence-based care. While this becomes our problem, it is important to know that it is not our fault.

Knowing that, I’m going to provide some options, but I want to remind those who undertake these kinds of fights that there is a lot that you are not in control of, and if you don’t get the desired result, that is not your fault. I also want to point out that both the options and their effectiveness can be impacted by things like privilege and bias which can have the greatest impact on those of the highest weights and/or with multiple marginalized identities. Of course, these options aren’t an exhaustive list so please feel free to add other ideas in the comments!

In terms of the blood pressure discussion, I went into that in-depth here. For the weight loss surgery, discussion I have a three-part series about that here.

For other situations, whether it is a cardiologist, or other practitioner, if they are assuming that the issue is your size and recommending weight loss, below you’ll find some options to get them to re-focus:

If you are a healthcare provider reading this, take a moment to check-in. A lot of weight bias (and other bias) is intrinsic – we don’t even know that we are operating from it. Consider using this as an opportunity to think about the way that you work with higher-weight patients/clients – might you be operating from weight bias? Here is a list of common examples that you can use as a checklist. Here are some thoughts on working from a weight-neutral paradigm. And here are diagnosis-specific, weight-neutral practice guides.

If you are a patient or advocate:

In the appointment:

You can try getting them to focus, saying something like

So far in this appointment you seem to have been hyper-focused on my size, at this point I would like to put the focus on my symptoms, which I understand thin people get as well. What would you recommend for a thin person with the same symptoms?

You can try third-party verification, especially if you have an idea of what you want:

My [person with authority – primary care doctor, nutritionist, etc.] suggested that I ask you about [diagnostic test, symptomology etc.].

If you are denied care, sent off with only a diet, denied a diagnostic test etc you can say:

 Ok. Just so that my records are complete, please document in my chart while I wait that I asked for [diagnostics, what thin people get etc.] because of [symptoms] and you refused and are only recommending [a diet, weight loss etc.].

If they’ve said something particularly egregious (like claiming that symptoms of walking pneumonia are just a lack of confidence!) then you can ask them to chart that as well.

If they’ve put something on your chart that is untrue (a blood pressure taken with a too-small cuff, called you “noncompliant” because you said no to a dangerous and doomed to fail weight loss intervention etc..) you can ask them to remove it and, if they refuse, you have a right to add a note explaining what happened.

Patient Advocate

This one was suggested by reader J. Alison Bess, Ph.D. If your practitioner works in a large facility, they may have a patient advocate available that you can request. If not, you may choose to take your own advocate with you, this can be someone who is professionally trained or just a friend/acquaintance.

After the appointment

It is completely valid if you want to get some support to process the oppression you’ve just experienced (and any harm to your health/healthcare that has occurred or is ongoing.) That might be venting with a trusted friend/family member, in an in-person or online fat-positive group, or with professional support if that’s accessible to you.

You can leave a review on social media sites (of the practitioner and/or the facility,) on yelp, and on sites like HealthGrades and ZocDoc.

You can contact the doctor’s facility/practice and ask about their procedure for reporting negative experiences.

In the US, you can file a report with your state medical board, with the facility at which the doctor works, Medicare has a list of reporting options,

Internationally you can file a report with The Joint Commission, and you can look up the reporting body in your country.

If you are looking for more support around this I have a video workshop with Shelby Gordon on navigating weight stigma in healthcare. (There is a pay-what-you-can-afford option to make sure that money is not a barrier.) You can find it here.

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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.