Reader Question – Top Three Phrases for Dealing with Medical Weight Stigma

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I received the following question from reader Holly:

I know you write a lot about what doctors can do to make healthcare less fatphobic and I think it’s great you do that. I’m just wondering, when it comes to those of us who have to deal with fatphobic doctors, can you give us like, the top 3 phrases that you recommend?

Thanks Holly, I’m happy to help. Of course, there are tons of techniques to navigate weight stigma, but when I think of the top three phrases, I think about options that will help us get the care we want and need, even in a healthcare system that often tries to reduce the entirety of our healthcare to “diagnosis fat, prescription weight loss.”

As always, for each of these phrases, your mileage may vary based on different providers, privilege, and other circumstances. If the result isn’t what you hoped for, please remember that while that may become your problem, it’s absolutely not your fault – we shouldn’t have to study for a doctor’s appointment in the first place!

Here are my top three:

What would you do for a thin person with this [symptom, diagnosis etc.)

One of the most frustrating things for me in terms of healthcare for higher-weight people is that we are constantly told to lose weight to cure or prevent health issues that thin people get. It can be incredibly difficult to talk about research or question the weight loss paradigm with a healthcare provider, especially with the power imbalance of a typical patient/provider relationship (made worse for those with multiple marginalized identities.) Sometimes we can bypass all of that by saying “what would you do for a thin patient in this situation.” I’ve found that there are even times when the provider is actually relieved – many of them know that the weight loss conversation is awkward (and not likely to work!) but they don’t know what else to do. For these practitioners, when we ask this question, we let them off the hook.  

I do want to point out that what would be done for thin patients is NOT the gold standard. What we actually need is healthcare created for higher-weight people - tools, best practices, pharmacotherapy and more. It is, to me, the difference between weight-neutral health and weight-inclusive healthcare. Still, I’ve found this question to help get me the care that I want and need.

I’m exercising my right of informed refusal

The right to informed consent/refusal to treatment is absolute. I go into what that entails in detail here, but the quick story is that you have the right to be informed of the possible risks and benefits of any healthcare intervention, and you have the right to consent to, or refuse, that intervention.

The paternalism in medicine that gets directed at fat people (including and especially those with multiple marginalizations and those at the highest weights) can mean that healthcare providers aren’t forthcoming about this process and/or they may not make it clear that we have the right to refuse (this type of stigma can be implicit, and the provider may not be aware that they are engaging in it which, of course, doesn’t negate the harm.)

This phrase isn’t necessarily the first one I go to, still it can can come in handy when refusing weigh-in or refusing weight-loss recommendations. When “no,” “no thank you,” or “I’m not interested” don’t work, when we’re getting pressured by a provider to acquiesce to a weigh-in or agree to try a weight-loss intervention, or when we just want to cut all of that off at the pass, we can say “I’m exercising my right of informed refusal of [the weigh in/intentional weight loss etc.] please move on.”

Thank you, but today I’d like to focus on…

Another seriously frustrating thing I’ve experienced as a fat patient is going to the doctor for help with a particular thing and then being ignored or even talked over by a doctor trying to push weight loss. The phrase “I’d like to focus on…” can be invaluable when you went to a healthcare provider for something specific (sprained ankle, strep throat, prescription refill, severed limb etc.) but the practitioner’s weight distraction is getting in the way of the ethical, evidence-based, patient-centered care you deserve. There are lots of ways to deal with this, including challenging them on the research, or naming the fact that they are failing at providing patient-centered care. Or, you can use this phrase to acknowledge what the provider has said, and then refocus them on what you need/want from the appointment. So you can say something like “Thanks for sharing that, I’ll [give it some thought or schedule another appointment to talk about it] but for today I would like to focus on my [sprained wrist/medication refill/sore throat etc.].”

You deserve excellent care, free from weight stigma and practitioner weight distraction. Unfortunately, what we deserve isn’t always what we get.

If you are looking for more support, I have a video workshop here on dealing with weight stigma in healthcare that includes a pay-what-you-can option so that money isn’t a barrier to the information!

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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.