Reader Question - What if My Doctor Believes a Health Issue is Caused by My Weight?

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I received a reader question from Rebecca who said “I was recently diagnosed with GERD. The doctor said that it was because of my weight and that the only solution was weight-loss. That doesn’t sound right at all, but I don’t know what to tell him. Could you write about this?“

I’m often contacted by someone who has just been diagnosed with a health issue, and their healthcare provider has blamed it on their size and, in most cases, suggested weight loss as a “solution.” The person contacting me has been typically been practicing weight-neutral health (usually after a lifetime of failed dieting,) but this situation has shaken them to their core, and they are wondering if maybe they should try intentional weight loss again, considering this new diagnosis and what their doctor said.

On the other side, I hear from healthcare professionals who don’t understand how it can be that a fat person’s health issue isn’t caused by their body size, or what could be done besides intentional weight loss to help them.  

Today we’re getting back to basics. For those at this point in the situation, I recommend looking at this in three parts:

Part 1 – Is it true that body size causes this issue?

Determining this can be tricky because our medical system, and the research around weight and health, is so steeped in weight stigma that people inappropriately extrapolate causation from correlation, and extrapolate correlation from embarrassingly shoddy, often weight loss industry directed, research. I’ve had doctors prescribe dieting to me for a broken toe, a separated shoulder, and strep throat. Almost any fat person can tell you that “diagnosis fat/prescription weight loss” is a huge barrier to fat people getting competent healthcare.

When it comes to health issues that can impact, or are impacting, mobility, plenty of this is about the intersections of ableism and fatphobia. The desire to manipulate someone’s disability – including and especially misleading to them (either on purpose, or because the practitioner wants to believe) about the possibilities of changing their disability through weight loss - is a form of ableism that should absolutely called out and eradicated.

The question that I’ve found often helps get to the bottom of this is “does this happen to thin people?” If the answer is yes (and it always is,) then we know that being thin can neither be a sure preventative nor a sure cure. (If the answer is “yes, but it happens more often in heavier patients,” then the follow up questions would be things like: “based on what research” and “how much more often are heavier patients tested for this than thinner people” and “is this issue also correlated with a confounding variable like weight cycling, weight stigma, or healthcare inequalities to which higher weight patients have greater exposure?”) Regardless, these health issues happen to thin people, so trying to make us into thin people as a solution is, at best, a questionable intervention.

Part 2 – Is attempting to manipulate body size an ethical, evidence-based intervention for this health issue?

Even if a healthcare practitioners believes that body size is causing the health issue, the next question would be “is attempting to manipulate body size a an ethical, evidence-based intervention?”

There is not a single study where more than a tiny fraction of people have succeeded at long-term weight loss, and very often these “successes” lost only 5-10 pounds. Almost everyone who attempts to manipulate their body size (through whatever method, whether it’s called a diet or lifestyle change, a healthplan or something else) ends up gaining back their weight, and up to 66% gain back more than they lost. I don’t think there is anything wrong with being fat or gaining weight, but if an HCP is considering body size to be the “problem,” then attempting to manipulate body size is the worst possible choice based on the research.

So that would be a no on the weight loss attempt from my perspective. Even if someone still thinks that weight loss is an ethical, evidence-based intervention, it’s important to note that it is literally never the “only option.” So even if a healthcare practitioner considers weight loss to be an option, there are always other options and you still have the right to informed refusal of weight loss as an intervention, at which point your practitioner should respect your choice and move on to other options.

Part 3 – If not weight loss, then what?

This last question takes us back to asking - what do we do for thin people with this issue? Healthcare providers can use that as a starting point for providing options to the patient. The entry point for weight-neutral healthcare is really about asking “if we took trying to manipulate the person’s body size off the table, what else is there?” (Of course there’s much more to it than that - for example we also have to start asking what healthcare would look like if it was created from the ground up to accommodate and support bodies of all sizes, we have to look at eradicating not just weight stigma, but also racism, ableism, homophobia, transphobia and their intersections with weight stigma. There are many layers to this. )

I don’t think that most doctors are harming fat patients on purpose. Still, the research since the 1950’s shows that telling fat patients to attempt to become thinner (to solve health problems that thinner people also have) almost never leads to long-term significant weight loss or improved health (which are two different things.) Fat patients deserve better than this, and healthcare providers must move on from a failed paradigm (even if they’ve based their career to it up to this point) in order to provide ethical, evidence-based care and avoid harming their higher-weight patients.

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*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.