Reader Question - What To Do When My Doctor Is Gaslighting Me?

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I got the following question from reader Kyrie:

I started having pain in my knee after I jumped out of a truck and twisted it. I went to my regular doctor and he referred me to an orthopedist. He (the orthopedist) told me that the only thing that could possibly help was to lose weight. I asked the question that I learned from you “what would you recommend for a thin patient in this situation?”  The orthopedist said “I don’t have to talk to thin patients about knee pain.” Obviously that’s a complete lie, but what can I do as a patient when a doctor just says something like that?

I do teach the question “what would you recommend to a thin person in this situation” as an option to try to help a provider who is mired in weight stigma or a myopic focus on weight loss move on. Often it works pretty well but sometimes they double down – though it’s usually something like “I’ll talk about those options if you still have this problem when you’re thin” and not something so obviously and patently false as to be ludicrous like thin people don’t have knee pain (in, apparently, any situation, let alone after jumping out of a truck and twisting their knee.) Still in this situation there is a power imbalance so it puts the patient in a very difficult position.

Healthcare providers using their authority to state completely untrue things as fact is, unfortunately, an issue that is common for higher-weight patients to deal with. For example, higher-weight patients are told there are tons of studies that prove that we can lose significant amounts of weight long-term if we just make behavior changes. They are told that weight loss will cure or prevent health issues that we know that thin people also get. They are told it’s proven the 5-10% weight loss creates health benefits. They are told that there could be no other cause for whatever is going on with their health than simply existing in a higher-weight body. They are told that there can be no cure other than weight loss, even though people thinner than them have the same issues and people fatter than them don’t.

At this point I want to pause and be clear that there are many reasons that this happens besides providers who are actively trying to harm or lie to their higher-weight patients. Often, they are relying on their training. Unfortunately much of healthcare training is based in weight stigma (and funded/created/conducted by the weight loss industry) and based on viewing higher-weight patients as, at worst, walking talking pathologies who cannot be believed. There’s also confirmation bias - perhaps Kyrie’s doctor literally forgets about the thin people he sees who have knee pain because he’s so focused on fat people having knee pain.

I think there are positive shifts happening, but this attitude is still very much around (just ask Kyrie!) and can lead to a provider who honestly assumes that whatever is wrong with fat* patients will be solved by weight loss, which they honestly believe can be accomplished if those patients just try hard enough. In other situations it’s about providers who are stuck in really difficult working conditions, they are frustrated, they aren’t treated well by their employers or their patients and they do not react well to being questioned etc. While none of this excuses healthcare providers giving patently false information to patients, it can be helpful to understand that it doesn’t necessarily come from an intention to lie or gaslight, though, of course, sometimes that is very much the intention and I don’t want to gloss over that.

Still, impact is greater than intent and regardless of the provider’s intention, it leaves higher-weight people in a tough situation as patients. Here are some options for dealing with these situations. As always, I want to point out that this shouldn’t be necessary, and the ways in which people are able to do the things below and the reactions they get are heavily rooted in systems of privilege and oppression.

1.      Agree to consider weight loss, ask again about other options

Even though you have no intention of actually attempting intentional weight loss you can try something like “I understand and I’ll definitely start that diet you recommended, but I also want to do whatever I can now, are there things that you would recommend to a thin person in my situation?

2.      Come with some ideas

Do some research about common treatments so if they tell you weight loss is the only option you can either suggest them outright or, as above, agree to the weight loss suggestion and then suggest them in the meantime. For example, if someone tells you that thin patients don’t have knee pain you can say “I understand and I’ll definitely start that diet you recommended. Also, I had a friend who had knee pain and she had good luck with physical therapy, could I get a referral to get that started as well?”

3.      Put the burden of proof on them.

If a doctor is adamant that you can achieve long-term, significant weight loss with diet and exercise, ask them for a study where the majority of people lost as much weight as they want you to lose and kept it off for at least 5 years. If they insist that 5-10% weight loss creates health benefits, ask to see a study that shows that it’s the weight loss, and not behavior change, that led to any health improvements. You might ask like “Oh, that’s interesting, I had heard that almost everyone regains their weight. I’d love to read more about this, can you suggest a study or two that show long-term significant weight loss?”

4.      Get a new doctor/healthcare provider

If it’s an option for you, you might want to consider looking for a doctor who is willing to provide weight-neutral care, or at least not state falsehoods as facts. The Association for Size Diversity and Health has a list here and Mary Lambert compiled a number of different community lists here!

EDIT - Bonus:
In the comments, Mary Saucier Choate recommended the following which I think is excellent!

I wonder if requesting that you put a note in your medical file documenting this exchange would change their tune?:

Dr. told me thin people do not get knee pain and the only treatment for me is to lose weight.

Dr. refused to refer to PT or other modality for treatment.

Question- is this the normal Standard of Care/Best Practice for heavier patients?

Finally, as always when facing weight stigma it can help to remember that, even though this is becoming your problem, it is not your fault. That can help avoid internalizing the experience of weight stigma, whatever the provider’s intentions.

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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.