Red Flags for Weight Stigma in Healthcare Practitioners

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In the part one of this two-part series, I wrote about weight stigma within healthcare in general. As promised, today I’m writing about red flags that might warn us that healthcare practitioners are coming from a place of weight stigma and bias.

It’s important to remember that because they are part of, and trained in, a system based in weight stigma, many of the things that are considered normal, daily practice and that the vast majority of doctors do (using terms like overw*ight and ob*se*, prescribing weight loss etc.) are, in and of themselves, weight stigma. In this piece I’m looking at examples that I think cross the line from “this is part of systemic weight stigma” (which is absolutely wrong, does tremendous harm, and MUST be fixed) to red flags that a specific practitioner is likely to do even more harm because of their personal weight bias. This is not an exhaustive list, as always please feel free to add your thoughts in the comments!

If you are a practitioner, I welcome you to use this as an opportunity for personal reflection.

They blame their patients for lack of accommodation

A lack of accommodation is bad enough, but a healthcare practitioner who blames fat bodies for that lack compounds the problem. If a practitioner uses phrases like “You’re too big for the MRI” (rather than “I’m sorry the MRI doesn’t accommodate you”) that’s a sign that they believe that healthcare inequalities are the fault of the fat patient for existing, and not the fault of the healthcare system for failing to accommodate patients of all sizes.

They suggest solving lack of access through weight loss

Often, in addition to using language that suggests that a lack of access is the fault of the fat patient for existing, the next suggestion is that the patient should change their body to fit into a thin-centric medical system, rather than suggesting that a thin-centric medical system is the problem and looking for ways to accommodate patients of all sizes. This would an excellent example of weight stigma in healthcare practice even if weight loss was likely to work, but the fact that it absolutely is not likely to work makes this even worse since fat patients have their healthcare compromised and delayed while being sent on a wild goose chase by their practitioners.

They buy into myths about the failure of intentional weight loss

I recently wrote about some common myths around the massive rates of failure of intentional weight loss attempts. If your practitioner is buying into one or more of those, that is cause for serious concern.

They document refusal to participate in weight loss interventions as “noncompliance” rather than informed consent/refusal.

When you exercise your right to informed consent/refusal of weight loss interventions, your doctor is supposed to chart that as an informed consent conversation. If, instead, they make a note in your chart that you are “noncompliant” that is a serious issue that demonstrates a lack of respect for you as a patient and a willingness to put weight stigma before ethical responsibilities. Not to mention, some risk management professionals recommend documentation of noncompliance as a risk management strategy, which causes me further concern that the fat people’s negative health outcomes (including and especially those resulting from weight stigma/bias) will be excused due to supposed “noncompliance” for those fat patients who aren’t willing to undertake an intervention that almost never succeeds, has the opposite of the intended effect the majority of the time, and has serious risks.  (If you have been labeled “non-compliant” by your healthcare practitioner, you can ask that it be removed from your chart and, if you are refused, you can add a note of explanation.)

They prescribe fat patients a diet when they would give thin patients an evidence-based intervention

If a healthcare practitioner’s first line of treatment for a thin patient is a an ethical, evidence-based intervention, but their first line of treatment for a fat patient with the same symptoms is a weight loss attempt, that’s a massive red flag. If they claim that weight loss is the “only option” for things like knee pain, blood sugar management, blood pressure management or other health issues that thin people also get (which is to say – all of them) then they are definitely practicing weight stigma instead of medicine. (If you are looking for a resource on weight neutral options, the HAES Health Sheets are weight-neutral, diagnosis-specific practice guides for practitioners, patients, and advocates.)

They deny surgeries based on BMI limits, then refer the patients to weight loss surgery

Fat patients get denied surgeries, from joint replacements to gender affirming procedures and more, based on artificial BMI limits. Then the same practitioners who refuse the surgery because it is, supposedly, unsafe at the patients’ current BMI, refer the patients to…surgery. More specifically, weight loss surgery which typically has greater risks and far less data available on long-term outcomes, not to mention the fact that the patient doesn’t need a surgery that takes their healthy digestive system and puts it into a disease state, they need the surgery they were denied. You don’t just have to be steeped in weight stigma to buy into this, you have to jump off the logic train way before it reaches the station. If your healthcare practitioner makes this recommendation without at the very least acknowledging how ridiculous and horrible this is (even if they aren’t in a position to change their facility’s policies,) then that’s a sign they are deeply entrenched in weight stigma. (Starting next week I’ll be publishing the three-part series specifically about weight loss surgery that I’ve been working on and telling you about.)

Summary

Unfortunately many healthcare practitioners, and the system in which they work, are immersed in weight stigma in ways that harm fat patients through delayed care, negligent care, lack of care, lack of access, and patient disengagement. These doctors and this system do the most harm to those at the highest weights and those with multiple marginalized identities, in particular patients of color since weight stigma itself (as well as BMI and other forms of weight-based oppression) are rooted in racism and anti-Blackness*.  Remember that if you are dealing with medical weight stigma, it is something that is becoming your problem, but it is not your fault. You deserve better.

If you are looking for support around dealing with fatphobia in the doctor’s office I have a video workshop (that includes a pay-what-you-can-afford option) 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.