Scripts to help advocate for a higher-weight person in the hospital

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One of the most vulnerable times for higher-weight patients in healthcare can be when they are in a healthcare facility. Recently I worked with an incredible woman with a complex health history who was scheduled for a surgery followed by a hospital stay. I was available to help remotely and she had a group of friends and family who would be on-site. One of the things I did to help prepare was create scripts for her family and friends to use. She kindly agreed that I could share them with readers here and they are below. These scripts are created for a hospital visit/procedure that is prepared for. They may also be used in emergency situations and/or in other healthcare facilities, and it may be helpful to share them with people who might help you in an emergency ahead of time.

Some of these may help people of all sizes and, while I’ve written them from the advocate’s perspective, they could be used by a patient as well. Of course you and/or your advocates, may choose to change these in whatever way makes sense for you.

As always when I talk about advocating please remember that you shouldn’t have to do this - weight stigma should not impact care and it becomes our problem, but it is never our fault. If attempts at advocacy are not successful, the blame falls squarely on weight stigma and those enacting it, not on the patient or advocate.

I also want to say that the weight stigma inherent in the healthcare system, along with issues in the system itself including inadequate staffing, overwork, underpay, poor work environment and more also harms providers. Often providers are under incredible pressure to do more than is possible with the resources that are available to them, including from private equity owners and/or executives who focus on profits over patients. This can also include hospitals that don’t have the tools and/or staffing that is needed in order to safely lift and move higher-weight patients. Unfortunately, providers can misdirect their anger/frustration/hurt about this onto their patients and not onto a healthcare system that is harming them both. I think it’s important that we look for ways that providers can get on the same team with patients in solidarity against weight stigma. That said, as an advocate, my primary concern has to be my patient so I do my absolute best to be empathetic and on the same team with healthcare providers, but when the patient wants and needs me to advocate fiercely, that is what I do.

Before The Scripts:

Set Boundaries

Talk to your advocate(s) and let them know what you do - and don’t - want them to do. Be clear about your wishes not just for your care, but also for your advocacy. When I’m in person/can see the patient (ie - not on the phone) I often work with the patient to set up a signal (in a nod to The West Wing, it’s usually tugging on their earlobe) that the patient does to let me know that they want me to step in. You may want to do the same, or you may want to tell your advocate that they are welcome to speak up whenever they would like. It is up to you, as the patient, to decide what you want, and your choices and boundaries should be respected at all times.

File the Paperwork

Even if you have advocates, it is recommended that you create and file an advanced health directive/living will to make your desires known to healthcare providers.

Create a document

Create a document that can be shared with advocates and/or healthcare providers. It could include your current healthcare providers (if any) and their emails and phone numbers, your medication list, your desires for advocacy, and any other information you’d like people to know. You could create one document for your advocate and another for you/them to give to healthcare providers, or just one document for everyone. I recommend having it online as well as printed copies.

Add your Advocates

Different facilities have different rules and processes to do it- I recommend adding potential advocates to the list of people that the providers/hospital/facility are allowed to talk to about your care before the procedure. You can ask your provider for the process and if they aren’t sure you can call the facility.

The Scripts

Pre-script - Interrupt the Flow

Sometimes there can be a flow to what is happening (ie, the provider who is taking the action that you know the Patient doesn’t want is listening to you white still taking that action.) For example, a provider is trying to take blood pressure using a cuff that is too small, you are trying to advocate for a larger cuff but the provider is listening to you but still preceding with putting the too small cuff on the patient’s arm.

In these situations you want to interrupt the flow. You can say, politely but with authority:

“Please stop for a moment.”

Or

“Let’s pause here.”

Unnecessary Weigh-In

The situation:

This is for a patient who has agreed to specific weigh-ins (for example, one weigh-in for anesthesia the day of surgery) and now a medical provider wants another weigh-in/routine weigh-ins.

The script:

The Patient was weighed on [x date] and once on the day of the surgery for anesthesia. Those are the only weigh-ins they consented to and they were clear that they did not want to be weighed any more than that if not strictly medically necessary.

If they push back you can ask “Please explain the medical reason for this weigh-in so that I can understand.”

Note - there may be situations in which the weigh-ins are medically necessary, for example if there is a concern that the patient may be retaining fluid.

Weight loss/diet talk

The situation:

Anyone (including medical providers) is talking about their own weight-loss, diets, "I ate some much over Christmas, now I only allow myself one piece of celery a day," etc.,

The script:

Excuse me, please. The Patient has requested that this space be free of diet culture and weight stigma for their mental health. We both appreciate you not engaging in that kind of talk in their room.

To be clear, people, including healthcare providers, have the right to be fully immersed in diet culture in their own lives. That does not mean that it’s ok for them to talk about those things in front of the patient. Weight loss and diet talk are harmful to patients and they have a right to a healthcare space where the conversations of their providers are not harming them.

Unsolicited Food Advice

The situation:

The patient is staying at/ eating at the facility and someone (including a healthcare provider) decides to comment, without a request or permission from the patient, on what they order/eat in a negative way having nothing to do with specific, medically relevant reasons. For example, "oh, two desserts, huh? Better watch that waistline!" Or "just pancakes? Shouldn't you have some protein/fruit/etc with that?"

The script:

The Patient would like their food choices to be respected without any weight talk, diet talk, or judgment. Thanks so much for not doing that moving forward.

Blaming the Patient’s Body

The situation:

A provider is blaming or talking negatively about the patient’s body or higher-weight bodies in general. For example “the patient is too big for this gown” or “These higher-weight patients are always such a challenge”

The script:

The Patient asked me to remind everyone that it’s not ok to blame patients for healthcare issues. She’s not too big, the gown is too small.

and/or

Body shaming has been shown to negatively impact patients’ stress level and recovery. We appreciate you not engaging in body shaming or body blaming during this process.

Unnecessary Roughness

Situation:

Healthcare providers are handling the patient roughly. This can be especially important for patients who have health conditions that create more delicate skin, more easy bruising, make them prone to bone breaks, sprains, etc.

The script:

Because of the Patient’s medical condition it's incredibly important that you be very careful [removing adhesives/repositioning the patient etc.] I know it takes some extra time and I’m sorry about that but it will make a really big difference for them

Unnecessary Procedure

The situation:

Healthcare providers are doing something that the patient doesn’t want to happen or want to happen now.

The script:

In general you can ask something like “can you explain to me/the patient/us why this is medically necessary please?” and if it isn’t medically necessary/the patient doesn’t want to move forward you can say something like, “they said no thank you, they’ll pass right now.” If they push you can say, “We understand what you are saying, but they are exercising their right of informed refusal for [this thing].

Care Coordination

The situation:

A healthcare provider wants to go against the advice of one of the patient’s other medical providers. This can come up a lot if the patient’s regular providers are weight neutral, but the providers at the hospital/facility are weight centric.

The script:

I apologize, but since the patient has been working with [Dr. X] and will be working with her after discharge, the patient asked me to get clarification from [Dr. X] before we do something different than Dr. X has recommended, just like to make sure everyone is on the same page.

Or

I’m sorry, but the patient has asked to get [Dr. X’s] opinion before moving forward. Their case is really complex, as you know, and they have been working with Dr. X for a very long time.

Or

The patient/I/we absolutely appreciate (your/your team/your resident/your nurse’s) opinion. Still, before moving forward, they would like to get an opinion from [name] from their primary care team. As you know their case is quite complicated and they’ve been working with [that provider] for a long time, plus they will be helping with the patient’s aftercare. I’m happy to reach out to them or for you to reach out, whichever is easiest for you.

Anonymous Provider

The situation:

A random person comes in the room and starts delivering care/asking questions without introducing themselves.

The script:

Introduce yourself: Hi, my name is [x} I’m [patient name’s] patient advocate… at that point they should introduce themselves, if not then say, I’m so sorry - I didn’t get your name? Then you can say something like “Are you a [nurse/doctor]” or “are you the [physical therapist] they said was coming by?”

In Summary

Remember, patients deserve healthcare that respects their wishes and their lived expertise of their body (as well as other expertise,) and their right to informed consent/refusal. When patients experience weight stigma (or any other kind of stigma) that is absolutely not their fault, but it becomes their problem. As advocates our role is to center the patient and their expertise and advocate for their wishes, offering our thoughts only when they are solicited and never ever trying to impose our own will/values/beliefs on our patients.

If there are other scripts that would be helpful, please feel free to leave them in the comments and we’ll get a part 2 going!

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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’