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In this piece I talked about the serious issues with the field of so-called “ob*sity* medicine.” Today I’d like to talk about what could be. What if there was a field of medicine dedicated to providing better care to fat* patients rather than dedicated to making us thin? Now, that shouldn’t be necessary. We should have a healthcare system that supports the health of people of all sizes. Unfortunately, that’s not what we have.
What we have is a system that was built for thin bodies, often to the specific exclusion of fat bodies. This means that no matter how committed a patient and physician are to get weight-neutral care, it can still be impossible for them due to these exclusions. A field of medicine dedicated to providing equal care to fat patients would finally let us move toward truly weight-inclusive healthcare.
We could start to catch up on everything from pharmacotherapy, to tools, to best practices that were created based on research that excluded fat people.
Imagine if, instead of BMI Cut-offs and denials of care (based on shaky-at-best research, and the idea that if fat people have worse health outcomes than thin people, then they don’t deserve care at all,) there were well-funded researchers working with the goal of improving surgical techniques, tools, and aftercare in order to improve procedure outcomes for higher-weight people.
Instead of doctors who are board-certified in risking our lives and quality of life to make us thin, imagine if we could go to doctors who were board-certified in weight-inclusive care. A board certification for those who want to learn about best practices for working with higher-weight patients from a weight-neutral perspective as well as learning how to best accommodate fat patients and eliminate weight stigma and bias in themselves and their practices.
Research suggests that this would also positively impact the health of fat people directly by drastically reducing weight cycling. Weight cycling (or yo-yo dieting) is the outcome of about 95% of weight loss attempts and has been linked to the same health issues to which being higher weight is linked. In fact, studies have found weight cycling can account for all of the excess mortality associated with “obesity” in both Framingham and the NHANES.
The weight-centric paradigm has been actively failing to increase the health of fat people or to make us thin, which are two different things, for about one hundred years, and there are still so many people (many for profit) screaming “let’s have a hundred more!”
If the healthcare system was just willing to move on from an utterly failed paradigm, then instead of weight-centric care obsessed with making us thin and giving us subpar care or denying our care unless or until we become thin, we could have weight-inclusive healthcare focused on supporting fat people’s health. That’s the healthcare system that fat people and, in fact, all people, deserve.
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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 Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.
Brilliant and timely. I just learned today that physicians can now be board-certified in "Lifestyle Medicine." I have several problems with this and certainly one of the first ones is that I'm sure it takes weight-inclusive medicine in absolutely the wrong direction.
Absolutely brilliant idea.