Three Options When Your Healthcare is Compromised by Weight Stigma

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!

Higher-weight people too often find themselves in healthcare situations where they are being treated poorly/unequally because of weight stigma (note that this treatment is NOT because of their weight, the notion that higher-weight people existing is the problem is actually an expression of weight stigma. The truth is that the poor treatment higher-weight people receive is the problem.)

Sometimes the provider is aware of what they are doing, and sometimes they are operating from intrinsic bias and aren’t even aware of the ways that they are compromising their higher-weight patients’ care, in other situations they are working within the strictures of the healthcare system/facility. These situations are, sadly, too numerous to count and in some cases need to be addressed in very specific ways. In many cases though, there are some standard responses that higher-weight patients and/or those advocating for them can use to try to get appropriate care.

As always, when it comes to advocating, we cannot control the outcome and if we aren’t able to move past, or blunt the effects of, weight stigma, that isn’t our fault and it doesn’t mean that we’ve done something wrong. This is the case in all kinds of advocacy, but in healthcare situations, there are often specific power imbalances that can make advocacy (whether it’s self-advocacy or advocating for someone else) more difficult.

Here are three general strategies you can try when you, or someone you are advocating for, experiences weight stigma in healthcare.

The thin person question

There are a number of situations where invoking a thin patient can be helpful:

If weight loss is being recommended as a healthcare intervention:

“What would you recommend for a thin person with this symptom/diagnosis/situation/?”

If unexplained weight loss or weight loss from illness is being ignored/cheered etc.

“If a thinner person lost x pounds or x percentage of their body weight [without trying/without wanting to/unexpectedly/after illness] what would you do?”

If the patient is being told to try weight loss before any diagnostic tests/treatment are offered:

“If I were a thin patient, what would you do today?”

Note that please

Sometimes asking a provider to make a note of what is happening in your chart can be helpful. Sometimes it can change the situation but if it doesn’t, at least there is a record of what happened for future appointments and/or second opinions.

If you ask for a diagnostic test - labs, imaging, etc. - and you are denied:

“Please note in my chart that I asked for [this diagnostic test ] and that you declined.”

If you ask a question and are not getting an answer:

“Please note in my chart that I asked [this question] and you declined to answer.”

If the thin person question doesn’t work:

“Please make a note in my chart that I asked for treatments for [health issue] besides weight loss and you told me that none exist.”

and/or

“Please make a note in my chart that I asked what is prescribed for thin people with [this issue] and you [declined to answer] or [told me that weight loss is the only treatment].

In these cases I recommend that you immediately check your chart through your healthcare portal to make sure that it was added as agreed. If not, you have the right to add a note to your chart such as “I asked for a treatment for [health issue] besides weight loss and provider claimed that none exist. I asked provider to document that in my chart and provider agreed, but upon checking through the portal it is does not seem to be included.” NOTE: Thanks to Lorna for pointing out an oversight - this right exists in the US, you may need to check the laws in your country.

Informed Consent/Refusal

Patients have a right of informed consent and refusal of healthcare interventions and it can help to invoke it. I go into detail about this right here. Often this isn’t the first thing that I would try. For example, when they ask me to step on a scale for a routine clinical weight-in, the first thing I try is cheerfully saying “No thanks!” if they claim that my insurance requires it I explain that is a common myth, if they continue to push, then I would use this. Here are some examples:

A provider tells you that you are required to participate in a routine weigh-in:

“I’m exercising my right of informed refusal for the weigh-in”

*Note - if the weigh-in is medically necessary (ie: for dosing anesthesia) then you still have a right to refuse but they can also refuse the associated care. I go into detail about this here.

A provider is pushing you to attempt weight loss to cure/prevent a health issue:

“I’m exercising my right of informed refusal of [a specific diet/drug/procedure or weight loss as a health intervention.] What are the other options for [my situation]?”

(Here you might transition to the thin people question)

Weight loss is being recommended for general health:

“I’m exercising my right of informed refusal of weight loss, what are some health supporting behaviors you recommend (you can also pivot to the thin person question here - what are health supporting behaviors that you would recommend for a thin patient?”)

The combination

Sometimes it can be helpful to put all three together. Here is a real life example from a patient for whom I was advocating (shared with the patient’s permission). The patient had been referred to an orthopedist for unexplained knee pain. I made this request of the ortho (at the request of my patient) based on their conversation.

“Please just note in the chart that the patient exercised her right of informed refusal to attempting intentional weight loss and asked you what options you would offer a thin patient, and you said that you don’t have to talk to thin patients about this because thin patients don’t get knee pain.”

Epilogue - the patient went to a physical therapist who determined that the issue was muscle tightness. He relieved the tightness and the pain disappeared immediately. After three sessions of physical therapy and the addition of stretches after her workouts, the patient has not experienced any additional knee pain.

Final thoughts

I recommend practicing these options in as realistic a way as possible - change the words to work for you, role play with a friend, say them out loud to yourself etc. Think about how it sounds, how it smells, how it feels when this is happening and practice over and over. That way if you’re faced with weight stigma in a healthcare situation you have these answers in your metaphorical back pocket.

A final reminder - weight stigma is not our fault, even if it becomes our problem. We shouldn’t have to learn techniques to navigate weight stigma in healthcare, we should be given healthcare without weight stigma.

I have printable cards with phrases for you to use and cards to give to providers all of which include a research link here.

If you are looking for extra help, I have a video workshop about navigating weight stigma at the doctor’s office as part of my video workshop library. (All workshops include a pay-what-you-can-afford option so that money isn’t a barrier.)

Want to learn more about the research itself? On January 14th at 5:30pm Pacific I’ll be conducting my first monthly Journal Club for the Association for Weight and Size Inclusive Medicine (AWSIM). The topic is The Usual Suspects of Weight Science Research and it is free for AWSIM members, others can attend for a fee.1.5 AMA PRA Category 1 Credits pending
Details and Registration: https://weightinclusivemedicine.org/events/

Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:

Liked this piece? Share this piece:

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.