How Lack of Equal Healthcare Access Harms Fat Patients' Health

It’s the last day of launch week for the Weight and Healthcare newsletter and today I’ve got an overview of some of the dangerous (and often ignored) impacts of weight stigma in healthcare. If you like what you are reading, please consider subscribing and/or sharing!

Before we start, a reminder that health is an amorphous, multi-factorial concept. It’s not an obligation, a barometer of worthiness, guaranteed under any circumstances, or entirely within our control. One of the major variables around health is access, which includes a number of things, many of which impact fat* people’s health specifically. In many health and cost models, fat people are then blamed for the negative health and financial outcomes that are causes by their lack of access to ethical, evidence-based healthcare.

Throughout this post I’m going to use HCP to mean Health Care Practitioner, including whatever type of practitioner someone might choose. This is a high-level overview, future posts will look into these issues in more depth.

Ability to get to the HCP

This includes proximity, transportation, ability to get time off work, or to visit before or after work, being able to meet insurance requirements for the patient to see the appropriate HCP, being able to get an appointment with the HCP they desire to see. Importantly here, weight bias in hiring can lead to fat people being hired less, paid less, and holding jobs that are less likely to provide health insurance and/or have less flexibility around work hours and time off, which means they may be more likely to struggle with this as well as the ability to afford the HCP.

Affording the HCP

Can someone acquire insurance? (Before the passage of the Affordable Care Act, many fat people weren’t able to acquire health insurance because companies were allowed to consider a fat body a “pre-existing condition” that was a justification to refuse coverage.) If so, can they afford the insurance? If not, can they afford the cost of care without it? If yes, does their insurance cover their health issues? Can they afford the co-payment and any percentage for which they are responsible? Can they afford any medication prescribed? Can they afford follow up care, physical therapy etc. Can they afford to take off work if necessary for the treatment? Can they afford childcare? etc.

Ability to receive ethical, evidence-based, compassionate care

HCP’s ability to provide this care can be hampered by their own stereotypes, preconceived notions, implicit and explicit biases. It can also be hampered by a lack of research that includes fat bodies, their facility and the equipment that is stocked there (which may or may not be within their control.) Lack of accommodation and access to office spaces durable medical equipment, diagnostic tools, durable medical equipment and more can have serious, even deadly, impacts on fat people’s health. As with all of these issues, the impact is increased for those who are higher weight and those with multiple marginalized identities.

Is it safe to go to the HCP?

In order to truly have access to healthcare fat people must first be willing to go to our HCP who research tells us is very likely to harbor implicit - and quite possibly explicit - weight bias. Even if they are not part of that group, there’s a good chance that no matter what we go in for, we are getting a lecture about our weight. If we practice weight-neutral health instead of having our priorities and choices respected we are probably going to have our research and choices dismissed as ridiculous by someone who is recommending an intervention that almost never works.

In order to get ethical, evidence-based care, we have to find an HCP who won’t let their personal weight bias get in the way of treating us for what is medically wrong. The lived experience of fat people, including my own, tells us that this is much easier said than done.

Instead of the knee jerk reaction of blaming fat bodies for health issues, we have to ask questions. How many of the incidences of major health problems in fat people are due to the fact that going to the HCP is such a stressful, humiliating, and ultimately useless experience for us that we don’t go until our minor medical problem has become something major? How many people miss out on early diagnosis and early cure of issues because they couldn’t bear to be humiliated and lectured at their annual physical, or they put themselves through the stress of going but didn’t receive a proper examination because their HCP is convinced that weight loss is some sort of magical cure-all (for health issues that thin people also get.)

How many people don’t go get diagnostics because they just can’t bear to put themselves through the process of being nearly nude in front of someone who is likely to hold, and possibly express, extreme weight bias? How many fat people put themselves through that stress only to find that the diagnostic test they need doesn’t accommodate their body? How many people gave up on HCPs because their HCPs were too buy practicing stereotyping to practice medicine.

One of the lines in a widely used version of the Hippocratic oath is:

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.

I cannot find a version of the oath that includes “unless that patient is fat.” No matter what their personal weight bias may be, HCPs should, at the very least, not harm the fat patients or create an environment that leads them to disengage from their own healthcare.

Again, this is just an overview, in future posts I’ll do deep dives into each fact of healthcare inequality and how it impacts fat people’s health and lives.

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More research:

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.