We Must Stop Blaming Higher-Weight Bodies for Healthcare's Failures

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There are many ways that weight stigma occurs in healthcare. One that is harmful on multiple levels happens when higher-weight people are blamed for the ways in which healthcare fails them. This occurs when a patient is blamed for being “too big” for something they need. 

This impacts patient care, safety, and engagement across many facets of their healthcare. Just a few examples include a sturdy armless chair in a waiting or treatment room, a gown for an exam or procedure, imaging equipment, a properly weight-rated table in the cath lab and more.

The fact that healthcare doesn’t accommodate people of all sizes is unconscionable and does irreparable harm. But when higher-weight people are BLAMED for this lack of accommodation, it just pours salt in the (sometimes literal) wound harming patients, driving disengagement, and creating/reinforcing weight stigma among providers. 

Sometimes this blame happens in person. It usually sounds like a provider telling a patient “You’re too big for…” [the gown, the MRI machine etc.] 

Sometimes it happens in charting, and that can be even worse, because the patient may think that they had a successful appointment without weight stigma and then be blindsided by weight stigma in their chart.

I see this a lot in imaging reports (though it’s certainly not limited to them.)  

I recently came across a paper called “Impact of Body Habitus on Radiologic Interpretations” by Chamith S. Rajapakse, PhD and Gregory Chang, MD in a journal called “Academic Radiology” from 2014 (Massive trigger warning on this thing for weight stigma, it starts out with “An enormous percentage of Americans are becoming [higher-weight]” and it does not get better from there.) They write

Experienced radiologists, however, have the ability to internally adjust their clinical interpretations by automatically taking into account the relative size of patients, in a manner similar to the way they can read through noise or artifacts on clinical magnetic resonance imaging. But if a patient is so overw*ight or ob*se that the contrast was off, regardless of how the windowing and other visualization parameters are adjusted, the ability to interpret the images accurately will be affected.

The entry in Radiopaedia (“Radiopaedia’s mission is to create the best radiology reference the world has ever seen and to make it available for free, for ever, for all”) for “ob*sity,” which was last updated in 2024, has (in addition to a bunch of weight stigma having nothing to do with radiology) sections on radiographic features, ultrasound, MRI and CT, blaming higher-weight bodies for issues. It refers to higher-weight people being a  “challenge” to practitioners. 

These are harmful distortions, rooted in weight stigma. The truth is, absolutely none of these things are the fault of higher-weight bodies. Higher-weight bodies don’t “challenge” practitioners, weight stigma and a failure to accommodate higher-weight bodies challenges practitioners and, more importantly, harms higher-weight patients.  

An important step that those in healthcare can take to improve healthcare for higher-weight people is to stop blaming higher-weight people for healthcare’s failures and start, at the very least, being clear that the problem is any part of healthcare that fails to accommodate higher-weight patients. 

Maybe the practice doesn’t have a gown that fits the patient - the patient isn’t too big, the gown is TOO SMALL. The solution is bigger gowns, not for higher-weight people to cease to exist or to show up for their procedure bare-assed or (ill-) covered in a paper sheet.

Maybe imaging equipment that works properly on higher-weight bodies doesn’t exist in a facility, or maybe it doesn’t exist at all yet. It’s not the patient’s “body habitus” that is the problem, it’s the lack of appropriate equipment. Limitations in the technology mean that “the ability to interpret the images accurately will be affected.” The solution is better imaging equipment, not for higher-weight people to cease existing or get a radiology report that’s little more than *shrugs with confused face*.

Anytime a higher-weight person is not fully accommodated in healthcare, anytime a higher-weight person can’t get the same treatment as a thinner patient, HEALTHCARE is the problem, not the existence of higher-weight people. Healthcare inequalities put higher-weight people’s health and lives at risk. We cannot hope to provide ethical, evidence-based healthcare to higher-weight people when we are blaming them for the ways in which healthcare is actively failing them. Healthcare should fit people as they are, people shouldn't have to change themselves to fit into healthcare.

So the first step is to be honest and clear - with patients, in their charts, with other healthcare providers - that fat patient’s deserve full accommodation and anything less is a failure of healthcare.

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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.