The air is thick as I sit in the gynecologist’s dimly lit waiting room. I’m anxiously scrolling through Instagram, waiting for my name to be called. It’s hard not to be afraid when you’re not sure what kind of experience or bedside manner you’ll be greeted with.
While going to the doctor can be distressing for most people, it can become significantly more harrowing when you’re fat. I should know — I’ve experienced it firsthand.
As I sit face-to-face with my gynecologist, I share the most intimate details of my prolonged menstrual cycle. Rather than talk potential treatments with me, which I was expecting, she stares at me point-blank and asks, “Have you tried losing weight?”
Weight discrimination is a widespread problem in America, including in healthcare. Many medical professionals — some of whom have told the media that “obesity is the biggest threat to the health of our nation” — vilify fat people for their bodies and dismiss their medical histories without considering anything other than weight.
They tell their fat patients to lose weight, to diet, selling them a bill of goods, and because of this, people’s lives have been put on the line.
Although doctors use data every day in their profession, they receive no education in medical school on the topic of weight bias and stigma. In 2018, the American Medical Association Journal of Ethics researched how many first year medical students had negative attitudes about obesity and fat patients. The results? 70 percent of the respondents had a preference for thinner bodies and showcased anti-fat attitudes.
“Medical schools devote relatively little attention to the subject of obesity, let alone weight bias,” says Rebecca Puhl, PhD, deputy director of the Rudd Center for Food Policy and Obesity at the University of Connecticut, in an interview with the BC Centres for Excellence in Eating Disorders.
This lack of education can turn bias and stigma into harm from physicians or anxieties in patients trying to access care.
Vicky Borgia, MD, of Radiance Medical Group, notes that patients may avoid going to medical appointments because of these anxieties. She acknowledges that weight biases are reinforced all around her: “We’re living in this society where people come into med school and they have their own biases. But we’re also taught different biases in school and during training. It’s hard to shake.”
On November 7, Twitter user @upupdowndown posted about how his 30-year-old Black female coworker had visited the doctor with medical concerns and been told to lose weight. A few days later, she suffered a heart attack.
Doctors not listening to their patients has become a huge problem. It has put the burden on fat patients to advocate for themselves, to ensure that their voices are heard and their health is looked after.
“Even though it’s very uncomfortable to realize that everything that we may have learned in school is wrong, we either need to change our values or we need to change our behaviors, thoughts, and feelings,” says Whitney Catalano, RDN, host of the Trust Your Body podcast.
As a result, Borgia has taken to practicing from a Health at Every Size (HAES) perspective in her office. Her patients, who wish to remain anonymous, have shared that a body-positive and HAES approach has been “different and affirming.” One told her “It was great to have weight talk avoided and to see someone who wasn’t judging my health.”
HAES is an alternative approach to the public health perspective on weight- and size-based issues. According to this philosophy, people of all sizes deserve respect and good health, and size does not determine health. It asks those medical professionals — or anyone, for that matter — to act as weight-neutral as possible.
However, HAES can be difficult for medical providers to get on board with.
“The reason why doctors and health professionals, in general, have such a hard time coming to Health at Every Size is that they may have to confront the fact that they have potentially caused harm by recommending weight loss to fat patients,” says Catalano. “For health providers, that’s really unsettling and really uncomfortable. No one wants to admit that they’ve caused harm or perpetuated weight stigma.”
But stories like the one shared on Twitter are not uncommon. Linda Dianne, a creative executive from Los Angeles, California, remembers hers vividly.
Dianne recalls a stomach issue she contracted while living in Central America for 3 years, explaining that the pain was so bad it rendered her unable to walk or talk. When she finally worked up the courage to get to the emergency room, the very first thing the doctor told her was that she needed to lose weight.
“At this point,” Dianne says, “I had just come back from Central America and was maybe 80 pounds lighter than I’ve ever been in my life. Was I still a ‘large’ person? Yes. But this was unusual for me and my body, and I knew something was up.”
It took nearly 15 more doctor visits until someone finally decided to take her seriously and sent her for a colonoscopy. “Maybe they don’t give a shit about my personal history or, you know, anything else for that matter,” Dianne says.
When doctors focus on weight loss or other health behaviors, it puts the burden on the individual. “Doctors are often incentivized for procedures and incentivized to prescribe medicine,” says Borgia. “We’re incentivized to see as many people as possible in a day — so it’s all challenging.”
That’s one of the small reasons Borgia decided to open her own practice, as she wanted to feel more connected to patients, giving them more time to speak and providing them with a safe, comfortable experience that put the patient first.
You don’t have to look too far. There are two websites listing medical professionals across North America and the world: Find A HAES® Expert and the Health at Every Size community registry. But it’s not as easy as scrolling through a list.
Jude Valentine, the Latinx content creator of Mermaid Queen Jude, explains that, for them, choosing a medical provider is a matter of who will accept their Medicaid.
“I don’t really get to be picky… It’s a whole battle of who will take my insurance, who is gonna make you pay money, and really just bracing myself when I’m going in to see a provider.”
And Valentine’s hesitation is valid. “There is a certain amount of privilege that you need to have in order to even just navigate our healthcare system,” says Catalano.
Society has by and large deemed fat folks unacceptable and cast us aside. In 2013, bioethicist Daniel Callahan argued for more “social pressure” against fat people. Researchers have also found that healthcare avoidance for fat folks is correlated with weight stigma, along with increased body shame and rising healthcare stress.
The entire weight loss industry — which, TIME Magazine reports, is worth $66.3 billion — is built on fear and stigma. It sells everything from diet pills to meal plans to fancy gym memberships, and for what? We now know that BMI is not a perfect assessment of health and that being overweight — spoiler alert — doesn’t guarantee being unhealthy in any way.
The good news is that some doctors are finding a way to treat patients either from a HAES approach or with a relationship of dignity and respect. To find these doctors, the internet is usually the first place to turn.
Borgia suggests being up front and asking questions, via e-mail or on the phone, about body diversity — specifically the doctor’s policies on being weighed and what type of patient advocacy they provide. But the most important question?
“Ask if they have practiced from a Health at Every Size perspective, and if they say, ‘I don’t even know what you’re talking about,’ you probably don’t want to proceed with them.”
Catalano agrees with trying to speak with your doctor ahead of time as well as providing resources for your first appointment on how they can or would provide weight-neutral care.
“One of the big problems with fatphobia in medical institutions and in doctor’s offices is that it does create a high degree of stress for the patient. When people go into doctors, the communication is really low, and often patients don’t feel comfortable with their doctors — that’s a problem. It means that patients are not being forthcoming and that doctors are not being able to provide care.”
Every single day, fat people are subjected to fatphobia and weight stigma. But no matter the size of our bodies, we are worthy of basic human decency and medical care. This issue is complex, but it shouldn’t be up to fat people to fight negative stereotypes.
Oddly enough, social media has been a big platform for fighting stigma and educating against weight bias.
“Even though we all have a love/hate relationship with social media, it can be so helpful,” says Borgia. She believes joining groups and reading their experiences can help you gauge whether a medical professional might be a good fit for you.
As for me, I wouldn’t have learned about the fat-positive doctors in my city, or the boundaries to set with future medical professionals, if it weren’t for the many fat-positive Facebook groups or the body-positive Instagram accounts I now follow.
Although I’ve always thought I could advocate for myself in these situations, I realized there was still so much for me to learn.
Being able to share candidly with other plus-size individuals about the problematic and anxiety-inducing situations in the medical industry was empowering. It gave me the courage to stop being so afraid to access the care I need and to fight for others to be able to access quality care as well.
Ama Scriver is a freelance journalist best known for being fat, loud, and shouty on the internet. You can follow her on Instagram.