Fatphobia in Health Care Is Way Too Common. Here's How to Deal

Fat shaming, also called weight discrimination, happens at the doctor's office when a patient is given inadequate care or blamed for their health because of their body size. It's a persistent problem in medical settings that can cause patients distress or even cause them to avoid care all together.

In a reverse of what some providers may see as a tough-love way to motivate people to lose weight, bias against fat people induces harmful health effects. It encompasses everything from a provider being less likely to bond with their patient if they see them as overweight, to incorrect dosages of medications and more.

"No one should have to choose between whether they get preventative care, or a cancer screening or treatment for active symptoms because they're afraid that not only will they get blatantly fat shamed, but that they will not get the care that they're seeking," says ani janzen (who styles their name with all lowercase letters), operations and projects leader at the Association for Size Diversity and Health, a nonprofit. 

You might have already had an experience where you feel your health was ignored or mistreated in lieu of a hyperfocus on your size, especially if your body mass index is in the "overweight" range or higher on the BMI chart. What can you do about it? 

First, it's important to realize what you're owed as a patient: quality care. If you don't get it, that is not your fault as a person seeking health care services. Secondly, it's important to realize that if a health care provider seems like they don't know what they're talking about in terms of advice for bigger bodies, it's because they probably don't. 

How doctors end up flying blind when caring for larger bodies

Dr. Fatima Stanford is an obesity medicine physician and scientist with Massachusetts General Hospital and Harvard Medical School. She says she learned more about nutrition and weight management leafing through wellness magazines than she did in medical school. (This was before her specialty training.)

"The answer to your question is we aren't trained," Stanford said, when asked about the training doctors receive to discuss weight with patients. "It's not a nice thing to say, but it's the reality." 

This lack of training in caring for larger bodies shows up in many ways, including offering nutrition advice (sometimes asked for, often not) that will only work for a small portion of patients, since diets alone usually aren't effective long-term. It can also leave a patient feeling defeated when the reason they showed up to the doctor isn't addressed, or generally disrespected as a societal bias against bigger bodies is equally as pervasive in the medical community.

How to get better care when you're navigating fatphobia

Feeling comfortable with your doctor starts in the waiting room. If you're looking to establish this office as your place of care, make sure there are seats that are accessible to you, and that you feel comfortable with staff at the front desk. Once inside the exam room, you can also make your decision on further details like whether the blood pressure cuff is accommodating and, most importantly, how well you feel you're being understood by the provider themselves.

For some of the layout stuff, you can call ahead of your appointment or send a message, if possible. janzen also suggests presenting your goals for the appointment or concerns ahead of time, with a letter you give to the person at the front desk, who can then share it with your care team ahead of time.

"It's not going to change anybody's mind between the time you enter the waiting room and the time you go back to the clinic, but it gives providers a second to sit with what's being asked of them," they said.

Within the next few weeks, janzen says, ASDAH will finalize a list of providers who follow the organization's Health at Every Size care framework, which may make it easier to find weight-neutral care near you. But finding a provider who subscribes to this specific label might not be the most important thing, janzen says. As providers, being able to "center" the patient and "meet the person in the room where they're at today without judgment" is a basic standard of care that could improve the health care system overall.

All of that to say: don't settle. If you don't feel good about the care you're receiving from your doctor, remember your rights as a patient and find a new provider. 

Reach out to community 

Joining a local group of like-minded people, such as the Twin Cities Fat Community, is a good way to get recommendations for providers near you or even tips for personal care, janzen says. Another perk of reaching out online or finding a similar group is that you may also find a support person, or someone to come to a doctor's appointment with you. 

A friend or loved one who comes with you could also serve as a patient advocate – someone who will help coordinate your care, assist in coming up with questions for your doctor and more. Sometimes hospital systems or clinics have their own patient advocates. 

You might also refine your search based on what kind of care you're receiving. We found a fat-friendly Facebook group for people who are pregnant or trying to conceive, for example.

Redirect the conversation away from your weight

Having your weight taken is often a routine part of a doctor's visit. However, you have choices on how – or if – you step onto a scale. "Don't weigh me" cards, which you can order from More-Love.org, are one way you can communicate to your provider you don't want to be weighed unless it's deemed medically necessary. But you can also ask whoever is taking your vitals at the beginning of the appointment not to read the number on the scale out loud, or tell them you'll be facing away from the scale.

If you feel like your weight or size is becoming the focus of your health care visit, and there's a pressing matter at hand (because there usually is when you're seeking health care services), don't be afraid to say so. 

Stanford offers a direct example of how to change directions. Something like: "I hear you're bringing up my weight, I have an ax in the middle of my head," she said. "I'd rather focus on getting the ax out of my head. It hurts – I'd really rather be able to keep my eyesight." Then, you can suggest a follow-up appointment or actionable resource if you would like to discuss anything related to weight.

If your provider keeps pushing weight loss as a topic against your will, take a page from this post from writer Virgie Tovar on tips for medical self-advocacy: "Doctors have a specialized field of knowledge that you are employing them to use – like the way you'd hire an electrician to deal with something electrical." They should treat you for what you're paying for.

In a 2019 post, the blog ComfyFat recommends asking your doctor to make note of requests for care you might have, such as specifics for urine samples. This way, another nurse or doctor at the practice will have the note in your file and can save you from having to repeat yourself. 

Remember your rights 

"As a patient, you have rights," janzen said, adding that there's a strong power dynamic in a health care setting when doctors are expected to have all the answers and also control access to medications.

"They're the ones with the keys to your treatment, to your care, to your prescriptions," they said. For this reason, it can be really frustrating – demoralizing, even – to be in a setting that's hostile to you and your needs. But that doesn't make it right, or something you have to tolerate. You have the right to respectful care, and the right to choose your provider.

"As a patient, it is your right to navigate your health and your health care the way that you want," janzen said. "The idea of body autonomy is incredibly important in the provision of health care services."