People living in larger bodies face unique challenges when they seek out medical care. Weight stigma and fatphobia are widespread in our society: weight discrimination has increased by 66% in the past 30 years, and is now on par with racial discrimination. And while all medical providers want the best for all patients, they’re not immune to this phenomenon, with weight discrimination showing up even among doctors who specialize in the field of obesity.
These biases can have a far-reaching impact on patient health. Research shows that weight bias can negatively affect patient care, leading patients to avoid or mistrust doctors and show low adherence with treatment plans. Weight stigma can also make people more vulnerable to anxiety, depression, and low self-esteem, as well as other mental health struggles that can, in turn, contribute to poor physical health.
Given all this context, it’s important for healthcare providers to understand how to best support their larger-bodied patients. While you may already be providing inclusive, weight-neutral care (and kudos to you if so!) it’s always helpful to gain greater understanding of how weight stigma can manifest and how you can cultivate an environment that promotes health for people of all sizes. Angela Celio Doyle, PhD, Equip’s VP of Behavioral Health Care, answered some common questions healthcare providers may have on this important topic.
What are some of the subtle, less obvious ways that weight discrimination might show up in a medical setting?
I’ve seen weight discrimination in medical settings affect my patients in many harmful ways. It could be the medical provider saying something condescending or critical about eating habits or fitness when they know nothing about a patient’s lifestyle. It could show up as a patient bringing up physical problems and the provider automatically blaming body weight as the reason for the issue.
For example, I had a patient who had terrible arthritis in her knees —a genetic problem in her family — and one medical provider automatically wrote off this pain as due to the patient’s weight. In actuality, she had osteoarthritis, and she suffered for a long time until she found a weight-neutral medical provider who did a more extensive assessment.
More subtly, we know from research that weight discrimination can lead to medical providers spending less time connecting with patients in larger bodies, which means the provider is less likely to show concern and empathy and develop a rapport with the patient, making communication much less open.
Finally, when medical offices do not have chairs, exam tables, or even toilets to accommodate people with larger bodies, that is weight discrimination.
What should I say (and not say) when working with larger-bodied patients?
First, be thoughtful about messages you send indirectly. Educate yourself by learning about Health at Every Size (HAES) and being intentional about size-inclusivity. If you have an office space, do you have magazines or other materials in the waiting room that elevate thin bodies over larger ones? Do you create comfortable spaces for people in all body sizes to sit and move? When meeting a patient in a larger body, listen to and use the words they feel comfortable using. If your patient describes their body as “fat”, take their lead: “fatness” is a morally neutral term and weight-inclusivity is reflected in your comfort using the terms that your patient chooses.
Also, if you are not living in a larger body, be willing to openly acknowledge that fact when issues of weight arise. If you are in a smaller or thinner body, you will likely not have the experience of being discriminated against due to your size and it will be important to show interest and openness to learning from their experience.
When, if ever, should a patient’s weight come into the conversation when addressing other health issues?
In conversations about mental health, I would allow the patient to raise their own weight as a potential contributor to their well-being if they feel it is relevant, but also ask about experiences of discrimination related to weight, given how commonly it occurs.
When it comes to physical health, medical providers should take a similar approach and allow the patient to raise the topic of weight before focusing on it themselves. There are many contributing factors to any health issue—genetics, lifestyle, undiagnosed conditions, and more—and you can’t tell much about a person’s well-being from how they look or the number on the scale. Remember that just because a patient is in a larger body, it doesn’t mean that weight, food, or exercise is one of their top concerns. Ask them what they would like to focus on in treatment.
Are there any particular mental or physical health concerns I should be on the lookout for in larger-bodied patients? Should my care differ at all from the care I provide to patients in smaller bodies?
When I am working with patients living in larger bodies, I start with asking all of the same questions I would of any other person. I thoroughly assess for depression and anxiety, staying aware of the impact weight discrimination could have on them.
I am also careful to assess the full range of eating disorder behaviors and am mindful to avoid assumptions about binge eating, body image, and risk of anorexia nervosa. Only 5-15% of adults who live in larger bodies meet criteria for disorders involving binge eating, such as binge eating disorder. People in larger bodies can also have atypical anorexia nervosa, which is when they experience all the symptoms and health effects of anorexia while remaining at a higher weight. Also, body image is quite individual and questions about how patients feel about their body shape and weight are important.
If you’re not a medical health provider, I also recommend that you make sure your patient has a medical provider they trust. It’s possible that they have not had medical care in a long time if they have experienced weight discrimination in a medical setting. You can also offer to contact their medical provider to discuss the importance of weight neutrality prior to a visit or help patients find a weight neutral medical setting, which can be a crucial step to good mental and physical health.
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