Multiple studies suggest that doctors have implicit biases regarding patients with larger bodies. A study published in Obesity Reviews found that doctors spent 28 percent less time with overweight patients. Another study, published in the American Journal of Emergency Medicine, suggests that emergency room physicians frequently underdose antibiotics in patients who are overweight. And a study that examined autopsy records from 300 patients found that those who were overweight were 1.65 times more likely to have an undiagnosed medical condition.
- Kara Richardson Whitely, Kara Richardson Whitely is a national expert on extended sizes and author of Gorge: My Journey Up Kilimanjaro at 300 Pounds.
- Katie Tomaschko, Katie Tomaschko, MS, RDN, is a registered dietitian nutritionist a contributor at Sporting Smiles.
- Melissa Landry, Melissa Landry, M.Ed., RDN, LDN, is a registered dietitian nutritionist and food freedom expert who helps women in bigger bodies find food freedom.
These studies don't address the clear emotional and psychological impact that medical biases have on patients. As a result of explicit biases and poor treatment, overweight patients may avoid going to the doctor. In turn, their health is compromised—and that’s unfairly blamed on their weight.
Ultimately, dealing with fatphobia in healthcare settings can be exhausting, but there are signs. We asked experts what to look out for, how to prepare yourself, and how to practice self-care after.
Three red flags that indicate your provider might hold weight bias
1. They assume how much you eat or exercise
How much you weigh depends on factors like genetics, medications, where you live, your sleep, and more. But doctors who hold harmful weight biases might automatically assume your weight is a result of how much you eat and exercise, according to Melissa Landry, MEd, RDN, LDN, an anti-diet dietitian who helps women with bigger bodies find food freedom. If your provider tells you to “cut down on sugar” or “get some exercise” without asking about what you eat, your exercise routine, or other aspects of your health (such as drug use and any pain you’re experiencing) this may be a sign that they overemphasize weight.
2. They ignore a history of disordered eating
Landry adds that your provider should also ask about your relationship with food, your weight cycling history, and how you tolerate weight changes. Not asking about this is a red flag. “So many people experience disordered eating and poor mental health at the hands of weight loss programs—why aren’t doctors asking more about it?” Landry says. “Registered dietitians are seeing problems of chronic dieting in droves.” Your mental health is important and doesn’t need to be sacrificed for weight loss.
3. They encourage weight loss regardless of healthy vitals and labs
You deserve respect and attention no matter your overall health. And even if you don’t have healthy vitals or labs, that doesn’t mean weight loss is the go-to treatment. However, it can also be frustrating when you’re healthy and your doctor prescribes weight loss, anyway.
Katie Tomaschko, MS, RDN, a contributor at Sporting Smiles, has experienced this firsthand. “It is astounding to me, that when I go to my annual doctor’s appointments with exceptional lab values: low blood pressure, looking perfectly healthy and happy, I get counseled on how to eat and exercise and lose weight,” she says. If you have a provider who seems to focus solely on your weight without exploring other factors, you might be encountering medical bias.
How to respond to medical biases
If you suspect your provider has medical biases, it’s natural to have feelings about it. You may want to yell at them, go with the flow to avoid conflict, or feel silenced by shock.
Landry recommends being proactive when you can. “Many times, letting your doctor know weight is not your priority before the visit begins is a good start,” she says. “If it applies, sharing a history of eating disorders or disordered eating may be helpful.” This can help professionals stay “on task” and give you the help you’re seeking, she says.
You can also preemptively address the issue by asking providers (or their office staff) questions when scheduling your appointment. Kara Richardson Whitely, a national expert on extended sizes and the author of Gorge: My Journey Up Kilimanjaro, suggests asking whether the team is trained in weight bias and if they have size-inclusive garments.
You’re also allowed to set boundaries during the appointment. “You can also simply tell them that you do not want to be counseled on your weight,” Tomaschko says. She adds that if they don’t respond well or you don’t feel comfortable speaking up, you don’t owe them anything—you can see a different provider. You deserve effective, inclusive, and thoughtful treatment.
Lastly, advocate for yourself and your beliefs. Whitely recommends asking for testing, saying you’d like them to have a conversation about your medical needs (that goes beyond your weight), and reminding providers that food restrictions can trigger you.
Ways to practice self-care after a visit
Hearing your doctor’s weight bias can be emotionally exhausting and downright triggering. Landry recommends reaching out to people who “get it." (If you don’t have any friends who understand, there’s always Reddit and Facebook groups!)
Tomaschko suggests doing anything that makes you feel good. This could be meditation, reading, eating some good food, doing a skincare mask—whatever makes you feel like yourself, she says.
Finally, Whitely stresses the importance of therapy—especially with a fat-positive provider. They can roleplay with you so you feel more comfortable the next time you need to visit your doctor and remind you that your weight doesn’t define your worth.
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