Years ago, when I was a university student, a raised bump with a hard carapace took over the space between the right side of my lower lip and my chin. It was hideous and frightening, and quickly grew to be about size of a five-cent coin.
The campus doctor looked me up and down — me with my soft belly and chubby legs — and asked why I didn’t do more exercise, maybe join a sports team to “run off that fat.” As for the thing on my face, he shrugged it off. “Could be anything. Gout, diabetes, high blood pressure,” he said, looking at what was likely a wart. He was no different from the doctor I had when I was a fat kid, the one who used to demand I take my shirt off so he could apply his stethoscope before counting my rolls of fat. Another doctor, another humiliation.
Fed up with being treated like an object rather than a patient, I went home, lit a stick of incense and blew on the tip until it was red hot. I dipped a pen knife in vinegar and sliced the warty bit off, cauterizing the wound with the burning end of the incense. Like many people who avoid going to doctors, I’m a skilled self-surgeon. After the wart incident, I did not see another doctor, for any reason, for a decade. I didn’t join any damned sports teams either.
If you’re overweight, you’ve probably had a “patienting while fat” (PWF) experience. The differences between the experiences of statistically overweight and “normal-weight” patients are well-documented in research.
A terrifying 2016 New York Times article on poor patient care experienced by overweight people notes that too often, overweight patients do not receive adequate diagnoses. It recounts stories of people who have almost died because their illness was seen as a problem exclusively related to their body size. Their doctors viewed them through the “fat lens.”
Of course overweight people know that we should lose weight. Memo received. But our body size is not all-defining.
In a blunt essay titled “Doctors Don’t Like Fat People,” in-Training writer Annika Burnett cites a Yale psychology study that concludes “even health professionals who specialize in obesity exhibit high levels of anti-fat bias, including endorsement of stereotypes that fat people are ‘lazy,’ ‘stupid’ and ‘worthless.’”
The ironies in these studies would be laughable if weren’t so harmful. While the medical industry never lets up about the obesity epidemic, practical issues go unaddressed, from the size of scanning machines to guidelines for drug dosages. Medical technologies are default-set to one standardized body type. And those same doctors worrying aloud about the “epidemic” are too often undereducated about their own biases — and how obesity plays out in the daily lives of their patients.
Of course overweight people know that we should lose weight. Of course we know that being overweight is not good for us. Memo received. But our body size is not all-defining. If an overweight person falls off their bicycle and breaks their forearm, their broken forearm is the medical priority.
When doctors apply the fat lens, they too often overlook whatever immediate, far more threatening problem is being presented by the patient. Even worse, they may not actually see it, because they’re too distracted by our cultural obsession with body size.
“My family doctor simply wouldn’t acknowledge that I have rheumatoid arthritis,” Ann*, a Berlin-based educator in her mid-40s, told me. “I go to the OB-GYN and everything — from cramps to rashes to not getting my period to side effects from the pill — is because I’m fat.”
Sudden weight gain, a red flag for “normal-weight” patients, is read as merely more of the same, as further evidence of a perceived failure to be less heavy. When Andrea*, who lives in Toronto, went to the doctor about a brain tumor, her doctor asked if she’d considered diet and exercise. One of the side effects of Andrea’s brain tumor was hormonally induced weight gain. “The disease would have been diagnosed sooner if the doctors saw my rapid weight gain as a symptom,” she said, “rather than an opportunity for derision.”
“Obesity does not make patients immune to conditions smaller patients develop and vice versa,” physician Jennifer Adaeze Okwerekwu wrote in a 2016 essay for Stat News. She points to two recent surveys showing that when doctors zero in on the possible dangers of obesity, they gloss over other disease risk factors.
Another study revealed that female patients at risk for heart disease were automatically advised to lose weight, even though a number of non-weight-related risk factors contribute to heart disease. Women given such advice tended not to return to their doctors.
The consequences of focusing on weight to the exclusion of other complaints, Okwerekwu writes, can be dire, especially when body-size biases held by doctors persist and patients feel enough shame or humiliation to avoid the doctor altogether.
Even though my current GP and I have healthy discussions about my weight (he won’t even suggest weighing me unless I ask), I still avoid going to the doctor, any doctor, because I know what to expect. For instance, after turning 53 in the spring, I thought it would be wise to have a colonoscopy. I did the preparatory cleanse and followed the pre-scan directions to the letter. But the test was inconclusive; I was informed afterwards by the somewhat snippy doctor that “some types of people” need to prepare with 36 hours of fasting, not 24. During and after the procedure, he asked repeatedly if I had broken my 24-hour fast, as if it were impossible to imagine a fat person going a day without food.
“But 36 hours,” he said, “that can be hard for people not used to it.” Not used to what? Who beside penitent monks intentionally go 36 hours without food? Is this something a thin person can do more easily? What was he trying to tell me? I left the clinic with one upsetting conclusion: I’m too fat to be tested for colon cancer. I will never, never, never do that again.
We live in a fat-hating culture that constantly tells us to overeat while selling us food that is bad for us and then shaming us for consuming it. Not all cultures do this. Several friends who live in countries like India, Thailand and Brazil told me that doctors who are less influenced by Western body standards, either through acculturation or education, have a more fluid understanding of body size. It would be easy to write off this chronic problem as merely reflective of the larger, systemic prejudice against plus-size people that infects all of Western culture; as just another example of general fat-lens viewing; as a reading of large bodies that is not very different from, say, the fashion or entertainment industries’ outdated perceptions.
Except lives are at stake. So what can we do?
There is a way forward. Because I’ve lost faith that the medical industry will come to grips with the reality of plus-size patients, I feel that change must be patient-driven. Yet many patients feel powerless to speak up for their needs or contradict their doctors. You are vulnerable the minute you walk into a medical office. On top of that, you have to confront an authority figure about something as deeply personal and as oppressively pervasive as body-type bias. The culture around you never lets you off the hook about your size. It’s like being asked to reinvent the wheel every time you put on a johnny gown.
Many doctors are so weight-obsessed that your hair could be on fire and they’d put you on the scale.
Facts help, so arm yourself. If you are overweight, according to stateofobesity.org (yes, that really exists), so is approximately 25 percent of your community, depending on where you live and how “overweight” is being defined. That’s a lot of patients. Your doctor sees people who look like you every day.
Remind your doctor of this basic fact. Remind them it’s mathematically impossible for all of you to have the same health issues. When I see a doctor who is not my GP and they start PWF-ing me, I recite those irrefutable facts and then ask them to move on to the problem at hand. I try not to make this a long conversation.
If your doctor insists on discussing your weight and not the actual reason you are in their office, I advise that you gently ask why. Why is this visit not centered on the actual reason you entered their exam room? Attempt, in other words, to focus the doctor’s attention. Many doctors are so weight-obsessed that your hair could be on fire and they’d put you on the scale. Remind the doctor that it is their time being wasted, because you already know you are fat.
Finally, ask another plus-size person about their doctor. Are they happy with their GP? Build a network to share lists of body-positive physicians.
You are not “sidestepping” when you request that your present health concerns be addressed. If your doctor only sees a fat person, see another doctor.
* All names have been changed.