We’ve been told our whole lives that being fat is bad for you; that a high BMI is a recipe for poor health. But not everyone fully endorses that view. In fact, some medical experts flatly reject it.
“Fat-friendly” or “weight-inclusive” doctors support patients in becoming their healthiest selves, both physically and mentally. One thing they don’t do? Pressure anyone to lose weight.
We talked to fat-friendly doctors to better understand how they think about health and weight, and how their approach to patient care deviates from the norm. Here’s what to know about these proactively non-judgmental medical professionals.
What does it mean for a doctor to be “fat-friendly” or “weight-inclusive”?
Doctors, as well as non-physician healthcare providers like dietitians, can choose to describe themselves as “fat-friendly” or “weight-inclusive.” Currently, there’s no specific training required to use either label. HAES, which stands for Health at Every Size, is a paradigm within the larger fat-friendly movement anchored by a set of principles for weight-neutral care. Some but not all fat-friendly doctors identify as HAES. Across the board, fat-friendly doctors largely avoid the word “overweight” because it implies that an ideal standard weight exists and fat patients exceed it. “Fat” is embraced because it’s more inclusive.
Fat-friendly doctors recognize that people can be healthy in both thin and fat bodies, says Dr. Lesley Williams, a family medicine physician and eating disorder specialist. On the flip side, they don’t assume thin patients are exempt from health issues often associated with fatness. Regardless of a patient’s size, a weight-inclusive physician would pay attention to symptoms of type 2 diabetes or sleep apnea, for instance.
In general, these providers are as vigilant about detecting, preventing and treating disease as anyone else in a white coat. They just pay far less attention to BMI when assessing how patients are doing and recommending ways to optimize their wellbeing. They believe patients can manage conditions like heart disease, diabetes and polycystic ovarian syndrome without pursuing weight loss.
If a fat patient says they’ve lost weight, a fat-friendly doctor won’t automatically assume it’s a good thing. Instead, they’ll assess the weight loss like any other physiological change that can indicate an underlying health issue. For instance, they might ask the patient about their eating patterns or check for hyperthyroidism.
Why don’t fat-friendly doctors encourage patients to lose weight?
For starters, proponents of fat-friendly care cite ethical motivations, such as providing inclusive, non-discriminatory care that helps reduce, not amplify, health disparities. Weight doesn’t always boil down to individual choices and genetics; social factors are part of the equation too.
Weight-inclusive clinicians also believe there’s reason to doubt the reliability of research linking being fat to being in worse health. There’s not much evidence to show large body size causes many of the medical issues people associate with fatness, says Dr. Lisa Erlanger, clinical professor of family medicine at the University of Washington School of Medicine. While plenty of studies do connect obesity to poor health outcomes, correlation isn’t causation. Even if being heavier does exacerbate some diseases, weight-inclusive physicians say the most effective treatment plan doesn’t necessarily require shedding pounds
When a disease occurs more frequently in fat people, experts have historically been quick to blame their size. Both Erlanger and Dr. Gregory Dodell, an endocrinologist at Central Park Endocrinology in New York City, say a well-designed study wouldn’t implicate weight without first exploring other things larger patients have in common. For instance, do they have high stress levels? Are they financially stretched? Do they live near affordable grocery stores? Is regular exercise feasible and safe?
Additionally, research suggests framing fatness as intrinsically unhealthy is an ineffective strategy. Weight stigma can make patients less likely to seek care, and thus more likely to develop diseases that could have been prevented or treated through early detection. Intentional weight loss, Erlanger says, “increases risk for weight stigma, disordered eating, eating disorders, depression, and being sedentary.” What’s more, weight loss can be a counterproductive goal, as it frequently results in long-term weight gain. A number of studies have found weight cycling (repeatedly losing and regaining weight) can actually be more harmful than maintaining a steady weight, even one that’s higher than average.
How can they help me?
A fat-friendly doctor will recommend lifestyle changes and medical interventions that are conducive to lasting health improvements. “You’ll see that a lot of the benefits [from weight loss interventions] come from things that people do, that are separate from weight,” says Erlanger. Increasing vegetable consumption and physical activity, investing in mental wellbeing and taking medication (when needed) are all evidence-backed ways to help manage diabetes, cardiovascular disease, fatty liver disease and other chronic conditions. As a weight-inclusive physician helps you adopt better habits, they’ll monitor your health using metrics such as blood pressure, blood chemistry and blood sugar levels.
Another reason why these physicians don’t prescribe weight loss: If you’re primarily focused on becoming a certain size and don’t get there, you might give up on newly formed health habits, says Williams. Doctors want to set you up for long-term success. An enduring commitment to personal health needs to be about more than a number on a scale. Also, fat-friendly doctors want to encourage you to keep getting care, not avoid it.
Does this mean the doctor will discourage weight loss?
A weight-inclusive doctor won’t express disappointment if your weight drops because of healthy activities. But they also won’t be upset if it goes up, says Dr. Vicky Borgia, a family medicine physician at Radiance Medical Group in Philadelphia. What matters is that good health is rooted in sustainable behaviors. If you do want to lose weight, don’t be afraid to tell a weight-inclusive physician. Ask them how they can support you.
“I have many patients who are pursuing potential weight loss and I welcome them to my practice. I don’t lecture them or try to take it away,” says Erlanger. But expect a fat-friendly doctor to discuss the potential consequences of reducing your body size. “If the pursuit of intentional weight loss means other aspects of their health and wellbeing is being neglected,” Erlanger says, “I will continue to advocate for health and wellbeing.”