Weight stigma is real—and many of us have experienced it, sometimes without knowing.

As someone who has been living in a large body since childhood, Hannah (not her real name) has experienced her share of weight stigma and discrimination. In 2010, she went to her family doctor because of a pain in her hip that started after she had an epidural during childbirth that was accidentally injected in the wrong spot. Her doctor advised her to lose weight, and that would solve the issue. He then sent her on her way. She tried everything, from a low-calorie diet (approx­imately 800 calories per day) to intermittent fasting (eating only between 2pm and 8pm) and the ketogenic diet (eliminating almost all carbohydrates), but despite devoting her life to the pursuit of weight loss, any pounds she shed were regained, and the chronic pain in her hip never ceased. Her doctor refused to explore other causes with an MRI until she lost the prescribed amount of weight, insisting her BMI (body mass index) was the problem. Fast-forward to 12 years later: Her hip is still in pain, and she’s been made to feel that it’s her own fault.

Hannah knows first-hand that society can be cruel to those who don’t fit the “ideal” body type. Weight stigma is a term that refers to the discrimination faced by people in large bodies—and they experience it in many forms, such as receiving comments from friends, family, coworkers or strangers, being teased or bullied, feeling uncomfortable eating in public out of fear of judgement, not being able to find clothing that fits in “straight size’’ retail stores, not fitting in airplane or theatre seats, and even being passed up for jobs or promotions because of one’s size. Another area in which weight stigma shows up, which has major consequences, is in health care.

Hannah knows first-hand that society can be cruel to those who don’t fit
the “ideal” body type.

Research shows that all manner of health-care professionals (doctors, nurses, dietitians, physiotherapists, psychologists, fitness professionals, etc.) can hold weight biases, including beliefs that larger patients lack self-discipline and are lazy or noncompliant. Many providers incorrectly believe that people at a higher weight are automatically unhealthy, that having excess weight is a person’s “fault” or that it’s easy to lose weight, and if they care about their health, they should be pursuing weight loss. After all, health-care professionals are human, too, living in the same diet-culture-driven society as the rest of us. But the problem is these explicit and implicit biases result in poor patient care and negative outcomes for their larger patients. Research shows that doctors may have less respect for these patients, spend less time with them during their visits, dismiss their concerns and prescribe weight loss as the cure without really investigating the root cause.

What’s most problematic, though, is that people feel as though their health-care provider doesn’t understand or respect them, shames and even blames them for their health condition, which may prevent them from seeking medical attention at all. Some people avoid doctor’s offices solely because
of the shame they feel during the routine weigh-in. All of this means many people in larger bodies avoid or delay going to the doctor, and their medical concerns go undiagnosed and untreated.

One study reports that 53 percent of women whose bodies are overweight or obese have received inappropriate or stigmatizing comments from their doctor. But the problem is not limited to women. After experiencing a scare in which he rushed to the emergency department with severe chest pains, Brian (not his real name) was advised—without any questions about what his diet consisted of—to “stop buying fatty foods, don’t go down the grocery aisles you’re going down now and just buy the foods you’re not buying,” if he wanted to be around to see his grandchildren. Not only is this advice overly simplistic, but it’s also degrading and belittling.

Shaming people with obesity is not an effective tool to motivate them to lose weight. Ironically, weight stigma is shown to cause people to actually eat more and to avoid physical activity, ultimately leading to weight gain. Not only does it not result in thinner or healthier bodies, but it may have other detrimental consequences like eating disorders, preoccupation with food and body, cycles of weight loss and regain, and poor self-esteem. Additionally, research has found that weight stigma itself may increase stress and inflammation in the body and put people at greater risk of type 2 diabetes, cardiovascular disease and mortality, even when BMI is controlled (the same is true for exposure to other forms of discrimination, such as racism).

Understanding the causes of obesity can go a long way to help health-care professionals build empathy and move away from placing the blame on individuals. Obesity is a complex condition, and individual choices are just one small factor. Body size is largely determined by genetics, but other factors like the neighbourhood you live in, your access to food and education, as well as income level and socioeconomic status, all play crucial roles.

Some people avoid doctor’s offices solely because of the shame they feel during the routine weigh-in.

Health-care providers need training to unpack their own weight bias, so they can help people of all body sizes improve their health without making recommendations based on weight. Being aware of weight bias is the first step, then working to overcome it is the next. And yes, that work is on them. But as individuals, we can work on feeling empowered to advocate for ourselves for stigma-free health care.

 

Illustration, iStockphoto

 

Here are some things you can say to your health-care provider:

“Is there a possibility that this problem is not related to my weight? What interventions, besides weight loss, are there for this condition?”

“I’d prefer to focus on [the issue you came in for] rather than my weight.”

“Are people in smaller bodies affected by this problem, too?” (In almost all cases the answer is yes...) “And how would you treat them for this same problem?”

“Shaming me about my weight doesn’t motivate me to become healthier—it has the opposite effect. I ask that you practice patient-centred care.”

“Research shows that up to 95 percent of people who lose weight gain it
back. And weight cycling has worse consequences to health than having
a higher BMI. So is prescribing weight loss really evidence-based?”

“I’d prefer not to be weighed unless it’s absolutely medically necessary for my treatment.” (This would be situations such as determining anesthesia dosage and some medication dosages, kidney failure, low-weight anorexia treatment, during pregnancy or tracking growth in children. You can also ask to be weighed backward, or “blind”, in these situations so you don’t see the number on the scale.)