Body Size is Not a Diagnosis

I hate to be a cliche but I’m going to start with a dictionary definition today.  Diagnosis – the act or process of identifying or determining the nature and cause of a disease or injury through evaluation of patient history, examination, and review of laboratory data.

Notice that it doesn’t say: “The act of looking at someone fully clothed, making guesses about their health, and then medicating, shaming and/or stigmatizing them based on your conclusions.”

That’s because that would obviously be a terrible idea.  Except it’s exactly what modern medicine does now.  They take a ratio of weight and height and then start making guesses about people’s health or lack thereof, eating habits, physical fitness,  etc.  Many fat people, including me, have even had doctors prescribe medication that we didn’t need based on just our size.

Maybe that could be justified in 1832, but considering the actual diagnostic tools available to us now, looking at someone’s body and making guesses is just completely unnecessary.  This isn’t just about fat people either.  Obviously if we gave every fat person medication for type 2 diabetes that would be incredibly bad medicine since we know that every fat person doesn’t have Type 2 Diabetes and therefore obesity is not an automatic affirmative diagnosis for the disease  What we often forget in our hurry to assign medical conditions to fat people is the tremendous disservice we are doing to all of the thin people who do have type 2 diabetes but aren’t being tested for it because their doctor thinks that their body size indicates that it’s impossible.

To be clear, health not an obligation, barometer of worthiness, entirely within our control, or guaranteed under any circumstances. The prioritization and path to health that we choose is an intensely personal decision and public health should be about making health options available to the public, not making fat people’s bodies the public’s business.

The thing about body size is that it is never an affirmative or a negative diagnosis of anything.  There may be some things that are more strongly correlated to certain sizes of body but that doesn’t mean that those things are always present in a body that size, or that bodies those size cause those things.  The only thing that you can tell from the size of someone’s body is how big they are and (to paraphrase Marilyn Wann) what your prejudices about a body that size are. Trying to diagnose anything else based on body size is a shamefully lazy way to practice healthcare.

If you are saying that a thin woman must have anorexia and needs to eat a sandwich, or that a fat woman must have diabetes and should put down the sandwich,  you should go ahead and check your assumptions.  There are too many healthy and unhealthy people of every shape and size for these kind of assumptions to hold up and, while we’re talking about it, why are you concerning yourself with this?  How about you be the boss of your underpants and the rest of us will be the boss of ours.

Confusing body size with actual health issues: bad idea when lay people do it, worse idea when reporters do it, worst idea ever when trained medical professionals do it. Don’t do it.

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19 thoughts on “Body Size is Not a Diagnosis

  1. I actually had an issue in a class where the professor was ranting about “Do you know if you are healthy?” and “When was the last time you checked your (fill in teh blank)?” All the time it looked like he was staring right at me (I do sit in front). I wanted to stand up and say, whatever you might think, my cholesterol and blood work is within normal limits, mister I just had to have a stent put in smoker. I almost walked out of the lecture hall.

    1. Of course, if you are stigmatised you cannot be healthy according to the WHO’s definition of health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” So, that guy was damaging your health right there and then with his stupid and rude questions.

  2. It’s not only lazy to default to a weight-based conclusion rather than a clinical diagnosis, it’s also rather callous. Could you imagine the outcry if a doctor told a patient, “You’re black, so you must have sickle-cell anemia,” or, “You’re gay, so your problem must be AIDS related,” or, “You’re Irish, so you’re obviously suffering from alcohol related issues”? There would be calls to boycott that doctor, and possibly revoke his license to practice, for such stereotyped assumptions. Sure, he could argue all day long about the increased odds of those conditions for the stated patients, but the point is, he should do his job and diagnose the actual problem, rather than defaulting to the most convenient assumption he can latch onto.

    1. Amen to that!!

      We can be ridiculed and judged en masse because we’re fat – and for no other reason. I’m looking forward to the day when this kind of judgement is looked upon with horror.

  3. Beautifully expressed! If I was still a nursing student I would forward this post to all fellow students and to profs. So clear. Wish they would get it. The harm they do by using size as a diagnostic tool is too complex and severe to measure.

  4. On board with this negative diagnosis issue: I’m pretty sure I have PCOS and that being thin has significantly contributed to not being diagnosed with it. Given the treatment options (limited/things I’m doing already), I’m not begging for a diagnosis, but it would have been nice if over the years when I’d gone to my doctor with “I am suddenly bleeding nonstop (OMG!) and my acne is getting worse” if they’d said “hey, there’s this thing you should know about that might be a possibility.” I think PCOS to a lot of doctors = overweight, when really, weight gain is significantly correlated with it, but they’re not totally overlapping groups.

    1. I went to the doctor with the same symptoms and I had gained a significant amount of weight in a short amount of time after stopping the birth control pill. An ultra sound found cysts on my ovaries. But they told me I was just fat and to lose weight. I reiterated that I had gained all this weight when the acne and heavy bleeding started too, after stopping Yaz, but the primary care doctor and the endocrinologist just said the same thing: you’re just fat. So I hear you. The laziness is frustrating.

  5. Also, it’s a bit of a self fulfilling prophecy, perhaps especially in the US with our for profit health care model.

    If you know that a doctor is only going to say “You’re fat, lose weight”, no matter what symptoms you present him with, there really isn’t much incentive to waste the $50 for a co-pay (or $500 if you don’t have insurance). Because they won’t offer any other treatment most likely, so the injury/illness will just keep getting worse until it’s so bad it lands you in the ER.

    And seriously, it can do that just fine without having initially thrown money at it. I mean, do you seriously think there is more than a handful of doctors who wouldn’t brush off a fat patient who came in complaining of an unexpected but smallish weight loss? Say 20lbs off a 280lb patient? They’d just be brushed off with “Well, whatever you’re doing, keep it up!”

    That could be an early symptom of the type 2 diabetes we’ll all supposedly get. Or of something like cancer. But instead of treating it NOW, when the only symptom is a bit of weight loss, this fixation on weight instead of health will lead to it being completely ignored until the situation is much more serious. Perhaps until it’s too late for any real treatment.

    Of course, that’s when we’ll be told we should have gone to a doctor sooner. *sigh*

    1. To highlight how much doctors love weight loss… my 5’7″, 135 pound friend unexpectedly lost 15 pounds in about 2 weeks. She felt like crap and KNEW there was something wrong. She also has a serious heart condition, so she was obviously concerned. When she explained her symptoms to the doctor, he said, “What’s the problem? Now you’re at the perfect weight!” Whatever she had eventually passed (just a bad GI bug) and she put the weight back on. But she was really frustrated that she didn’t get the care that she expected from the doctor, because he automatically equated weight loss with improved health.

      1. HAH ! This post is resonating amazingly with me. I lost 13 kilos (almost 29 pounds) in the first trimester of my first pregnancy with Hyperemesis gravida and the Obstetrician kept telling me it was fine, and that it would stop soon (it didn’t).

        If I had been the mythical 75 kilo(165 pound) “ideal” weight for my height, my baby would have died and I would have ended up in hospital, but as it was, it very clearly came across that I could “afford” to lose the weight so it wasn’t a problem…

        And then afterwards, when I came down with a screaming case of Hashimotos, it took a year to find a Doctor who would actually measure my thyroid levels (even tho I have a 4 inch scar on my neck from a thyroid op when I was 15) instead of telling me that my problem was that I was fat.


  6. You know, something just clicked for me. I’ve gotten used to the first thing a new doctor discusses with me being “what are you doing to lose weight.” The next time I (can afford to) go to the doctor I think maybe I’ll suggest a blood panel and a follow up to discuss any actual medical issues. Since I’ve never had any problems with normal health indicators other than weight, I figure it should be a pretty short discussion.

    I’m 5’9″ and about 260 right now. I’ve always been a big girl (in every sense of the term) and often felt ashamed for it. Being directed to this blog has been a wonderful eye opener.

  7. Small typo: “That’s because that would be obviously be stupid” Extra “be”.

    AWESOME FRIGGIN POST! My neighbor and I are always chatting about your blog now.

    1. Hi Janelle,

      Corrected! Thanks for letting me know I’m horrible at proofing my own work. Glad that you like the post, it makes my day that my blog is a conversation topic with you and your neighbor.


      1. Indeed! I’ve actually had to learn that little size 12 women get shit on too, and thus have been more compassionate with smaller folks claiming the fat label. You’re really an inspiration!

  8. I am just realizing how much of a prejudice there is against overweight people in the medical realm.. I just started seeing a new doctor…not for anything related to my weight and it seems like my other issue which is severly affecting my quality of life right now has been totally pushed aside. I went in with complaints and ER documentation, about my back and I walked out with an appointment for type 2 diabetes testing? What? Excuse me, I’m in pain!

    It’s a really terrible feeling when you are putting your trust and faith in a “professional”, hoping that they are going to help you, and not only are they not listening to you they are making judgements.

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