If Being Fat Makes Medical Procedures More Difficult

In a community I am in online, someone asked if it’s medical fatphobia (aka weight-stigma) for healthcare providers to refuse surgeries to fat people because anesthesia poses greater risks for fat patients.

This is definitely fatphobic and, more insidiously, fatphobia (including internalized fatphobia) can dupe us into believing that if a healthcare provider can claim that it’s more difficult to treat fat people, then it’s perfectly reasonable (and not fatphobic) to refuse to treat us.

Let’s start here, the job of healthcare providers is to give healthcare to the people who need it. It’s not about refusing care to anyone who isn’t the easiest case.

In this specific case there are plenty of situations that make anesthesia more complicated or risky, but with those who aren’t fat, the research has actually been done to figure out how to mitigate the risks as much as possible. With fat people, the medical establishment tends to just throw up their hands and refuse (unless, of course, we are having our stomach amputated in a desperate bid to become thin that may ruin our quality of life or kill us, then the office absolutely understands how to accommodate fat patients and suddenly anesthesia is no problem.) In fact, fat patients who are refused simple surgeries because anesthesia is “too risky” are often counseled to get “weight loss surgeries” that threaten not only their lives, but their quality of life.) That is blatant fatphobia.

So to answer the question, yes it’s fatphobic, and it’s also fatphobic to claim that it’s not.

The medical establishment’s insistence on treating fat patient’s lives as less valuable and more riskable than thin patients is, quite literally, deadly.  If a procedure is more risky for fat patients there are several questions to be asked:

1. Is this actually true, or is the weight bias that is inherent n so much research giving us incorrect information? (In which case the solution is better, more ethical, research practices)

2. Is this actually true, or is doctors’ weight bias causing the problem. (In which case the solution is doctors who aren’t weight-bigots, and who take their oath seriously for all patients, not just the thin ones.)

3. If it is true, is it caused by the weight stigma that leads to fat people not being included in research when it comes to medical interventions and devices, and fat people and bodies not being included in medical education? (The solution to this is to do research that includes/focuses on fat bodies, and to include fat people, bodies, and a fat-positive perspective in medical education so that students not only don’t get to practice with fat people/bodies, but by extension get the idea that only thin patients are worthy of good care.)

4. If it is true, and the risks can’t be mitigated, what are the options to care for the fat patient? (Rather than trying to make them into a patient who looks different, especially since the vast majority of intentional weight loss attempts end in weight gain.)

Again, it’s not just about individual healthcare providers (though a good HCP would demand training and research so that they can give excellent care to patients of all sizes,) it’s about the systemic, institutional bigotry that makes healthcare providers unable (and allows them to be unwilling) to provide the same competent care to fat patients that they give to thin patients. 

It’s also a self-fulfilling bigotry. We keep hearing that more than half of people fall into (total bullshit, but I’ll talk about it here because we’re talking about how the medical community deals with weight) BMI categories that denote fatness. But surgeons do most of their work on thin patients? The history of refusing to treat fat patients (rather than figuring out how to best treat fat patients,) is what creates the present justification to refuse to treat fat patients (rather than, again, figuring out how to best treat fat patients.)

Fat patients deserve better than medical fatphobia.