If Being Fat Makes Medical Procedures More Difficult

medical fatphboiaIn 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.

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I mentioned that I want to have more fun with my activism this year. As part of that, I’ll be doing a stand-up comedy set as a guest performer at the FATCH New Year, Same You show on January 10th at 9pm at the Upright Citizens Brigade Theater on Sunset in Los Angeles. Tickets and info can be found here (Accessibility info: there is a fat-friendly bench in the front, the rest of the seating is stadium theater seats with arms up at least one step. The venue is wheelchair accessible, but there is limited space for wheelchairs.)

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8 thoughts on “If Being Fat Makes Medical Procedures More Difficult

  1. Seriously. It is about bias. I had gallbladder surgery at 390. Nobody said I needed to have my guts cut out first. I am an organ donner too. I once asked if being fat made getting the organs harder. Guy said no, they’d just do it.
    If they want to do it, they can, where there’s a will there’s a way. It is a lack of will power on the part of medical professionals to get fatter bodied people the care/dignity/treatment/respect they deserve as much as any other patient.

  2. Yeah, I think “you can’t have this procedure because you’re fat” is something people accept because they haven’t really thought it through. With all the conditions that can make procedures more or less risky, and all the ways professionals have found to reduce the risk for those conditions, there is no legitimate reason for the doctors of fat patients to default to refusing treatment… or worse, to dangling treatment over the fat patient’s head as an incentive to lose weight in some twisted carrot-and-stick scheme where the stick is suffering and/or dying from a treatable ailment. It’s absolutely fatphobia that this is considered normal.

    1. Exactly! And our culture has a history of treating doctors as almost all-powerful and unquestionable and so almost everyone starts from a communication disadvantage and being part of a marginalized group (and especially more than one marginalized group) compounds that. Ugh.

  3. Thank you Ragen, you always put it perfectly when I’m just too mad and confused. I can’t stop thinking about all the gay people who have been passed over for organ transplants (giving and receiving).

    1. Thanks, and I absolutely agree. And trans and non-binary patients who are currently being refused surgeries that are necessary for physical and mental health, until they meet some bullshit BMI requirement, who are then referred for completely unecessary stomach amputation surgeries. The ways that our social inequities and bigotries (racism, homophobia, misogyny, ableism, classism et al) map to our medical inequities is absolutely disgusting.

  4. One of my friends had to go on a diet to hit a certain weight before she could have knee replacement surgery, and another is contemplating one of the ‘weight-loss’ surgeries because of her knees. Is this more common for women, or do fat men get this kind of discrimination too?

  5. They can operate on babies in the womb. They can replace fully functional organs. They can ffing learn to safely operate on fat people!
    And I’m saying this as someone who is disabled because I’m refused knee surgery.
    As posed in the text above I’m fiercely pushed towards stomach amputation though. Not happening.

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