Fat People Avoid The Doctor Because Of Weigh-Ins, And That Matters

Weight-based shame, stigma, bullying, and oppressionI received an e-mail from a reader who is worried that she is having some health problems, but has been afraid to go to the doctor because of the fat-shaming that she received the last time she went.

This is not the first time I’ve heard this. Sadly, it’s not even the hundredth time. It’s mostly been from fat people, but also people who have dealt with eating disorders and just those who struggle with being weighed and then feeling judged.

All too often, this is shrugged off by healthcare professionals as a “they need to get over it” thing, but it matters and it needs to be taken seriously because anything that gets in the way of people getting healthcare matters and needs to be taken seriously.

Unfortunately, it can also be profitable, as insurance companies have specific codes for “obesity counseling” (which, sadly, is not counseling to help doctors stop pathologizing bodies based on their height/weight ratio, or counseling about why we should give every fat person a pony.)

Let’s start here: In a fatphobic society, being weighed and/or negatively judged by a person of authority – including and especially a healthcare practitioner – can lead to trauma that interferes with the person’s future ability to engage with their own healthcare. That needs to be taken seriously, and solutions need to be offered (and let’s all be clear that “how about you just stop being traumatized” is NOT a solution.)

In good news, getting someone’s weight is almost never actually necessary – only in special cases (like medications that are dosed by weight) is this something that even needs to be done, and the need to tell patients their weight is even more rare.

Not to mention that focusing on a patient’s weight can cause healthcare practitioners to miss important diagnoses when, overcome by their weight stigma, HCPs fail to provide competent, evidence-based care.

Speaking of competent, evidence-based care, there is no point prescribing body size manipulation (aka weight loss) anyway since:

1. The same conditions happen in thin patients, meaning that thinness is neither a sure preventative nor a sure cure

2. Treatments besides “try to look different” are available for all of the conditions for which weight loss is often recommended (Pro-tip, they are the treatments that are prescribed to thin patients, so if a Healthcare Provider recommends weight loss, try asking “How do you treat this in thin patients?”)

3. There isn’t a single study where more than a tiny fraction of people succeed at significant long-term weight loss and the majority of weight loss attempts result in weight gain, which is to say that weight loss as a medical practice does not meet the basic criteria for an ethical, evidence-based intervention since the most common outcome is the exact opposite of the intended effect

Until they stop with this bullshit, we have the option to refuse weigh-ins, just like any other medical procedure (of course, getting weighed isn’t actually a medical procedure, but if they are going to act like it is, then we can treat it like one.) More-Love.org has created these cards to help!

I have found it effective to just say “no thanks” and keep on walking. If they push you can say something like “If we find that knowing my weight is actually necessary then I’ll be willing to discuss it, otherwise let’s move on.” You can explain that you have a history of disordered eating (dieting counts!) or eating disorders and that a weigh-in can be triggering, with no actual upside for you. If they ask to guess your weight (yes, it happens!) you can explain that this is not the County Fair and refuse that too. You can also agree to step on the scale facing away, but that won’t guarantee that they won’t bring it up, or print it on paperwork that you’ll eventually see.

It can also be extremely helpful to call ahead, let them know that for your psychological wellbeing you cannot be weighed in, and ask them to make a note of it, then remind them of it at check-in.

Taking someone with you can also be incredibly helpful. They can help advocate for you, and HCPs tend to behave more appropriately

This sucks, it should not happen, we should not have to strategize just to go to the damn doctor – and the difficulty is compounded by additional oppression due to things like racism, health issues like anxiety, depression, chronic illness and more. Our medical system is currently rife with fatphobia and that’s not our fault but it becomes our problem, so it can help to think about our options.

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2 thoughts on “Fat People Avoid The Doctor Because Of Weigh-Ins, And That Matters

  1. This is awful. I know doctors have a historic saint/sinner role in society and they make people uncomfortable with kill joy attitudes to most things. Literally don’t eat,drink,smoke,sleep around. mantras. Yes, good ideas, moderation in all things (minus drilling into your head-any of that is a no non), but I think some of them do know that their hostility and shaming at fat patients might kill them in the long run. Then they can point to it and use it as proof that “fat kills”. Sounds more like bias and substandard health care kill.
    I have heard that the diseases fat people get and those found in minorities often over lap. I think other people who want other people to “get sick and die” often succeed. In a per capita/ Western society sense. People with “low social value” get low social value care. Fat people, women, minorities, the poor, under educated… You know, scum.

    I really feel for people dealing with this. You go to them for help! You’re scared you might be dying. You are greeted with an attitude that makes you feel ashamed for asking for help and the under lying feeling that they really just assume you’d kick the bucket anyhow.

    I am not a brave person. Best I can say, for people who don’t feel up to the task of advocating for themselves in the face of such hostility and “book learned accusations of fault” ie. you’re fat, of course you’re sick”, is to say “No.” politely and refuse to be weighed.
    Seriously, that is all I got. Say “No.” and don’t let em weigh you. Then tell them what you concerns are, if the don’t listen. Go to another doctor, if possible. It’s hard to advocate for yourself in a world where people tell you you have no value.

  2. 1) Go to psychiatry department for monthly check in regarding mental health issues including eating disorder

    2) Talk to medical assistant about eating disorder and explain that you need to be weighed backwards and not be shown the number

    3) Face medical assistant as they write your weight in red pen at the top of your chart and circle it

    4) Repeat next month

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