A Spider Bit You? It’s Because of Your Weight
by Dr. Deanna McCrary, ND
If you’re like me, at some point in your life you’ve gone to see your doctor about one thing and ended up getting a lecture about something else. Often for me, that “something else” was about my weight. Whether I came in with the sniffles, swelling in my hand due to a spider bite, or a sore ankle due to slipping on a wet floor at work in which the HR director insisted that I go to the doctor, somehow all of my concerns became reduced to “well, if you just lost weight …” As a larger woman, I began to wonder if losing weight might be better than winning the lottery as apparently one is bestowed not only with perfect health but also the ability to never slip on wet floors or encounter angry spiders! Do such assumptions sound fishy to you? Me too. And rightly so. The basis for such irrational prejudice is due to a prevalent phenomena in western societies known as “weight stigma.”
Weight stigma is bias, discrimination and stereotyping based on one’s body size – whether large or small. Unfortunately, weight stigma is rampant within the medical community. For example, a 2003 research study found that more than half of the 620 primary-care doctors in the study characterized their large patients with unflattering monikers such as “awkward,” “unattractive,” “ugly,” and “noncompliant,” and more than one-third of them threw in “weak willed,” “sloppy,” and “lazy” to boot. According to the Yale Rudd Center, “Heavier patients are more likely to avoid, cancel, or delay important preventive services. When asked why, obese patients attribute these decisions to disrespectful treatment and negative attitudes from providers, unsolicited advice to lose weight, embarrassment about being weighed, and bad experiences with medical equipment that is too small for them.”
Despite the prevalence of weight bias among health care providers it is a dangerous way of thinking that harms thin and fat alike. Larger people may be less likely to seek out care and thin patients may have serious metabolic conditions such as diabetes or hypertension overlooked due to assumptions that because of their smaller size those conditions would not exist. When the focus is put on weight, and not health, everyone loses.
According to Michelle May, MD, an outspoken advocate for Health At Every Size®, “It is disrespectful, lazy, and even dangerous to assume one knows anything about a patient’s health, risk factors, or choices without taking a thorough history, performing a skilled physical exam, and ordering necessary labs and diagnostic studies. It is tantamount to guessing. At best, these assumptions are a shortcut that damages the patient-clinician relationship. At worst, it is discrimination that has potentially serious medical consequences.”
What are some of those potential serious medical consequences? Depression, lowered self esteem and suicidal ideation are a few. One study found that 79% of adults cope with the effects of weight stigma by eating more. Among adolescents and teens binge eating and purging may develop and a life-long course of weight cycling and body hate may commence for others. Clearly, instead of helping, stigma can lead directly to weight gain, disordered eating and body dissatisfaction and merely serves to exacerbate the condition that the biased person is so disdainful of. What can you do if you have experienced weight bias in a health care setting? Directly addressing the person and expressing your feelings about how you have been treated can help health care providers become more aware of their biased attitudes and actions. Since weight stigma is so prevalent within our culture your provider may not have had an opportunity to understand firsthand how their attitudes are coming off to a patient.
Now that I have become a physician myself and learned to care for and honor my body no matter its size, I find it easier to insist on respectful care from providers. For others, being direct is not always so easy. Writing a letter or contacting a patient advocate may feel less confrontational. Linda Bacon, PhD, author of “Health At Every Size” has a pre-written letter you can give your doctor or provider. You can find it at Providing Sensitive Care to People of All Sizes.
Lastly, if your doctor goes off on a tangent about your weight remind him or her of why you came in and that you would prefer if your visit stayed on topic. Remember that you always have the power to leave a situation where you are not feeling respected and valued. Seeking out the care of a practitioner that embraces the tenets of Health At Every Size® where the diversity of body shapes and sizes is respected and accepted is also an option.