Medical fatphobia: Weight-based discrimination in healthcare settings

Unpacking medical fatphobia

Fatphobia, or the fear of fat bodies, is prevalent in medical settings due to the common misunderstanding that weight is an accurate health measure.

The fatphobia of BMI

The Body Mass Index (BMI) is a fatphobic measurement of health. For years, healthcare providers have used the outdated and fatphobic concept of BMI as the standard benchmark for “healthy weight,” even though BMI only considers height and body weight as its measurements. For this reason, BMI is no longer being used by most practitioners, especially those who treat eating disorders.

There are many other measurements outside of BMI to consider when examining a patient’s health, especially a patient with a history of disordered eating. Being thin doesn’t automatically equate to being healthy, just as being fat doesn’t automatically make someone unhealthy.

Fatphobia is a barrier to receiving medical care

People with higher-weight bodies are exposed to many types of medical fatphobia, from provider behavior to diagnostic tools and lack of accessibility.

Examples of fatphobia in medical settings

Here are some common examples of fatphobia and weight bias in health settings:^1,3

• Ignoring the symptoms of fat people or assuming the only solution is to lose weight
• Requiring patients to be weighed when it’s not medically necessary or denying a blind weigh-in request 
• Using BMI as a measurement of health
• Falsely believing weight is the best indicator of health
• Misattributing complaints or symptoms to weight
• Spending less time with higher-weight patients
• Shaming patients into losing weight by dieting and exercising
• Failing to take an intersectional and systemic approach to the medical community’s fatphobia 
• Viewing higher-weight patients as “undisciplined” or “lazy”
• Conducting fewer preventative or diagnostic procedures on people in larger bodies

Other examples of weight discrimination involve physical barriers to quality healthcare, such as:¹

• Lack of access to appropriate-fitting blood pressure cuffs and gowns
• Not offering exam and x-ray tables that can support people living in larger bodies
• Not offering armless chairs that larger people can comfortably sit in
• Lack of MRI scanners that can accommodate larger bodies

These physical barriers can trigger and traumatize patients in larger bodies and result in inaccurate or late diagnoses.

The harmful effects of medical fatphobia

The consequences of medical fatphobia are far-reaching and pervasive. Research has revealed that women living in higher-weight bodies are less likely to be screened for various cancers, such as:³

• Breast cancer
• Cervical cancer
• Colorectal cancer

Consequently, higher-weight women are more likely to die from cervical cancer and breast cancer than women of average or below-average weight who have these cancers.³

Further, individuals who have experienced weight stigma in the healthcare setting may avoid accessing healthcare in the future due to:³

• Physical barriers
• Unsolicited weight loss advice
• Medical trauma
• Fear of health problems being dismissed
• Internalized fatphobia
• Shame

Healthcare avoidance can lead to additional health problems, late diagnoses, and rapid disease progression.

Additional negative effects of weight stigma in the healthcare setting can include:^1,4,5

• Anxiety
• Depression
• Suicidality
• Disordered eating 
• Poor self-esteem
• Body dissatisfaction
• Psychological distress
• Extreme dieting and or restriction 

More often than not, fatphobia in medical settings can worsen a person’s mental and physical health and increase the risk of disordered eating.

How treatment providers can combat medical fatphobia and create an inclusive environment

First and foremost, it’s important to interrogate and dismantle your own fatphobia and weight stigma by:

• Challenging the idea that weight is the most important predictor of health
• Recommending intuitive eating over dieting
• Speaking out against fatphobic attitudes
• Stopping prescribing weight loss as medical treatment
• Adopting a HAES (Health at Every Size) approach

The HAES approach in healthcare

HAES is an alternative approach to healthcare that prioritizes a size-inclusive model and takes the focus off of weight. It rejects inaccurate and stigmatizing scales, such as body mass index (BMI), and takes a holistic approach to well-being and health while also viewing health as a continuum that is ever-changing as opposed to a single goal. In addition, HAES celebrates and respects body diversity while positioning patients as the experts on their own bodies.

By adopting a HAES approach as a treatment provider, you reject the weight-centered approach that shames and stigmatizes people living in larger bodies, instead understanding that health is multi-faceted and much more complicated than a person’s weight or size.

Other tips for creating a size-inclusive medical setting

Another thing you can do to make your medical practice more weight-inclusive is to avoid weighing patients unless it’s absolutely medically necessary. Many patients are uncomfortable with stepping on the scale at a routine medical visit, and it can trigger psychological distress, shame, and disordered eating behaviors. And often, these patients may struggle with speaking out about their discomfort, so an easy way to get ahead of the problem is to remove weighing from your patient visits unless needed for a specific reason, not just as part of a vitals routine. When weighing is necessary, you can provide a blind weigh-in as an option. 

Additionally, you can use metabolic measures, such as blood sugar, blood pressure, and cholesterol levels, to establish a person’s health rather than weight and size. You can then focus on health-seeking behaviors for nutrition and weight management, such as eating a balanced, nutritious diet, getting enough sleep, and engaging in joyful movement, as opposed to weight loss. 

Lastly, some things you can do to eliminate or reduce the effect of physical barriers include:

• Offering comfortable, large, armless chairs
• Making sure the exam tables are sturdy and large enough to accommodate diverse body sizes
• Offering gowns that can fit larger bodies
• Ensuring you have a blood pressure cuff that fits larger arms

Taking these steps towards cultivating a more inclusive environment can be the difference between getting a person the appropriate healthcare and not. It’s easy to make these changes that improve patient comfort and create a more welcoming atmosphere.