When You Know Better, You Should Do Better

I believe that the majority of the time, weight stigma in a health care setting is a misguided attempt to help. But that does not excuse rudeness, shaming, guilt, scare tactics, cruelty, or poor medical care.
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I love the mission of Weight Stigma Awareness Week and all of the online activity around this important issue, but it is hard on me too. I end up reading countless posts about the stigma people have faced from their own doctors. It makes me feel ashamed to be part of the health care profession. What happened to "First, do no harm"?

What happened to compassion, care, and non-judgment?

I believe that most physicians (at least the ones I know) wouldn't intentionally hurt their patients' feelings. I also know that the majority of physicians are compassionate, caring, and non-judgmental. I want to believe that a physician wouldn't dismiss their patient's symptoms, concerns, and illnesses as a consequence of some perceived "failure," then suggest weight loss, however elusive, as some miracle cure for just about anything wrong with an obese patient. Yet the research and personal anecdotes show that it happens all the time.

For the sake of argument (and based on some of the horrifying stories of weight stigma in medical settings, there is room for argument), I believe that the majority of the time, weight stigma in a health care setting is a misguided attempt to help. But that does not excuse rudeness, shaming, guilt, scare tactics, cruelty, or poor medical care.

An Old Problem With a New Target

We've been down this road before, and we should know better. At the very least, we've finally arrived at a time when blatant discrimination based on sex, race, and increasingly, sexuality, are not tolerated, at least not openly. There is still much work to be done, but we are slowly headed in the right direction. As Maya Angelou said, "When you know better you do better."

So why is there a need for a week dedicated to understanding the serious problem of weight stigma?

Weightism: The Other Stigma

How is it that weightism is tolerated, and even encouraged? How is weightism any different from stigma based on the color of one's skin or other personal characteristics?

It's not.

In their defense, I know that my health care colleagues are being bombarded from all sides about the "war on obesity" (who isn't?). They are even sometimes blamed for not doing enough, and criticized for not raising the issue with every patient, no matter what they came in for. Medical journals are packed with research about the effectiveness (or more accurately, ineffectiveness) of various "treatments" and conflicting data on the causes and risks of obesity. Still, physicians are pressured to talk to their patients about losing weight, even though most don't have any better advice than, "Eat less, exercise more," or "Have you thought of going to Weight Watchers?" (Uh, yeah, thanks.)

I know better now too

Let me share a few of the things I know after 14 years of working with people who struggle with the issue of weight:

  • Focusing on weight leads to dieting.
  • Diets don't work.
  • Diets often lead to disordered eating.
  • Mindful eating can heal a broken relationship with food.
  • Mindful eating is doorway to vibrant living.
  • Mindful living is about being in the present moment, not postponing one's life until you attain (or in order to attain) some idealized version of beauty or health.
  • Health is a personal and evolving concept for each individual, one that cannot be measured in numbers.
  • Health comes in all shapes and sizes.
  • Beauty comes in all shapes and sizes.
  • Weight is a poor indicator of health.
  • Using BMI as a surrogate measure of health is misleading and lazy.
  • Weight stigma hurts.
  • Shaming and threatening people doesn't improve their health.
  • Weight stigma hurts health.
  • All people deserve respect and a life free of judgment about the size of their bodies.

(There are a lot of people who are smarter and more academic than I who can provide references that confirm these observations. See "Resources about weight stigma for health professionals" below.)

What should patients do?

  • Set clear boundaries with your health care providers, preferably at your first meeting, but anytime will do! For example, you could say, "I am looking for a doctor who will be a partner in caring for my whole self. I am interested in living a healthy lifestyle, but I am not interested in lectures, guilt, or scare tactics. I want my symptoms, issues, and concerns to be taken seriously, and I will not accept 'lose weight' as the treatment for whatever ails me. Can you be that kind of partner in my health care?"
  • If you feel that you are being stigmatized by a health care professional, educate them about the issue (see resources below) and set firm boundaries. If the problem is severe or persists, find a new health care professional. You deserve better!
  • Resources about weight stigma for health professionals

    To my colleagues, if you are still reading this, you are already headed in the right direction. Please, know better so you can do better! Here are a few resources that will help:

    For more by Michelle May, M.D., click here.

    For more on personal health, click here.