Going to the doctor as a fat person can be infuriating.
As I reported last week in a story for Highline called “Everything You Know About Obesity Is Wrong,” fat patients say doctors are misinformed, uninformed or downright bullying to larger patients. Some said their physicians refused to diagnose them with anything other than a weight problem. Others were told they couldn’t receive treatments, tests or medications until they slimmed down. Others had to listen to tedious lectures and store-brand advice without ever being asked what they were already doing for diet and exercise.
These attitudes have profound consequences. As I detailed in the article and learned over the 15 months I spent reporting it, fat people are overlooked by the medical system in ways that are bad for their mental and physical health.
That doesn’t have to be true. For decades now, fat people have formed communities, built resources and shared tips for finding good doctors and coping with bad ones. In my reporting, many of my sources shared what worked for them and how they were able to get the treatment they needed from a medical provider without having their weight needlessly inserted into the conversation.
If you’ve ever found yourself in this position, here are a few tips and resources from those patients, plus a few experts, you can use to get good care for your medical needs ― without the body shaming that may sadly come with it.
1. Do research to find the right doctor
Preventing a negative interaction is always better than surviving one. For years now, the Association for Size Diversity and Health has offered a database of doctors who’ve committed to an approach called Health At Every Size. This means, as the name implies, that they won’t push you to lose weight, won’t make assumptions about your habits and won’t frame diet and exercise as moral imperatives. If you can’t find a doctor in the database, HAES also has a Facebook group where you can ask for recommendations, get tips and share warnings.
But you still might have to take matters into your own hands. Kimberly Gudzune, a doctor at Johns Hopkins Medicine who mostly works with fat patients, said she advises her clients to make appointments with more than one provider to ensure they’re a good fit. Check doctors’ websites for the language they use to describe fatness. Patients can also call ahead, Gudzune said, “and let the new provider know that you’ve had negative experiences with the health care system before and you’re looking for someone sensitive to these issues.”
Another sign of empathic care is the environment doctors create for their patients. Fat-accepting doctors offer armless chairs, larger gowns, size-appropriate blood pressure cuffs and accommodating beds and tables. Some of them even vet the magazines in the waiting room for stigmatizing images. These are exactly the kinds of offerings that clinics should be able (and eager) to tell their patients in a phone call or first appointment.
2. Decline the weigh-in if you feel uncomfortable
You don’t have to be weighed every time you go to the doctor. You just don’t.
Andy (not their real name), a researcher in the Northeast, told me that they haven’t stepped on the scale at a physician’s office for years. It’s not always an easy request to make and it’s not always familiar to clinic staff, but being weighed is only necessary for specific medical treatments, like determining anesthesia dosing before a surgery. As a patient, it’s perfectly within your rights to decline to be weighed and ask doctors to add a note to your chart saying so.
Nearly every time Andy makes this request, it goes smoothly. The few times they’ve gotten pushback, they said, “I tell them, go ahead and take my blood pressure. If you need to run tests, take my blood. If you want to know my actual health, then measure it. Otherwise, what’s the point of being in a hospital?”
Another approach, according to Melissa A. Fabello, a feminist writer and speaker who has lived with an eating disorder, is to use phrases like, “I can estimate how much I weigh for your records” or “I haven’t gained or lost a significant amount of weight recently” to deflect clinic staff who insist that she step on the scale. Other options include being weighed standing away from the number and telling staff members that you agree to be weighed, but would rather not know the result.
Fabello and Andy both stress, however, that it’s not easy to make this request, especially the first time. If you’re nervous about speaking up, bring a friend or partner along to your first visit to help boost your confidence.
3. Keep your doctor focused on your health
This is where it gets tricky. The worst experiences for fat patients, I heard again and again, often happen once you’ve navigated all the hurdles and think you’ve reached safety.
Emily Richman, a counselor in eastern Washington, said that after experiencing bullying interactions with doctors her whole life, she now goes out of her way to be clear about the kind of care she needs. At her first appointment with a new primary care provider last year, Richman said, “I told her that I’m not interested in weight loss. I’m interested in being as healthy as possible. If that’s a problem, I’ll find another doctor. I cried the whole time I said it. It felt like a dangerous thing to say.”
But Emily was pleasantly surprised. “She was great about it. She just said, ‘That sounds fine.’ I had a little breakdown. It meant so much.”
If you’re not ready to be that direct, there are lots of other resources to help make sure your appointment stays focused on your health and not your appearance. Printouts from Linda Bacon, the author of Health at Every Size and the blogger Ragen Chastain provide helpful phrases ― “Focus on treating the condition rather than the weight”; “Provide me with shame-free health care” ― in case the interaction starts to drift weight-ward. Author and activist Marilyn Wann has created wallet-sized guidance with reminders of your rights as a patient and the components of compassionate care.
Andrew (not his real name), a musician and consultant in the Northeast, said he asks follow-ups (“How is this related to the condition I came in for?”) when a doctor gives him advice to make sure it’s aimed at his actual symptoms. Like so many of my interviewees, he also inquires if his doctor would give different advice to a thin person if they came in with the same symptoms.
“Be courageous,” said Lesley Williams, a family medicine doctor and eating disorder specialist in Phoenix who practices the HAES approach. “This is your body and your health. Don’t be afraid to advocate for yourself and request that they focus their attention on what matters most to you.”
But if you’re still not getting the care you need, you can always consider finding another physician. Kathy, a social worker in New England, told me that a few years ago, she went to her doctor with knee pain. He gave her the same it-must-be-your-weight brushoff he had given her before. Frustrated, she found another doctor who took the time to touch her knee, ask her how it was hurting and inquire about her exercise habits.
“She asked me if was squatting a lot, which I was,” Kathy said. “It turned out I was straining my kneecaps. If I hadn’t switched doctors I would have just lived with this pain.”
4. Speak up about your experience and connect with others going through the same thing
It sucks feeling like you have to do all this extra work just to receive the kind of care that others take for granted. That’s why the final recommendation is not to let a bad interaction with a doctor be the last word. Write a letter to their employer or board certification describing the interaction and how it affected you. Leave a review on Yelp or other doctor review websites. Send them NAAFA’s Guidelines for Healthcare Providers.
Plus, because all of this unfairly amounts to even more work on your part, make sure you find communities in real life and online where your experience will be believed and your values will be supported. Facebook groups for fat liberation are a good place to start, as are the National Association for the Advancement of Fat Acceptance and the Association for Size Diversity and Health. Podcasts like She’s All Fat and Food Psych can keep you informed and armed for the next appointment. Tell thin allies how they can support you by speaking up to their own doctors.