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Even Harvard Medical School is aware of how pervasive - and damaging - weight bias is in medical care.
Below are 6 things that plus-size patients want medical care providers to know - as well as 8 additional immediately actionable suggestions - all sourced from a Facebook thread on my professional page.
Offer me weight-neutral and unbiased care.
Fran shared, "I think (medical care providers') initial bias delays true diagnosis and may often may create more serious illness." Gabrielle adds, "I prefer the determinants of health chart over the BMI chart. It’s more supportive and is not discriminatory."
Natalie suggests that providers ask: "How would I treat this person if they weren’t fat?' And for patients who have been told to lose weight, throw back, 'What would the medical protocol be if I wasn’t fat?'"
"Talk about my weight in a matter of fact way. My boxing coach doesn't ignore my weight. He comments on how it affects my balance, or how I'm stronger than I think I am because I carry the weight I do," shares Dawn.
Multiple people commented that they would like all practitioners to be trained in Health At Every Size principles.
Ask for my consent to be weighed or stop weighing me unless it's actually necessary for proper medication dosing or specific procedures.
"Asking if I wanted to be weighed when I went to urgent care was a lovely acknowledgment of my choice in medical experiences. I loved that," says Nancy.
"If I have to get on the scale, no need to read the number aloud," Paris adds.
"I went to a doctor in Olympia who asked in her new patient questionnaire if you were interested in losing weight and wouldn't pester you about your body if you said no. That could be a cool standard practice," says Alexandra.
Have equipment made for my body - from waiting rooms to MRIs.
Dawn asks for "exam tables that aren't five feet off of the floor!"
"Provide gowns that are big enough to cover our bodies. Larger-sized blood pressure cuffs, too!" suggests Michelle
"I shouldn't have to go without a medically necessary MRI as a cancer patient just because you haven't bothered to think about the significant proportion of the population with bodies like mine or larger. (We need) doorways wide enough to fit wheelchairs used by people in fat bodies. I should be able to access any health care facility," says Ceara.
"More research on weight-based medication dosages. With many meds, weight does not matter. But with many others, it does," points out Juli.
"They didn't have the right size needle in the OR when I had my c-section. They couldn't give me the epidural properly because they didn't have a needle long enough to get through all my back fat quote-unquote," shares Danny.
Stop prescribing weight-loss. Many plus-size patients, in fact, have undiagnosed eating disorders.
Says Helen, "Weight loss should be the last clinical 'solution/suggestion' not the first!"
"I had a provider tell me to just eat less - not having asked what I actually ate and at that time I was half starving myself. I needed to see an ED dietitian to realize I needed to actually eat more. I don’t think it changed my weight, but damn I feel so much better physically and emotionally," says Jennifer.
Helen adds that "health positive" actions and behaviors can "absolutely be encouraged, with no mention, encouragement or pressure about weight loss."
Give me the tests and treatment I'm asking for without the condition of weight-loss first.
Rose Ann shares, "I can’t seem to get a scan of my back after an injury until I lose the weight to see if that fixes the issue. One specialist (orthopedist) walked into the exam room for my first visit, saying, “You-have-a-BMI-of-____-are-you-diabetic-as-well-of-course-you-are.” No pause between sentences or opportunity for me to speak. I knew then that I wasn’t going to be listened to. The second one (neurologist/spine & sleep specialist) scheduled an MRI of my head and back and then changed the plan, only doing the scan of my brain. The case note read that we would be waiting to address the back pain until after my weight was under control. He really pushed weight loss surgery. The biggest change that I would like to see is for medical professionals to somehow see all of their patients as human beings, regardless of their BMI."
Trust me. Believe me.
"Assess physical activity and diet (with permission) rather than assuming that the person must be inactive/ignorant about nutrition. Take their word about what works for them," says Sara.
"I have seen in my medical file that I am obese due to overeating. No discussion was had, no questions, no exam. This is gross neglect and a dangerous assumption. My eating disorder was overlooked for years. My endocrine disease was missed," shares Pamela.
Carrie would like unbiased advocates to join the patient to be sure they are being heard. "In my cancer journey, I've experienced so much medical gaslighting." Carrie says her concerns were often dismissed but then validated by scans later, including a suspicion that tumors had spread and were leading to pinched nerve pain.
Here are 8 additional immediately actionable suggestions from plus-size patients:
Carrie suggests a weight neutrality statement on the medical provider's website. That way it won't always feel like "a roll of the dice" when you try someone new, which makes people avoid medical care.
"Firmly do away with the BMI all together," says Betsey, who had three other suggestions (below).
"Ask patients to disclose if they have an ED and/or would prefer to avoid weight discussions and then follow through with those requests."
"Non dieticians need to stop giving diet advice, period. Refer to a dietician if you feel food assistance is needed for a patient."
"Always give the differential diagnosis to all patients regardless of size and reasoning behind why specific conditions are being ruled out."
Bobbi asked that medical providers stop recommending weight loss surgery.
Don't see plus-size patients as inherently ill and incapable of a meaningful life at their size. Amy tells of a moment when a medical care provider encouraged them to see their health holistically: "I once had a doctor tell me, 'There are beautiful 'fat' people all over the world, and as long as your blood work checks out fine and you aren’t having other complications, you shouldn’t be spending every waking hour stressed about your weight because you are more than a number on a scale.' That was honestly one of the best gifts I’ve been given."
When providing care, take into consideration that most plus-size patients have experienced medical negligence or bias. Heather points out, "Healthcare providers should assume that anybody classified as overweight or obese has experienced medical trauma. They should expect that all fat people have been mistreated in a healthcare setting, likely over and over again. Sometimes I find providers who are sensitive, but not sensitive enough because they don’t factor in the harm that has already been caused." Teauna adds, "Know that Black plus women may have different medical needs."
I want to end this article with a reminder that Ceara shared in the thread: "Anti-fat bias kills. It needs to be taken seriously on a systemic level. It's not enough for us to ask for individual doctors to do the right thing. It needs to be addressed systemically."
+ Take a look at my books: You Have the Right to Remain Fat (I narrated the audiobook), The Self-Love Revolution: Radical Body Positivity for Girls of Color, Hot & Heavy: Fierce Fat Girls on Life, Love and Fashion