How to cope with fatism and weight bias in healthcare

Sadly, fatism and weight bias in healthcare have been an issue for decades. This is wrong, it shouldn’t be ‘the norm’, and it’s not acceptable. Just to be clear, being treated in a discriminatory way due to your body size is not something you deserve. You deserve better. You deserve to be provided with equitable treatment to understand your physical health difficulties without your healthcare provider reducing everything to your weight.

If you live in a larger body and you’ve ever sat in the doctor’s office and felt they perhaps sat far away from you, made little eye contact, frequently referred to your weight rather than your presenting issue, and you were not being offered a full range of treatment options, this post from Associate Psychologist, Gabriela Enache, will help to guide you in the right direction.

What is weight bias and fatism?

Weight bias means having a negative social devaluation based on body size or body weight. It can lead to prejudicial or stereotypical beliefs, towards people because of their size. Holding these beliefs and attitudes can cause fatism – discrimination against people living in larger bodies.

Weight bias is unfortunately a prevalent issue in healthcare settings. It can be so potent, that this alone can prevent people from engaging with healthcare services, which, ultimately, can have a negative impact on both physical and mental health.

Recognising fatism and weight bias in healthcare

Typical signs of fatism and weight bias in healthcare include the medical practitioner:

  • Sitting away from you, not making eye contact, and/or not welcoming you to sit down.
  • Spending less time with you than they do with other patients.
  • Speaking down to you, for example, “You’re not making enough effort.”
  • Using phrases such as, “You need to…” rather than taking a more collaborative approach to address your difficulties.
  • Frequently referring back to your weight as the main cause of your illness or complaint, without ruling out other possible causes and first assessing your overall health.
  • Not asking for permission to talk about your weight.
  • Not providing you with additional tests to explore your presenting issue, not offering a check up, or referrals to other appropriate services.

Healthcare providers with a weight bias may make the assumption that your weight is problematic for you. They may give the impression that you alone are responsible for your weight and hence you could and should manage it, which may leave you feeling ashamed. If you do feel your weight is an issue for you, they may also exhibit a lack of curiosity, and be disinterested in getting to the root causes, and hence be less collaborative during the session, which often means you don’t receive the empathy and support you need.

The impact of fatism and weight bias in healthcare

Evidence suggests that because of this, individuals living in larger bodies have less trust in healthcare providers and are less likely to engage with healthcare services.

It’s not uncommon for people living with obesity or struggling with their weight to postpone treatments or interventions, allowing the problem to worsen until they can’t delay any longer.

Research has shown that the experience of weight bias/stigma is associated with high blood pressure, stress, anxiety, depression, body dismorphia, disordered eating, low self-esteem, low self-confidence and avoidance of physical activity. Furthermore, rather than their actual weight, it is the experience of weight stigma that increases an individual’s likelihood of developing these conditions.

In summary, weight bias in healthcare compounds health issues rather than improves them.

How to tackle weight bias in healthcare

While it shouldn’t be your responsibility to educate healthcare providers about weight bias, a little bit of preparatory work will help you to be better informed, and therefore feel more assertive, during appointments. Here are some suggestions:

  1. Write down the issue/s you would like to talk about with your doctor

Make a list of your symptoms, medications, and questions you have for your healthcare provider. This can help if you feel anxious during your appointment in reminding you of the concerns you may want support with.

  1. Bring a friend or family member with you to your appointment

This person can act as a support in many ways. They can raise concerns on your behalf or help you to express any difficulties you may have. They can note down and even query (where/if necessary) the information you’re given. For example, they can ask questions about how the health issue you’ve come to discuss today may or may not be linked to your weight.

  1. Decide what language you’re comfortable with

Ideally, your healthcare provider should ask what language you prefer to use when addressing your weight. Many people are very comfortable identifying as ‘fat’, while others prefer to use the term ‘overweight’ or as having a ‘high BMI’. There’s no consensus on the correct terminology to use.

If your healthcare provider uses language that makes you feel uncomfortable, be sure to let them know. For example, “I don’t like it when you talk about ‘my obesity’, I would prefer if you could use the term ‘excess weight’ or ‘high BMI’”.

  1. Highlight your concerns in advance

If you don’t want to talk about your weight during your upcoming appointment and would prefer talking about ways to increase healthy behaviours instead, you could write an email to your healthcare provider in advance to let them know.

  1. Speak up

Ask questions, take notes during the appointment and be honest, clear and direct about your symptoms.

If you don’t understand what your healthcare provider has told you about your treatment or diagnosis, don’t be afraid to ask enough questions to give you full clarity.

In addition, if you encounter something during your appointment that makes you feel uncomfortable or nervous – whether that’s an attitude or a remark – raise it with your healthcare provider.

  1. Reach out to other people

You may feel it’s too difficult to communicate these feelings to your healthcare provider during your appointment. In this instance, you can discuss any difficulties with the patient liaison team. You will also find plenty of useful online support groups for those living in larger bodies.

Undoubtedly, there needs to be a shift in the medical culture from shaming individuals living in larger bodies in a clinical care setting. Speaking frankly, if shaming people for being ‘fat’ worked, we would all be thin because it’s been happening for the last 30 years since obesity first became a national health issue in the UK. Shaming is not a tool for behaviour change. It’s not an acceptable strategy. Shaming only damages individuals and their quality of life.

If weight bias and stigma are impacting your life, please do not accept this as normal. Everyone deserves to receive fair and equitable treatment from their healthcare provider. Please get in touch to find out how we can help.

Take care,

Gabriela Enache

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