For the last 20 years, Americans have been embroiled in a full-fledged health and morality panic about the widely reported obesity epidemic. Nightly news, newspapers and daytime talk shows alike bemoan the state of American bodies, while often failing to report the
1998 change in the BMI’s definitions of “overweight” and “obese,” or the
racist history of the BMI itself. Health reporting frequently cites the dangers of living in a fat body. Most people don’t give it a second thought, with some of us even coming to believe that a higher BMI necessarily means that all fat people will come to develop diabetes, hypertension, heart disease, and an early grave.
But a growing body of research shows that the health issues attributed to being fat may be exacerbated — or even caused — by the bias and discrimination too often leveled against fat people.
Bias among health care providers may be worsening fat patients’ health outcomes by perpetuating weight stigma. A 2014 study published in the journal
Obesity found that
67% of medical students exhibit overt bias against fat patients, with over half of respondents characterizing fat people as a whole as being “lazy, unmotivated, noncompliant, and unhealthy.”
Providers’ bias doesn’t end with their own perceptions, either — it measurably impacts fat people’s care. A 2013 study in the journal
Obesity found that doctors “
build less emotional rapport with obese patients.” And a
2001 study in the International Journal of Obesity found that “although physicians prescribed more tests for heavier patients, [they also spent] less time with them, and viewed them significantly more negatively.”
Research published last year found that nurses who belied in weight controllability (that is, the idea that people can control their own weight, and that fat people are simply failing to control our own behaviors) also reported greater weight-based discrimination in medical settings — ultimately negatively impacting the care they provide to fatter people. Some researchers even argue that weight stigma is a
primary driver of the so-called “obesity epidemic,” citing a range of studies showing that experiences of discrimination and internalized weight stigma cause weight gain, and that health care providers’ bias leads many fat people to postpone health care or avoid it altogether — another driver of poor health outcomes.
Research released earlier this month further underscores the depth of medical weight stigma in vulnerable populations. A new study published in the journal
Women’s Reproductive Health found that
people seeking reproductive health care can have negative experiences “shaped by dominant notions of health, the body, motherhood and fatness.” A follow-up commentary in the same journal cautioned that “
providers need to examine their own biases” lest they allow those biases to influence the quality of care they provide to expecting parents.
If so many are, as they claim, “just concerned about fat people’s health,” the best way to express that concern is to address the overwhelming stigma facing fat people in doctor’s offices.
Last month,
Obesity: A Research Journal published new findings on weight stigma in LGBTQ communities, who already experience high rates of medical discrimination, leading to
significant health disparities. Researchers found that LGBTQ people experience similar rates of weight stigma to straight, cisgender people (that is, people who aren’t transgender), but that gay men were most likely to internalize that weight stigma. Internalized weight stigma, according to the study, is also “associated with poorer mental [health-related quality of life], lower eating self-efficacy, and increased eating to cope, controlling for demographics and BMI.” That is, because gay men were more likely to believe the stigma leveled against fat people was true and correct, they experienced an increase in negative health outcomes across the board.
These new studies also include recommendations to address providers’ bias that largely focused on standardizing health care provisions, limiting shaming approaches, and confronting providers’ existing internalized biases. While health care providers undergo immense technical training, little (if any) of that training requires them to confront biases they may hold against the people they’re tasked with treating.
The authors of the
Obesity: A Research Journal study write that their findings underscore the need among health care providers to recognize that some people “may be vulnerable to stigma and unfair treatment because of both their body weight and their sexual identity.” This awareness could not only make medical appointments more comfortable and productive, but also, as the researchers write, can help medical professionals understand that stigma puts people “at additional risk for compounding stressors and adverse health outcomes.”
Too often, the stigma fat people face is thinly veiled by a purported “concern for our health,” a kind of well-intended bullying that only ends up compounding the harms we face. If so many are, as they claim, “just concerned about fat people’s health,” the best way to express that concern is to address the overwhelming stigma facing fat people in doctor’s offices. After all, while some of us may be sick, stigma from health care providers often prevents us from accessing the care we need, which only makes us sicker. Until providers’ biases are effectively addressed, the privilege of reliable, respectful health care will, paradoxically, be reserved for those already seen to be healthy.
Elemental
Your life, sourced by science. A new Medium publication about health and wellness.
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