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Going to the doctor can be nerve-wracking for anyone, but for fat people, it’s often dreaded for a whole different reason. Many people of size have experienced some form of discrimination at the doctor’s office, whether it be their weight being blamed for unrelated health issues or having their symptoms ignored all together. That’s why physicians like you are so important! Your interest in and thought about accommodating patients of all sizes is the first step in having these non-judgmental conversations. But, of course, I do have some thoughts.
Creating an environment of safety and respect for patients of size begins at the very first touch point — a doctor’s website or profile. Clearly stating that you have a size-inclusive practice will signal to patients that your office is a judgement-free zone. The terminology here is flexible. For instance, mentioning “health at every size” in your bio or using the term “size-inclusive” will signal to fat patients that they can be at ease before they even walk through your door.
Once patients are in your office, what they see is important, too. It’s crucial that the setting where these conversations take place is hospitable and welcoming to patients of all sizes. I’m talking everyone. What is the width and weight limit on your examination table? Do the chairs in your waiting room and office have arms that can bruise hips or prohibit patients of size from sitting? Can your gurneys carry someone 600 pounds or more? How wide are the doors in your office? Do you have longer-length arm cuffs easily accessible? If the patient chooses to be weighed, what is the weight capacity on your scales? A size-inclusive equipment overhaul does require a budget that not everyone may have, so this might not be realistic for your clinic, hospital, or private practice. But even small changes make a difference and signal to patients that they are welcome. To consider someone’s physical comfort is a sign of respect. It’s much easier to be mentally and emotionally at ease if you’re already physically at ease.
Now, let’s get to the actual discussions. When I think of the medical professionals I’ve been most comfortable around, they’ve made it clear from the beginning that our relationship is rooted in safety and respect. It takes clear, consistent communication to build that trust. What does that look like? A simple disclaimer at the top of an appointment. Something like, “I want to make sure you’re comfortable today so I can provide you with the best care possible. Is there anything specific you’d like to discuss? Are there any topics that are off limits?” This purposefully makes space for patients (of any size) to inform their doctor of any sensitivities they may have. A generalized disclaimer goes a long way.
Of course, discussions of weight can’t be completely abolished from medical treatment, but they can become more thoughtful, specifically in the choice of language. Presenting evidence and options without judgment can, in my experience, be helpful. It’s when conversations steer into blaming and shaming territory that things go bad. Most fat people understand that certain health conditions can be exacerbated by weight, and many fat people have, at some point, attempted to lose weight. Being talked to like they’re ignorant, lacking self-control, or, perhaps worse, having every health issue pegged to their size, is what can make many fat people the most uncomfortable. The larger on the size spectrum you are, the more stigma you face. If the doctor has successfully established an atmosphere of safety and trust, a patient of size will be more likely to engage in a deeper conversation that advances them towards their health goals.
While keeping the inherent imbalance of doctor-patient power dynamics in mind, it’s also essential for the patient to communicate their feelings. Assistant Dean for Clerkship Education at Stanford University School of Medicine, Tracy Rydel, MD, notes that, “If you want your doctor to know how you feel about being a person of your size, it’s okay to say it out loud and say it hopefully early enough in your conversation. The caveat to that is that it will uncover; you’ll figure out real fast if this is the doctor for you. And if you get a reaction that is crappy, then run.”
Not everyone has the privilege of choice when it comes to medical care. Choice depends on factors like who’s in your insurance network, whose practices are open, what level of care you need, your geographic location, how much you’re able to pay, etc. Race, sexual orientation, gender identity, size, ability, age, class, and more can make seeking healthcare even more complex. It’s important for doctors to be curious, cautious, and aware of a patient’s identities and backgrounds in order to engage in a thoughtful dialog about health.
This question might be easier to answer if there were some kind of guide I could point you to on the best language to use or what to consider when engaging with fat patients, but perhaps not so shockingly, there aren't currently any centralized best practices for vocabulary around weight and size. Dr. Rydell says that, “Anti-fat bias isn’t addressed at all [in medical school; nutrition is hardly addressed. We keep chipping away at structural biases, and I hope that this can be one that is included with our diversity and inclusion movement. I would say it’s very poorly covered.” As we as a society progress in so many ways, size-based oppression is one of the last remaining vestiges, specifically in institutions like medical schools.
Overall, the onus shouldn’t be on the patient to decree their worthiness of respect, it should be on the doctor to create a hospitable environment for the patient to speak their mind and receive care in a non-judgmental setting. Our providers need to be the ones actively seeking new information, pushing boundaries, and taking the initiative to educate themselves and push boundaries with size-inclusive care.
Archive
Going to the doctor can be nerve-wracking for anyone, but for fat people, it’s often dreaded for a whole different reason. Many people of size have experienced some form of discrimination at the doctor’s office, whether it be their weight being blamed for unrelated health issues or having their symptoms ignored all together. That’s why physicians like you are so important! Your interest in and thought about accommodating patients of all sizes is the first step in having these non-judgmental conversations. But, of course, I do have some thoughts.
Creating an environment of safety and respect for patients of size begins at the very first touch point — a doctor’s website or profile. Clearly stating that you have a size-inclusive practice will signal to patients that your office is a judgement-free zone. The terminology here is flexible. For instance, mentioning “health at every size” in your bio or using the term “size-inclusive” will signal to fat patients that they can be at ease before they even walk through your door.
Once patients are in your office, what they see is important, too. It’s crucial that the setting where these conversations take place is hospitable and welcoming to patients of all sizes. I’m talking everyone. What is the width and weight limit on your examination table? Do the chairs in your waiting room and office have arms that can bruise hips or prohibit patients of size from sitting? Can your gurneys carry someone 600 pounds or more? How wide are the doors in your office? Do you have longer-length arm cuffs easily accessible? If the patient chooses to be weighed, what is the weight capacity on your scales? A size-inclusive equipment overhaul does require a budget that not everyone may have, so this might not be realistic for your clinic, hospital, or private practice. But even small changes make a difference and signal to patients that they are welcome. To consider someone’s physical comfort is a sign of respect. It’s much easier to be mentally and emotionally at ease if you’re already physically at ease.
Now, let’s get to the actual discussions. When I think of the medical professionals I’ve been most comfortable around, they’ve made it clear from the beginning that our relationship is rooted in safety and respect. It takes clear, consistent communication to build that trust. What does that look like? A simple disclaimer at the top of an appointment. Something like, “I want to make sure you’re comfortable today so I can provide you with the best care possible. Is there anything specific you’d like to discuss? Are there any topics that are off limits?” This purposefully makes space for patients (of any size) to inform their doctor of any sensitivities they may have. A generalized disclaimer goes a long way.
Of course, discussions of weight can’t be completely abolished from medical treatment, but they can become more thoughtful, specifically in the choice of language. Presenting evidence and options without judgment can, in my experience, be helpful. It’s when conversations steer into blaming and shaming territory that things go bad. Most fat people understand that certain health conditions can be exacerbated by weight, and many fat people have, at some point, attempted to lose weight. Being talked to like they’re ignorant, lacking self-control, or, perhaps worse, having every health issue pegged to their size, is what can make many fat people the most uncomfortable. The larger on the size spectrum you are, the more stigma you face. If the doctor has successfully established an atmosphere of safety and trust, a patient of size will be more likely to engage in a deeper conversation that advances them towards their health goals.
While keeping the inherent imbalance of doctor-patient power dynamics in mind, it’s also essential for the patient to communicate their feelings. Assistant Dean for Clerkship Education at Stanford University School of Medicine, Tracy Rydel, MD, notes that, “If you want your doctor to know how you feel about being a person of your size, it’s okay to say it out loud and say it hopefully early enough in your conversation. The caveat to that is that it will uncover; you’ll figure out real fast if this is the doctor for you. And if you get a reaction that is crappy, then run.”
Not everyone has the privilege of choice when it comes to medical care. Choice depends on factors like who’s in your insurance network, whose practices are open, what level of care you need, your geographic location, how much you’re able to pay, etc. Race, sexual orientation, gender identity, size, ability, age, class, and more can make seeking healthcare even more complex. It’s important for doctors to be curious, cautious, and aware of a patient’s identities and backgrounds in order to engage in a thoughtful dialog about health.
This question might be easier to answer if there were some kind of guide I could point you to on the best language to use or what to consider when engaging with fat patients, but perhaps not so shockingly, there aren't currently any centralized best practices for vocabulary around weight and size. Dr. Rydell says that, “Anti-fat bias isn’t addressed at all [in medical school; nutrition is hardly addressed. We keep chipping away at structural biases, and I hope that this can be one that is included with our diversity and inclusion movement. I would say it’s very poorly covered.” As we as a society progress in so many ways, size-based oppression is one of the last remaining vestiges, specifically in institutions like medical schools.
Overall, the onus shouldn’t be on the patient to decree their worthiness of respect, it should be on the doctor to create a hospitable environment for the patient to speak their mind and receive care in a non-judgmental setting. Our providers need to be the ones actively seeking new information, pushing boundaries, and taking the initiative to educate themselves and push boundaries with size-inclusive care.
