Addressing Weight Stigma at the Doctor: A Guide for Self-Advocacy

Author: Kathryn Lodwick-Jones, LPC, BC-DMT, NCC

What is Weight Stigma and Why Does it Matter

Weight stigma refers to “discriminatory acts and ideologies targeted towards individuals because of their weight and size”. Weight stigma is a result of weight bias, also known as anti-fat bias; the negative beliefs associated with obesity. Common stereotypes about larger bodied and fat people are often related to the untrue assumption that they are lazy, lack willpower, have poor hygiene, have compromised moral character, and are less attractive and intelligent. Larger bodied individuals are at an increased risk of experiencing harassment, discrimination,  and verbal and physical assault due to their size. As you can imagine, having a medical provider who may carry these false assumptions or beliefs about you, the patient, based on your size can have negative consequences on the quality of your care. In fact, when physicians focus too much on weight, this not only contributes to weight stigma but can lead to worse health outcomes for all patients regardless of size. Some environmental aspects of medical offices may also reflect weight stigma, including: non-inclusive seating sizes, limited size of gowns, and limited accessibility options for patients to get on the exam table.

 

Impacts of Weight Stigma on Health Outcomes

• Larger bodied individuals are less likely to seek medical care, regardless of whether they have been poorly treated by a provider in the past
• Weight stigma has shown to increase the likelihood of disordered eating patterns
• Reduced adherence to potentially necessary medical treatment
• Experiencing weight stigma negatively impacts mental health by reducing positive body image and self-esteem
• Stress related to weight stigma can increase medical concerns, including high blood pressure, increased stress hormones, and impacts to cardiac health
• In rare cases, increased risk of severe depressive thoughts and suicidal ideation

 

These factors not only foster distrust in the medical profession, but inhibit access to medical care.

 

The BMI and Your Rights

The BMI, or Body Mass index, has been utilized by physicians for decades; however,  it is flawed at best, harmful at worst. Adolph Quetelet, who was not in the medical field nor did he intend for it to be utilized in medical settings, developed the BMI in the mid 1800s, aiming to find the “perfect human”. Although his sample only comprised of white, European, cisgender men and not representative of the diverse human population, it is still utilized as a standard tool for measuring weight in healthcare. The BMI is not representative of diverse body shape and size compositions, nor does using it as a sole measure for health take into account other contributing factors that impact patient health. It is an inaccurate measure to determine patient health outcomes and is not translative across all races, ethnicities, and sexes. Knowing your rights as a patient to make a plan of collaboration and advocacy is not only important but crucial to your well-being. You can start by learning more about weight-inclusive health practices and preparing in advance for your visit.

 

How to Make a Plan for Your Visit

• Research a HAES-aligned physician or ask for a referral from another trusted provider
• Plan ahead by setting clear health goals for the visit, such as addressing specific symptoms or concerns, not weight

• When you meet your provider, explain upfront that you prefer the focus be on your overall health rather than your weight. You can use a statement like “I’ve had experiences with weight-based judgment in healthcare, and I’d like to make sure this appointment focuses on my specific health concerns instead of my weight.”

Redirect Conversations and Assert Priorities 

• If your provider or staff insists on weighing you, you can ask “is this medically necessary?”, or state “I would prefer not to be weighed today” or “I’d like to skip the weight measurement, as it’s not relevant to the reason I’m here today.”
• Emphasize that you would prefer to focus on specific health concerns or symptoms, and if weight is brought up unnecessarily, gently steer the conversation back to your health goals. Here are a few examples of what you can say:
  •  “I’d like to focus on my current health issues, such as [insert concern], rather than focusing on my BMI”
  •  “I’m more concerned with addressing [specific health issue], and I’d like to focus on that today.”
  • “I’m here to discuss [insert health concern], not my weight.”
• If your provider brings up BMI, acknowledge it briefly, but gently steer the conversation away from it, you can say something like:
  • “I understand that BMI is often used as a tool in healthcare, but I don’t think it’s the most relevant indicator of my health right now.” Emphasize that you want a holistic approach to your health, considering mental, emotional, and physical well-being, rather than just weight loss or dieting.

• If the doctor insists, remain firm but polite, you can say:
  •  “I understand that weighing is part of standard procedures, but for my own health and comfort, I would prefer not to be weighed today”
  •  “I’ve read that BMI doesn’t always reflect overall health, and I’d prefer to focus on the health markers that are more relevant to my situation.”
  • “I’ve found that focusing on my BMI doesn’t align with my overall well-being, and I would prefer to focus on a more holistic approach
• If BMI is being used to assess health risks, you can ask for alternative assessments:
  • “Are there other health measures, like blood pressure or cholesterol levels, that we could focus on instead of BMI?”
  • “Can we look at other health markers, such as activity levels or lab results, to guide my care?”
• Reaffirm that you want to discuss your overall health, not just your weight or BMI:
  • “My goal is to improve my overall health, and I’d like to focus on how we can achieve that together, rather than focusing on BMI alone.”

Follow Up and Seek Advocacy

If the visit felt stigmatizing, consider providing feedback to the healthcare practice or seeking a more weight-inclusive provider in the future. You can also reach out to advocacy organizations if necessary for further support. You do not have to explain yourself; if you feel comfortable, you can provide a brief reason, such as “I find that focusing on my weight in medical visits can be discouraging, and I’d rather focus on my specific health concerns today” or “I’m more interested in discussing my [specific health issue] and would prefer not to have my weight measured.” If you are ever uncomfortable with the way a provider is treating you, you can always ask for a referral to a different provider who respects your boundaries.

 

Resources 

• Association for Size Diversity in Healthcare’s (ASDAH) registry for finding a HAES-aligned provider
• Anti-diet focused healthcare providers for those in Eating Disorder Recovery
• Medical Students for Size Inclusivity (MSSI)
• Don’t weigh me cards 
• National Association to Advance Fat Acceptance (NAAFA)

Equilibria is a group of licensed mental health professionals in Pennsylvania and New Jersey with multiple specialties to serve all aspects of our diverse community’s mental, emotional, and behavioral needs. We provide in person and telehealth services to individuals of all ages, families, and those in relationships. Click here to schedule an appointment today.