More than 40% of American adults have encountered some form of weight stigma in their life. And in a healthcare setting, weight stigma can start in the waiting room. As Dr. Asher Larmie, doctor and activist, says, “When we go and see a doctor, we’re not going to see a doctor just to catch up over a cup of coffee. We’re going to see a doctor because we’re worried about something that’s happening to our body. So we’re already stressed. We’ve probably spent a few nights worrying about our symptoms. We’ve probably spent a few hours researching it on the internet.” If the chairs in the waiting room are too small to be used, that potential humiliation can create another stressor. An underlying message? This space is not designed for you.
Beyond the waiting room might await gowns that are too small, leaving patients potentially feeling vulnerable and depersonalized. Then, that could be followed with a blood pressure test that has a cuff that is too small, which can result in inaccurate readings. One study found that 39 percent of participants were misdiagnosed due to an undersized blood pressure cuff. But the doctor’s visit itself can contain layers of weight stigma, from the nonverbal – like looks of judgement – to the diagnostic focus centering only on weight, despite what the patient may have come to discuss.
As Dr. Larmie says, “I hear this all the time from people. I went in to talk about my sore throat and they start talking to me about weight loss. Already that’s derailed the conversation. And what happens then is this patient who is already feeling vulnerable, who is already feeling scared, no longer feels able to communicate with their doctor because the lines of communication have ended.” So what ends up happening? “A lot of people with big bodies will say, ‘Actually, I would rather sit home and suffer than go and see my doctor and face that humiliation again.’”
Weight stigma is just one of the unconscious biases healthcare providers might bring to their practice. The CDC recognizes racism as a serious threat to the public’s health, citing inequities in social determinants of health such as housing, education, wealth, and employment, as key drivers of health inequities and greater risk of poor health outcomes within communities of color. In addition to race, other biases and assumptions based on gender identity, sexuality, and disability can also affect patients’ quality of and access to medical care and further exacerbate unequal treatment when patients’ identities intersect.
Despite the prevalence of obesity in 43 percent of the American population and numerous studies measuring the pervasive harms of weight stigma, many medical schools don’t require obesity education training. One immediate way to create change is for individuals, and institutions to engage in anti-fat bias training. It can be a matter of life or death.
As Dr. Larmie says, “I have come across people whose cancers were missed, whose diagnosis of arthritis, rheumatoid arthritis, all sorts of gastrointestinal problems missed because their doctor was so sure that it was weight related, that they didn’t even bother to check everything else.”
Watch the video to learn more.