This is why fat people have problems with doctors and good health care

I got an email from a reader the other day with this article in it. I thought everyone who reads and contributes to this blog should get to read this article.
It’s all about weight bias among medical students. So those doctors you see that tell you your problems would all be solved if you just lost weight? They learned it in medical school. Those doctors who don’t like touching fat people? Their biases are reinforced in medical school. Those doctors who treat fat people with scorn and disdain? They learned it and had it reinforced in medical school.

Now, medical school isn’t entirely to blame here, I will admit that. Part of the blame lies with our fat-phobic society that tells us all, from cradle to grave, that fat is bad, fat is unhealthy, fat is disgusting, and thin is good, thin is healthy, thin is beautiful. But the medical community has the opportunity, and the knowledge, to counteract that message, and they fail at it, miserably, most of the time.

Yes, there are doctors that get it, that know diets don’t work, that eating well, that exercising in ways that one likes is the best path to health and will actually treat one for whatever problems one has, and look for the true causes instead of blaming those problems on weight alone. But those doctors are few and far between.

The rest of the doctors are all too ready to perpetuate stereotypes and recommend diets that they know don’t work for long-term weight loss because that’s the easy way out. They then don’t have to justify ordering tests to actually diagnose the true cause of a problem and risk not getting paid by one’s insurance. They don’t have to face their biases and realize that they’re bigots – that they need a dose of attitude adjustment to treat all people, no matter what their size happens to be, the same – to give everyone the same quality of care that they would expect.

That is the true shame of our medical schools – they’re turning out bigoted doctors who give substandard care to certain classes of people.

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15 Comments

  1. lilacsigil

     /  January 19, 2011

    and risk not getting paid by one’s insurance.
    Especially as in most countries this is not an issue – doctors will get paid for the tests and STILL won’t order them for fat people! This article is spot-on: while the social and medical system continue to be patient-blaming rather than problem-solving, the good doctors will continue to be the independent-thinking rarities that they are.

    Reply
    • vesta44

       /  January 19, 2011

      Unless, of course, you’re in the United States. This is an issue here, with insurance companies doing all they can to cut costs and maximize profits – it’s common for them to demand tons of documentation and reasons for any/every test ordered by a doctor in order for the doctor/lab to get payment for the test, as well as payment for the office visit when the test(s) was/were ordered. Universal health care might mitigate that to some extent, but as you say, the bias still exists where doctors won’t order the tests simply because the patient is fat and doctors blame problems on what they see as “excess” weight (dunderheads, they are).

      Reply
  2. Ruth

     /  January 22, 2011

    Im a medical student and honestly- I dont think its the education. I think its the biases people come in with. The bias is most certainly there, but I have never heard the kind of bias I hear from other students from our lecturers or practical staff. The teaching staff are very practical about weight- if it would actually have a positive effect on quality of life, weight loss can be encouraged. Otherwise? It doesnt really figure much. The students however are quite often of the “fat is inherently unhealthy and diets MUST work, fat people are fat through choice, lazy and undisciplined etc etc” camp.
    Yes the staff arent perfect by any means but lets put it this way they are very unlikely to figure on this blog.
    I am scared for the future though.

    Reply
    • vesta44

       /  January 22, 2011

      Ruth – the problem with that is that doctors, who were medical students at one point in their lives, very seldom look beyond fat for the cause of a fat person’s health problems. They automatically recommend weight loss and exercise without even asking the patient what they eat, how they eat, and how much they exercise. That’s not something that is just personal bias, those personal biases have to be reinforced by what and how they’re taught in medical school.
      Doctors know, and have known for more than 50 years, that diets don’t work for permanent weight loss, but they keep recommending weight loss as a cure for arthritis pain, fibromyalgia, MS, cancer, heart disease, hang nails, sinus infections, sprains, depression, etc (just take a look at some of the posts on this blog and you’ll see what I mean).
      It may not be an out-and-out statement that fat people are always unhealthy, ugly, disgusting, etc from educators in health care fields, but the underlying assumptions are there, and subtly reinforced. If you had ever read any of the blogs on the fatosphere, you would know this (I realize, being a medical student, you don’t have time for that much reading, but believe me, it happens more often than not).

      Reply
  3. Ruth

     /  February 2, 2011

    heehee I have read quite a lot of stuff online about weight and health and HAES (definitely a system I’d like to use when treating any future patients). I know where youre coming from vesta44- its just that i feel medical education shouldnt shoulder all the blame. Yes we could really do with more nutritional education (a little “diets dont work education” would help) and the biases are there but people are only getting reinforcement of what they already believe if they find anti-fat bias at medical school. It isnt everywhere here the way it is in normal life. Its really frustrating reading this blog because the fat bias isnt everything there- the unprofessionalism, the superiority and the arrogance are startling. We can do better.

    Reply
    • DeAun

       /  July 26, 2011

      I am in medical school and we often hear about “Obesity” as a cause for disease and weight loss as a “cure”. My cardiology professor talked extensively about weight loss and I can’t count how many times I’ve seen that picture of that very large child at McDonalds on slide show presentations.

      I agree that the bias often comes in with the students, but it is reinforced in the discussion of etiologies and treatments. I am struggling to bring a HAES perspective to my school and have met with minimal interest and occasional aggression. It is something that will take time and effort to change.

      Reply
  4. Star

     /  February 10, 2011

    Dreading seeing my new Medicare Advantage primary–because I decline the scale. Always. I asked the receptionist would I be shown the door–she checked and said the doctor says a lot of people don’t want to get weighed. Whew. She ordered cholesterol–I said I won’t take a statin–my sibs had had the muscle thing. She said let’s see if you need it. I didn’t–my tests were all normal! Wow–this is weird. She asked was I interested in a diet–I said no, I had lost the same weight 2.5 times and was out of that game. She said OK. This could be a keeper!

    Reply
  5. Rosalind

     /  March 25, 2011

    This is why I’m going to school, actually. I’m about to start a master’s program to become a nurse practitioner, specifically because I want to help combat some of these attitudes. So, a few years from now, if some of you are looking for a fat-friendly primary care practitioner, I’ll be around!

    Reply
  6. I have a story to tell about how the health care system treated me. I have been looking for the contact information for this blog, so I can email my story, but have so far been unsuccessful. If this blog is still active, I would be delighted to have that contact info. Thanks! 🙂

    Reply
    • vesta44

       /  April 1, 2011

      audrey – you can email your story to fathealth at gmail dot com and I’ll be checking the email there for your letter.

      Reply
  7. Louise

     /  May 7, 2011

    My heart goes out to all the people who suffer because of fat bias.specially in physicians. They don’t take the Hippocratic Oath seriously or else they have forgotten it. I am obese. I despise going to doctors because of this. And I hate the term “morbidly obese” as they call me. Right now I am searching for a new doctor and I don’t know how to even begin. I have been in chronic pain for many years (I am a 64 year old woman) in my lower back. All I have ever been told was that if I lost weight the pain would go away. I did, it didn’t, the weight came back on. Just last month my daughter insisted on my having an MRI study done. They did three and found that I have spinal stenosis. Spinal stenosis can cause excruciating pain which I am in. I can’t stand up for more than two minutes and it is all I can do to walk out to our car.

    My PCP kept telling me to walk and “push through the pain”. He was an Army doctor and told me about our boys fighting in the war and crawling to helicopters with limbs missing. Like, if they could do it so could I. I kept telling him how my legs would go numb on me and he dismissed that also. The pain management doctor I went to two days ago told me that weight does not cause spinal stenosis. He is going to give me an injection to see if that helps. The PCP wouldn’t even give me any pain pills. “Walking and losing weight” would cure my back according to him. That is why I am never going back to him. I have to find a new PCP quickly, but like I said I don’t know how. Any suggestions?

    Reply
  8. @Louise, I hope you have figured out by now how.to change your PCP but if you have not call Customer Service with your medical provider and have them help you find.someone. I’m with Kaiser and just discovered they let us change providers through the web as well.

    Reply
  9. Common

     /  July 30, 2011

    I find this to be horrific. I wonder why there are so many attacks on people who are fat. I do not find all skinny people healthy and beautiful, and I do not find all fat people unhealthy and ugly. I am a plus size woman, and I truly love myself.

    Media is telling me that I should be depressed with a low-self esteem, but that is far from the truth. There are so many skinny people taking pills for depression. I love me, and I believe people should learn to love who they are. If these biased doctors love themselves, they would love all people to treat them accordingly.

    I heard doctors tell people to lose weight to diminish their health conditions. Well, the health conditions are still there after weight loss. I heard doctors tell people after they lost weight that the conditions are a result from them being overweight. What the heck!!!!

    We all must be careful in how we treat people. I remember reading how plus size used to viewed as beautiful. I think I am beautiful. I want all people to feel this way about themselves regardless of size.

    If I gross people out for my size, I have nothing to be sorry for. May be these people are grossed out from their own lives. I try not to allow people to define me. I am sure my clothes will fit better if I lost weight here or there, but that is what people say on the average. If they can only change this about themselves or that. Funny how fat-less people want us to feel just as depressed as them.

    Reply
  10. Anna

     /  September 26, 2011

    I have the interesting position of being a Holistic Nutritionist and a bit over weight. Many people won’t hire me because I’m not skinny. However, my arthritis medication makes me over weight. Which I think is an area that is often forgotten. There is a number of drugs that do make it hard to lose weight. Conditions are another factor and a number of chemicals have been said to be “Obesogenic.” So what is the solution? I don’t think there is an easy solution.

    I do know that I too have issues when I see the doctor. With my arthritis I keep getting told to lose weight (um yeah it was normal before the steroids so I don’t get it). I’ve been told that due to a deficiency caused by the drugs I’m only allowed to walk no heavy sports or lifting… So I need to diet, watch my weight, and exercise, but I’m not really allowed to exercise. So my doc sends me to the in clinic dietitian and refers me to a “Trym-Gym.” I call the “Trym-Gym” folks. Even with a discount because my doctor referred me there is no way as a student I can eat healthy and still afford the “Trym-Gym.” I also had to see the dietician who said that apart from the rheumatic factor and the deficiency caused by prednisone, my blood is 100% perfect as are my other numbers. She said I probably know what to eat better than most. But my doctor still thinks weight loss is the only way to cure my arthritic condition… but at least she’s the LEAST pushy doctor I’ve seen about it.

    As far as my practice. I plan on focusing on HEALTH first. I already have a practicum client who came to me about weight loss and we’ve sat down and discussed why she wants to lose and such and most of her reasons are health related. Fair enough, so we are going to sit down and focus on her being healthy and having a healthy relationship to the food she eats (the word’s BAD FOOD need to be stricken from her diet). We are focusing on reducing white sugar and processed foods but otherwise she’s falling in love with food again and her body (WHICH IS THE GOAL!). At the conference I went to the one speaker even said that a few extra pounds can be protective to health. I’m not an expert but I know that being too thin is bad and a lot of women “diet” themselves to nutritional deficiencies.

    Reply
  11. meerkat

     /  March 2, 2012

    I’m picturing medical school being like the cult school in the episode where the Simpsons joined the Movementarians, and Bart got every question right by answering, “The Leader.” Except instead of “the Leader,” every answer is “weight loss.”

    Reply

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