Healthcare for Larger Bodies: Advocating for Yourself When Your Doctor Won’t
In a perfect world, going to the doctor would be this simple: you visit your healthcare provider, tell them what’s been ailing you, they listen, they diagnose, and they treat you.
Unfortunately, however, for far too many women in the United States, this can be a process fraught with landmines, especially when it comes to your weight.
Now, it doesn’t matter whether or not a woman’s weight actually has anything to do with why she’s visiting the doctor (and in most cases, it is entirely irrelevant), some doctors simply can’t see past their own biases and stigmas to give their patients the proper care they deserve.
Fat shaming is a real and serious issue and one that can affect up to 66 percent of the population. It is especially harmful to marginalized communities that are already overlooked by the medical community, particularly women of color. In fact, according to the National Women’s Law Center, racism that exists in the healthcare field “is a matter of life and death” for black women, especially those who are pregnant.
So what can be done about this major healthcare problem? We spoke to women who have experienced this crisis firsthand, as well as experts, to get a better idea of how to advocate for yourself, your body, and your well-being at the doctor, no matter what the scale says.
Women Who Have Experienced Fat Shaming at the Doctor’s Office
Jean, 32, was experiencing severe abdominal pain after losing a significant amount of weight in a short period of time. Having just moved across the country, she found a new doctor in her new home state who, she says, “incidentally, caught some abnormal autoimmune markers that no other doctor did,” but like other healthcare providers, “continued to insist that I should just ‘eat a low-fat diet’ and the pain would go away.”
This was, Jean tells us, “despite performing an ultrasound and seeing that the problem resided in my gallbladder.” (Gallbladder issues are common in fat bodies, as well as in those who have lost weight rapidly.)
“I was eating 800 calories a day at the time, mainly protein and low-carb vegetables (under the supervision of my old doctor in my old city), but the new [doctor] refused to refer me to a surgeon to remove my gallbladder,” she says.
Jean’s doctor was more than “happy to prescribe me extra-strength painkillers to help me through my increasingly more frequent [gallbladder] attacks.” But Jean says that her body began rejecting anything but simple carbs, “to the point where I was subsisting only on protein shakes, juice, and tortilla chips.”
She says that after a year of debilitating pain, she finally got her gallbladder removed, but not before her diet was damaged and she gained back a large portion of weight she’d worked hard to lose.
Pregnant Women Who Have Experienced Fat Shaming
Jacqueline, 34, went through her own ordeal regarding her weight during her first pregnancy. “I gained nearly 60 pounds over the course of the pregnancy and my doctors only ever told me to make sure I was watching what I was eating,” she says, adding, “I was being fairly healthy and still was going to the gym almost until the end of my third trimester, so I was surprised my weight had ballooned up so much.
After giving birth, Jacqueline says she had a hard time losing weight, and she was experiencing issues such as hair loss, fatigue, and problems with her milk supply. “I mentioned all of this to my primary care doctor on two different occasions while I was there for a checkup and a sick appointment. And both times I was instructed to eat less and exercise more,” she says. “In the first appointment, they actually handed me a pamphlet on the dangers of having a high BMI.”
The new mom says that it wasn’t until she discussed these issues with her OB at her annual checkup (at which she was 1-year postpartum), “that they suggested hormones might be causing some of my issues and sent me for blood work.”
“Unsurprisingly, my blood work showed I was suffering from hypothyroidism, which was easily treated with synthetic thyroid medication,” she says. “When I finally got the diagnosis, I broke down in tears. I was relieved that I finally had a diagnosis. I was frustrated it took so long for anyone to listen. I was angry when I thought about how I didn’t have to lose my hair or gain so much weight if only someone had taken me seriously and not brushed me off as a lazy fat woman.”
Jacqueline and Jean both say that their experiences taught them valuable lessons about advocating for their own health. As Jacqueline put it: “I can’t trust that my medical practitioners will do that for me.”
How to Be Seen, Heard and Treated Properly By Your Doctor, According to Experts
Stories like Jean’s and Jacqueline’s are far too common, and it’s something that is seen and heard time and time again by those who advocate and educate on behalf of women like them.
Renowned body positivity advocate Dr. Linda Bacon, author of Body Respect: What Conventional Health Books Get Wrong, Leave Out, or Just Plain Fail to Understand about Weight, puts it simply: “There are a lot of people in larger bodies that are scared to go to the doctor and don’t look to doctors to be their source of support.”
Bacon says that people in this situation will often delay and avoid medical care “because they’ve been stigmatized by doctors and given bad advice in the past.” She says that this fear amongst those who have larger bodies is understandable, as “doctors do spend less time with heavier people, and tend to blame them [for their problems].”
But, you shouldn’t have to live in fear or give up on the quality healthcare that should be provided to you. One way to do this, Bacon says, is to “harness your inner resources, and take back your power.”
Understanding the biases out there and knowing what you deserve can allow you to listen to yourself and what you need. “You know your body better than your doctor does and you’ve gotta trust that,” she says.
Assuming you already have a doctor who isn’t understanding or on your side, Bacon says one of the best things you can do is to research and find a doctor that’s going to give you respectful care. Find online communities that share stories about doctors, as well as resources in which doctors who are committed to sensitive care share their mission.
Another thing you can do, Bacon says, is to interview your doctor in advance. You can tell them, in the simplest terms, “I’m a heavier person and that’s not why I’m seeking treatment, and I want you to respect me and look at these other symptoms.” (Bacon also provides a letter to your doctor, which you can print out and bring with you to appointments.)
Other paperwork you can, and should, bring with you to your doctor is educational materials, especially, Bacon says, “if you’re expecting to get the whole weight lecture.” She also says to be aware of the language you use, and that your doctor uses. “Overweight is a medical term that signifies there’s something wrong with you from the start,” she explains.
If you still feel anxious or uncomfortable, Bacon says you can bring a friend or a support system along with you to your doctor’s appointment. What’s most important to remember throughout all of this, she says, is that “the problem is not in you, the problem is not in your body. The problem is in the culture and the healthcare system that is not taking good care of you.”
What Doctors Need to Keep in Mind Regarding Fatphobia and Fat-Shaming
While fatphobia and fat-shaming are all-too-common amongst healthcare providers, qualitative health researcher and Assistant Professor of Public Health at William Paterson University, Zoe Meleo-Erwin points out, “There’s little evidence to suggest that shame-based interventions actually result in substantive, durable health improvements. And regardless of their efficacy, shame-based tactics to change behavior are highly unethical.”
Meleo-Erwin notes that shame-based strategies, when it comes to weight and health, have negative effects, “and result in factors such as delays in seeking care, increases in depression, body dissatisfaction, the stress response, and decreases in self-efficacy, self-esteem, and physical activity.”
“Given this, it’s a wonder that providers continue to use and advocate for these methods,” she says, adding, “But perhaps it’s not really that surprising given the substantial evidence documenting pervasive weight bias within the medical profession. Not only does this bias effect providers’ attitudes toward larger patients, but it seems to negatively impact the quality of care such patients receive as well.”
So how can healthcare providers change the course? Bacon says, “The first thing I suggest to physicians, or any healthcare practitioners, when they’re working with a patient in a larger body is to ask themselves, ‘If this was a person in a more slender body what recommendations would I give them?’”
In addition to facing their own fatphobia, and that of their colleagues head-on, Bacon says healthcare providers have to remember, “Being in a larger body is going to affect people differently, and it’s helpful to recognize what that might mean for each person’s body.” For instance, telling someone with knee issues to just “go to the gym” requires a different outlook and understanding of what that means.
Bacon also points out that every medical disorder, even if weight is participating as a problem, there are other solutions “that are going to be much more effective than telling someone to lose weight.” She notes that it is never appropriate for doctors to encourage weight loss; rather, to have a caring and understanding conversation about it.
For instance, a doctor could (and should) say to a patient in a larger body, “I know it’s hard living a heavier body in this world, if you want to talk to me about suggestions about how to best take care of your body, I’m happy to do that.”
By taking these small and important steps, doctors can begin to eliminate the stigmas, as well as make their patients feel safe, respected, and getting the care they actually need.
Author Bio Aly Semigran is a Philadelphia-based writer whose work has been featured in Well + Good, Amy Poehler's Smart Girls, Bustle, Refinery29, InStyle, and more. In addition to writing about women's health, she spends her free time with her dog at the park, going to the movies, swimming (weather permitting), and reading everything she can get her hands on.