Tag Archives: weight bias

Weight (Stigma) Affects School Children’s Grades

My dear friend and colleague Angela Meadows recently penned this important article for The Conversation discussing the issues surrounding weight, school children and academic performance. There have been a number of studies over the years linking higher weights with lower performance in school–particularly among female pre-teens and teenagers. Many of these studies have sought and eliminated co-variables in other health issues, potential depression and the onset of menses in women. However, many of these early studies seemed to avoid what would seem the most obvious connection between school performance and weight–the impact of weight stigma on school children of all ages (especially girls).

Angela then shared with us the results of a new study from the Harvard School of Public Health specifically documenting the results of weight stigma on kids in school. For the most part, the study which followed over 3,000 kids for over 10 years found no significant difference in test scores for the kids who became fatter. However, the study indicated that as the students weights went up, the teacher’s evaluation of the kids abilities went down. (Primarily for reading in girls and math in boys). And to a certain extent, as weights went up, the students evaluations of their own abilities went down. Although, the studies didn’t specifically measure attitudes of weight bias in teachers, Angela pointed to other studies that do just that.

Angela goes on to discuss important research linking weight stigma to bullying by other children as well as studies that indicate that much of the lag in academic achievement by fatter kids can be explained by bullying from both fellow students and educators.

I have not been shy in the past in saying and saying and SAYING that stigma does not make people healthier, happier or thinner. In fact weight stigma makes people less likely to seek medical treatment, leads to disordered eating and risky behaviors, leads to more stress, anxiety and illness and yes, leads to lower academic performance. And since there is literally no scientifically proven way to help most people lose a lot of weight and keep it off, perhaps telling people to lose weight to avoid this stigma is ill advised.

We know that weight-based stigma is harmful for people of all ages, yet we continue to march in the war on obesity for the fatties’ own good. We continue to fight body fat and ignore the plain fact that it is our societal attitude towards fat people that is causing much of the damage. We continue to wring our hands and shout “What about the children?” as an excuse for maintaining this war on big bodies, without addressing the simple fact that the number one casualty of the “war on obesity” seems to be from “friendly fire” on the folks we are purporting to help. At what point will we finally realize that stigmatizing children into a fruitless attempt to change their body size so that they can avoid weight stigma is at best, seriously messed up?

I hope that moment is coming and I hope it is coming soon. Our kids have enough to deal with just trying to grow up in this world without being victimized by the very people who we engage to help them. I hope that we can start some efforts to seriously help our educators and child caretakers recognize weight bias in themselves and work to push past it. I hope that we can stop allowing our kids to be collateral damage from a war that it is nearly impossible for them to win.

Love,

Jeanette DePatie (AKA The Fat Chick)

New study says weight stigma signficantly reduces Quality of Life–and water is wet.

Hippocratic Hypocrisy?

Jillian Michaels Co-opts Body Love Messaging (This is why we can’t have nice things…)

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Body love courtesy of Jillian Michaels.

In an epic moment of facepalm, my facebook feed threw up this little fact: Jillian Michaels has published her “Top 3 Guidelines for Improving Body Image” at EverydayHealth.com. (No, I’m not gonna link to that ish. Nope.) This seems in line with her recent move to distance herself from Biggest Loser after she made untold millions from screaming at fatties on the show.

Now the irony of Jillian Michaels would be really funny if it weren’t so very sad. This woman styled her entire career on being the queen of mean. She came into our living room every week screaming at the fatties–about how ugly we were and how we were killing ourselves. And some might suggest that Jillian Michaels might be making a genuine change or shift in attitude. And I might even consider believing her if she started pulling products like her “6-week Six Pack” or her “Banish Fat, Boost Metabolism” or her “No More Problem Zones” off the shelves. Nope, no, nopety nope. You don’t get to give advice like “Be realistic about your body type.” when you are actively marketing a product called “1 Week Shred”. And you don’t get to advise people to “Stop negative self talk.” while marketing a product called “No More Problem Zones.”

And if that didn’t tickle my sarcasm zones quite enough, this little gem is posted on EveryDayHealth.com with the tagline, “Always choose well.” Seriously? You put the queen of scream in charge of body image on your site? For REALZ? Is that choosing well? Look, I’m sorry guys. Just because Jillian is wearing a nice soft stripy sweater, and you’ve got her on a white set with a soft filter, it doesn’t make her nice. And it certainly doesn’t make her qualified to talk to women about body image.

But can we talk here? This is really a bigger issue than the Biggest of the Biggest Loser Meanies trying to change her image. The real issue is the co-opting of important messaging in the body acceptance movement by people who just see it as the latest way to add market share to their products. And I think as we go forward, and we start to gain traction, this is likely to become a bigger and bigger issue.

Let me take a moment and disclose some facts about me. First, I acknowledge that even as “The Fat Chick”, I have an awful lot of privilege. I’m white, middle class, and heterosexual. That makes a lot of things in this society a lot easier for me. Also, in terms of my size, I’m what you might call a mid-size fatty. I’m certainly “plus-sized”. But my size and my shape make certain things a lot easier for me than for many other fat people. I face discrimination, but nowhere near as much or as intensely as many of my brothers and sisters in the movement. I don’t receive these privileges as a result of anything virtuous I’ve done. I was born with them. And thus, while I can sympathize with people of all sizes, I can’t say that my experience is the same as all other fat people. It just isn’t true.

I also have to admit that, having been in this space for many years, some messages are easier to sell. Some messages are more palatable for the general public and as such, are more fun to say. I get a lot more rewards for telling people to love themselves than I get for saying that society is brutalizing entire segments of the population, and that it is not okay and it has to stop. A lot of people look at my midsized status and nudge me and say, “Well you’re okay, you’re not THAT fat.” To which I usually respond, “ALL bodies are good bodies. And people thinner than me are okay and people fatter than me are okay. You don’t get to decide what sized body is acceptable for the general population.” I say usually. Because sometimes I just don’t have the spoons to deal with it and I just walk away. I am not a persona. I am not perfect. I’m just a person.

But I think it’s important going forward to acknowledge that it’s not really okay to co-opt body diversity, size acceptance and body love language just to soften a campaign of ongoing body hatred. It’s not really okay to call yourself an activist against weight bias or weight stigma if you still adhere to the “fat but not that fat” ideal. It’s pretty easy to accept that nobody looks like a supermodel. “Not a supermodel” is a pretty safe position to take. Only a few of us in the world look like that, and even those few are Photoshopped beyond recognition. But true work against weight bias and weight stigma includes recognizing that weight stigma and weight bias are institutionalized, rampant and ubiquitous. It includes recognizing that even if most of us hate our bodies, that stigma and bias are likely to be different at size 12, size 22, and size 32. And that weight stigma is not allowed once you are beyond a certain size. Body acceptance is not just loving your body, unless you are, you know, really fat. Body acceptance is for EVERY BODY. And this work demands that you accept that you can’t simply solve the problems of weight stigma and weight bias with a poster and a little boost to your self confidence. Working on your own feelings and confidence are important first steps to coping with weight stigma and weight bias in your own life. But they are only first steps. If you really want to fight these problems, you have to move on to finding these oppressions out in the world and making things better–no matter how uncomfortable or unpalatable these messages might be.

And for those of you who want to feel better about your body, here are three pieces of advice:

1. Don’t listen to Jillian Michaels.

2. Don’t listen to Jillian Michaels.

3. Don’t listen to Jillian Michaels.

Love,

Jeanette DePatie (AKA The Fat Chick)

P.S. Want to hire me to speak about size acceptance, weight bias and weight stigma? CLICK HERE.

Want to join me in making the world a safer place for bodies of ALL sizes? Click here and join me!

Dear Abby, Let The Fat Chick Give you a Little Advice

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So I don’t know if you’ve been following the kerfluffle regarding Dear Abby’s terrible advice regarding a fat woman and her mother’s reaction to the crime of wearing a bathing suit while fat. The whole thing started in August when a woman wrote to Dear Abby saying:

DEAR ABBY: I’m a 24-year-old plus-sized woman (60 or 70 pounds overweight), but very comfortable in my own skin. When swimming in public, I wear a one-piece bathing suit because it doesn’t attract a lot of attention. When I’m home, I have a bikini top and shorts I prefer to wear. This is because I don’t like being covered up like it was in the 1950s, and I feel good when my curves are properly accentuated.
When I go back to see my family and swim, I wear a bikini top and black shorts. Recently, my mother said, “When the family comes over, you can’t wear that. It makes people uncomfortable.” I was shocked, and we had a huge argument. Most of my cousins are fine with my attire, as are my aunts. Only Mom has a problem with it. I asked if she’d feel the same about a large man swimming without a T-shirt. She said it’s different for women. Am I wrong for wanting to be comfortable in my childhood home? Mom should be proud to have a daughter who accepts herself as she is. Who is wrong here? — OFFENDED DAUGHTER IN CHICAGO

And here’s Abby’s assumption-ridden (and apparently clairvoyant) response:

DEAR OFFENDED DAUGHTER: You are not wrong for wanting to be comfortable. But please remember that when you visit someone else’s home, that person’s wishes take precedence — even if it used to be your childhood home. While you say you are comfortable in your own skin, it would be interesting to know what your physician thinks about your obesity. I suspect that your mother would be prouder of you if you were less complacent and more willing to do something about your weight problem.

Oh. My. God. This response has problems on so many levels. On the one hand, okay. When you are visiting someone else’s house, it is a good idea to keep their wishes and their “rules” in mind. It is their house. But then, after that we slide off a deeeeep dark cliff into nonsense land. Why would it be interesting to know what her physician feels about her obesity. I suspect it’s not interesting at all but rather a sort of boring restatement of the “fat bad, skinny good” trope played out in doctor’s offices everywhere. The only way this would be interesting is if this doctor were one of the few medical professionals aware of the significant evidence showing:

1. Weight is not in and of itself a health risk.

2. Focusing on healthy behavior is more effective than focusing on weight loss for long term health.

3. Stigmatizing people based on their weight is likely to make them sadder, sicker and fatter.

But that’s not what Abby meant at ALL. Abby thought, “Hmmm, I’m not a doctor, but if I vaguebook that hazy potential future health threat thing that doctor’s often do towards fat people, maybe I can get away with sounding sort of medical.”

And then we get to the real kicker line of the whole “advice” thing. Abby says: “I suspect that your mother would be prouder of you if you were less complacent and more willing to do something about your weight problem.” And I suspect that you, dear Abby are an @ss. Here’s how I know. First of all, you are basing this next bit on on assumptions and everybody knows that an assumption makes an @ss out of u and me.

First of all, who says this woman is complacent? She says she is comfortable in her own skin. It does not say whether or not she is trying or has tried to lose weight. It does not say whether or not she exercises or eats well. It does not say whether or not she actively works to be healthy or not. It says she doesn’t hate herself for the way she looks. Well here’s a news flash dear Abby. Hating yourself is bad for your health. Period. Being comfortable in your own skin helps you do the things that give you a more healthy and productive life. And living your life caught in a cycle of weight cycling to make your Mom proud of you does not even bear discussion.

But wait, it gets “better”.

Not surprisingly, thousands of people wrote Abby letters telling her that she was insensitive, inappropriate and off base. This presented Abby an opportunity for a “growth experience”. She could accept that if thousands of people told her she was being an insensitive jerk, perhaps she could reflect carefully on what she wrote. Maybe she could learn from this experience. Maybe she could do a little research about the unsubstantiated assertions she made about fat and health. Maybe she could seek to make amends to the people she hurt with her ham-fisted response.

Did she do this?

Nope.

Abby responded with an even less informed, more hateful response. And clearly she felt proud of it. She presented just one of the thousands of letters that called her out and then responded thus:

DEAR LINDA: Thousands of readers in newspapers and online wrote to tell me how angry they were about my response to that letter, accusing me of “fat-shaming.” If anyone was hurt by my reply, I sincerely apologize, because my remarks were not meant to be rude or disrespectful. When I called the young woman after that column ran to apologize if I had hurt her feelings and read her my response to her letter, she told me she was not offended.

When I answer questions, it is my responsibility to be honest and direct. As anyone who has read my column knows, I am not always politically correct. When I saw her statement that she was 60 to 70 pounds overweight — which is obese — and “comfortable in her own skin,” my reaction was alarm. If she doesn’t become proactive now, by the time she’s 35 she could be far heavier.

Everyone knows the many health complications associated with obesity, so I won’t list them. And while not everyone develops complications, in general, the greater a person’s weight, the greater the likelihood of developing them. While losing weight may be challenging, as I know from personal experience, it’s important to make beneficial lifestyle changes to promote healthy weight, just as it is important to have healthy self-esteem.

That young woman needs to have a frank talk with her doctor about what’s causing her to be so heavy. I told her that when I talked to her. I also suggested it might be helpful to consult a nutritionist.

As to my comment about her mother, I strongly suspect what I said is true, and I’ll stand by it until I hear from the woman telling me different.

Oh. My. GOD.

I could honestly write fourteen blog posts about how terrible Abby’s response to the response to her response is, but I have to get my fat butt over to teach an exercise class now. So let me just move on to offer our dear Abby just a little advice about taking criticism.

1. If thousands of people take the time to write you a letter to say they are offended, chances are, you said something pretty darn offensive. This is an excellent time for you to start listening. In order to do that you will need to STOP TALKING.

2. If thousands of people take the time to write you a letter to say they are offended, it’s a little silly to say “if anyone was hurt by my reply”. Yes they were. And they took the time to tell you so. If you’re not sure about whether or not they were hurt, some cognitive impairment may be at work here so you should probably STOP TALKING.

3. Saying you sincerely apologize because you didn’t mean for your remarks to be rude or disrespectful and then continuing for SEVERAL PARAGRAPHS to be even MORE RUDE AND DISRESPECTFUL just makes you look hypocritical and foolish. If you want to apologize, say I’m sorry. Say you’ll try to do better and then STOP TALKING.

4. Saying that somebody who is fat and comfortable now is only going to be fatter down the road is just stupid. You don’t know that. You are not psychic. So this means you should STOP TALKING.

5. Saying everybody knows the health problems associated with obesity so you won’t list them is lazy. Literally hundreds of studies contradict the notion that health problems are caused by obesity and a lot of those studies indicate that the real problem is the sort of B.S. stigma you are perpetrating here. So maybe, as I said before, you should STOP TALKING.

6. When you insult an entire group of people to the point that thousands of them take the time to write you letters, and then you call one person in that group for absolution. Even if that person says they are not offended, you are not absolved of your infraction. You are guilty and that means you should STOP TALKING.

I could go on and on. But I think I will take my own advice now and listen to what you all have to say. So I’ll STOP TALKING.

Love, Jeanette DePatie (AKA The Fat Chick)

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Powerful new Resource Helps Medical Professionals Understand HAES.

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I am very excited to tell you about an epic new article that has appeared in the Journal of Obesity. This article called, “The Weight-Inclusive versus Weight-Normative Approach to Health: Evaluating the Evidence for Prioritizing Well-Being over Weight Loss” reviews much of the available literature on doctors and weight loss and comes to a very firm conclusion: our medical obsession with weight loss is not making us any healthier. The article defines the difference between the Weight Inclusive and Weight Normative approaches this way:

In this paper, we review evidence that challenges the weight-normative approach for health promotion and offer evidence to support a weight-inclusive approach for health promotion. Instead of imagining that well-being is only possible at a specific weight, a weight-inclusive approach considers empirically supported practices that enhance people’s health in patient care and public health settings regardless of where they fall on the weight spectrum [1, 2, 22]. These approaches differ in the emphasis each one places on weight. While health care professionals using either approach may share some commonalities (e.g., recommending similar self-care practices), they contrast in the relative importance they place on body weight in the context of health and medical treatment, their perceptions of the malleability of weight, and how they respond to patients based on their weight.

The article is very long and rich and cites hundreds of sources. But I thought I’d pull out

10 things you can learn about weight-focused healthcare in this article:

1. Recommending weight loss is actually a less conservative approach than recommending HAES because there are negative consequences associated with weight loss attempts. Thus prescribing weight loss can go against the edict to “first do no harm”.

2. The data do not support the notion that higher BMI causes poor health outcomes.

3. Prescribing weight loss supports the notion that permanent weight loss is largely under a person’s control, and that fat people cost society more money. Neither of these notions are supported by the data.

4. Weight bias not only exists, but is common in clinical environments. This is a part of the general increase in weight stigma in the wider world, and weight stigma is dangerous to your health.

5. Not only does weight loss not work on a permanent basis, but weight cycling (the common result of repeated weight loss attempts) is dangerous for your body.

6. Obsession with weight loss has led to an increase in eating disorders.

7. But there is another way. The weight inclusive approach focuses on weight as a simple data point in a much larger view on health and focuses on positive behaviors.

8. The basic principles of the weight inclusive approach are these:

1)Do no harm.

(2)Appreciate that bodies naturally come in a variety of shapes and sizes, and ensure optimal health and well-being is provided to everyone, regardless of their weight.

(3)Given that health is multidimensional, maintain a holistic focus (i.e., examine a number of behavioral and modifiable health indices rather than a predominant focus on weight/weight loss).

(4)Encourage a process-focus (rather than end-goals) for day-to-day quality of life. For example, people can notice what makes their bodies rested and energetic today and incorporate that into future behavior, but also notice if it changes; they realize that well-being is dynamic rather than fixed. They keep adjusting what they know about their changing bodies.

(5)Critically evaluate the empirical evidence for weight loss treatments and incorporate sustainable, empirically supported practices into prevention and treatment efforts, calling for more research where the evidence is weak or absent.

(6)Create healthful, individualized practices and environments that are sustainable (e.g., regular pleasurable exercise, regular intake of foods high in nutrients, adequate sleep and rest, adequate hydration). Where possible, work with families, schools, and communities to provide safe physical activity resources and ways to improve access to nutrient-dense foods.

(7)Where possible, work to increase health access, autonomy, and social justice for all individuals along the entire weight spectrum. Trust that people move toward greater health when given access to stigma-free health care and opportunities (e.g., gyms with equipment for people of all sizes; trainers who focus on increments in strength, flexibility, V02 Max, and pleasure rather than weight and weight loss).

9. Along with the data that shows the weight normalization (weight-loss focused) approach is ineffective and harmful, is significant data showing the weight inclusive (HAES-oriented) approach is more successful, and that it does not share the negative side effects of the weight normalization approach.

10. With these thoughts in mind, it makes sense to move to a weight inclusive approach in both personal and public health and actively work to reduce stigma both within and outside of the world of medicine.

I urge you to take some time to work your way through this epic piece of work. And I urge you to print a copy and bookmark this for sharing at a later date. Maybe you could take this along to your next doctor appointment. Maybe you have a friend that is struggling with health care that can use the data to his advantage. In any case, I’m very, very excited about this and couldn’t wait to share it with you.

Love,

Jeanette DePatie (AKA The Fat Chick)

A Sensible Approach to Healthy Kids

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Folks of ALL ages dancing their hearts out!

I have to admit that the blog post I did on Monday broke my heart. The idea that it is even possible that a six-year-old girl may have died because of weight stigma is just so sad. I need to reiterate, that none of us can know precisely what that doctor was thinking. But the testimony she gave at her own trial makes me more than a little suspicious.

And you know what? It doesn’t have to be this way.

There are far simpler ways to help kids be healthy. Not the least of which is simply helping them find safe places to play and joyful places to move their bodies. Because one of the best things we can do to help kids be healthy is offer them fun ways to get exercise. Yet another study came out this week that indicates that cognitive abilities among kids have a lot more to do with fitness levels than BMI. But this fact, doesn’t seem to deter those who feel the best way to help kids be healthy is to send home a BMI report card. Despite the fact that BMI is very loosely correlated with health in young children, and that focusing on BMI makes kids more likely to develop eating disorders, and that focusing on BMI tends to lead to shame in kids which not only makes them develop other bad health behaviors, but also tends to make them gain weight, we are STILL PERPETRATING THIS NONSENSE IN SCHOOLS. Let’s focus on helping kids be healthy without increasing the risk from eating disorders. Remember this chart?

Helping kids be healthy can be positive and fun. This past weekend I led some fitness demonstrations at a local event. The City of Hope hosted its Foothill Fitness Challenge event here in Duarte and over 1,200 people showed up. It was so much fun! I led two fun dance demonstrations and was so excited to see moms and dads and kids all dancing together and having a good time. Check it out:

It made my heart so happy. Little kids and big kids and grandmas were all dancing together. If we want to help kids be happy, LET’S DO THAT! Let’s find some kids, put on some music and dance with them. Sure maybe it’s simplistic, but it’s also fun and is likely to do no harm.

So what do you say? I challenge you to connect with a kid and go out and play this week. Dance, bike, throw a ball around–whatever makes you (and them) happy.

Love,

Jeanette (AKA The Fat Chick)

Six Year Old Girl Dies–Diagnosed as Fat?

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Sorry to start your week out with such a sad story, but I think it needs to be told. Late last week I became aware of the story of Claudialee, a six-year-old girl who passed away after being misdiagnosed with type 2 diabetes, when she actually had type 1 diabetes. There is a very detailed account of the story here.

I’m not going to go into every detail of this story, but I did want to point out a few things that stand out for me. One is that Claudialee has a family history of diabetes. Another is that the doctor diagnosed Claudialee as obese. It is clear that the doctor was deeply concerned about the young child’s weight–prescribing diet and exercise in an effort to get her to lose weight. It is also clear that the mother closely followed the doctor’s recommendations–carefully monitoring what Claudialee ate and making sure she got plenty of exercise.

What is not clear is why the doctor felt so strongly that this child had Type 2 Diabetes as opposed to Type 1. According to a source cited in the article (The National Institute of Health) at that age group, Type 1 Diabetes has an incidence of about 20 in every 100,000 kids, whereas Type 2 Diabetes has an incidence of .4 in every 100,000 kids or 1 in every 250,000 kids. What’s more, at that age, Type 1 Diabetes is a far more urgent problem than Type 2 Diabetes. So what led to the doctor’s misdiagnosis?

We may never know for sure. But it does invite one to speculate whether the child’s weight was a factor. Clearly, getting Claudialee’s weight down was a prime part of the prescription to the parent. And as the child’s weight went down, the doctor neglected to do some of the critical follow-up blood tests that would have indicated that something was drastically wrong.

The article states:

Because Mercado [the doctor] had locked in on type 2, she did not monitor her patient’s blood. She did not tell Irma [the child’s mother] to purchase a $20 blood sugar meter from the drugstore. She did not ask Irma about the frequency with which her daughter drank and urinated. And neither she nor Cabatic [another doctor] described to Irma the danger signs to look out for.

When asked in court, why the doctor seemed so certain that the child had type 2 diabetes when type 1 diabetes was so much more prevalent among children that age, she stood by her original diagnosis:

“How many type 2 infant diabetics have you treated?” a lawyer asked her.

“A lot,” she replied. “Maybe it’s geographical, because I work at Brooklyn as an assistant professor and also in wellness program where there are a lot of obese children, so we diagnose a lot of children with type 2 diabetes.”

Clearly there may have been other issues at play here. Claudialee was on Medicaid and doctors are paid significantly less for treating patients on Medicaid than they are for those with private insurance. The doctor was not board-certified, and the article points out that finding board certified physicians willing to work in clinics that take Medicaid can be difficult. And this is a single case where a single doctor has been convicted of malpractice. We will never know exactly what was in the doctor’s mind.

I but I personally found myself wondering if this doctor had ever previously considered that she may have a bias against fat patients–and maybe even fat children with low SES in particular. I wonder, had this doctor considered the potential for her own bias in this arena, would that child still be alive? Would Claudialee still be running around and playing today?

We certainly have plenty of evidence for a seeming “hysteria” around the issue of childhood Type 2 diabetes. A simple google search of “childhood diabetes epidemic” yields hundreds and hundreds of articles. This hysteria has spawned a number of shaming techniques aimed at children despite the fact that shame has been proven over and over again to be ineffective at treating obesity at any age, that shame is more likely to make kids engage in unhealthy behaviors, and that eating disorders are much, MUCH more prevalent among children than diabetes of any kind.

All I know for sure, is that stories like that of Claudialee get me even more fired up to fight against weight stigma in medicine. And that passion leads me to come to you with a plea. The Association for Size Diversity And Health and the Size Diversity Task force have embarked on a documentary film project to help doctors see and understand weight stigma and weight bias in medicine. This project is called the Resolved project. But this project needs a little bit of help from you. We are raising funds to finish the documentary on Go Fund Me here. Any help you can offer would be greatly appreciated. Even if you can only give a few dollars, that will help. And if you don’t have a few dollars to spend, would you consider sharing this with your friends and asking them to help? Let’s see if we can end weight stigma and weight bias in the healthcare industry for good. And maybe, just maybe we won’t have stories like Claudialee’s any more.

Love,

Jeanette (The Fat Chick)

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Paging Doctor Good…

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Sometimes fat chicks have to shop a little harder to find a good doctor…

Well, yet another study has come out indicating that fat stigma is alive and well among medical students. Even NPR (with it’s RWJ-fueled, anti-fat slant) released a story about this study conducted among medical students in South Carolina. Over one third of the students tested, demonstrated moderate to strong bias against obese people. What’s more two thirds of those students who demonstrated fat bias were even aware that they had any bias against overweight and obese subjects. And while the study only checked bias among students in one school, it is clearly in line with other studies that demonstrate fat bias among doctors and med students.

None of this comes as much of a surprise to overweight and obese people seeking health care in this country. Many of us have experienced not only a flat refusal to treat the illness or injury for which we are seeking care, but also outright and overt disdain from our doctors. I have spoken extensively about my own story in the past. And as I have reviewed the videos that have been submitted for the Resolved Project created by the Size Diversity Task Force and ASDAH, I’ve cataloged so many distressing stories. We are compiling a veritable library of cases of little kids put on speed, doctors refusing care and medically supervised fat shaming.

It’s so hard to find a good doctor that will treat us with respect. It can be a long and arduous search. So it’s probably not a shock that another report was released last week that shows that overweight and obese patients are more likely to engage in “doctor shopping”. If one in three doctors coming out of medical school are displaying recognized or unrecognized bias against people of size, it makes sense that we have to look a little harder. What I find interesting about the study however is the way it connects doctor shopping with quality of care. One of the lead doctors from the Johns Hopkins study, Dr. Kimberly A. Gudzune, stated:

“There’s something going wrong in these doctor-patient relationships that make these switches so frequent for this group of people… The real problem here is that the health of overweight and obese patients who doctor shop is being compromised. Because they do not remain with their doctors for very long, they are ending up in the emergency room, likely for things that could have been taken care of in a primary care office.”

I wonder, does this point to yet another reason why fat stigma may be causing health problems that are currently blamed on fat? I’ve stated before, and I’ll state again, there is no proof that weight loss improves health. (For one thing, we can’t get enough people to keep enough weight off for long enough to do a real test.) We also know that people who engage in healthy behavior live longer, regardless of body size. What would be very interesting to me would be to see what impact medical training to reduce weight stigma would have on the health of fat patients. That’s the study I would like to see.

In the meantime, I guess we’ll just have to keep searching for Doctor Good…

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First Do No Harm: Are Doctors Who Discriminate Hurting Us?

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Hippocrates: “First, do no harm.”

There’s been a fairly hot story in the news this week about a Shrewsbury, MA doctor who has publicly stated that she will not treat patients who are over 200 pounds. Dr. Helen Carter claims that several of her medical staff were injured treating larger patients and that she doesn’t want to see anyone who weighs more.

The story broke after one patient, who had actually come in for her second appointment had been sent home. Ida Davidson was very surprised when she came in for her follow-up appointment and was told, that she would no longer be accepted as a patient since she weighed over 200 lbs. Dr. Carter said she did not feel equipped to deal with Ida’s needs. She stated, “There’s an obesity center over at UMass that is much better staffed and has more resources than I do.”

Now first, let me state for the record, Dr. Carter’s decision is not illegal. Doctors can choose to take on patients or not take on patients as they see fit. But is it ethical? Is her response even logical? She refuses to provide any detail about the injuries to her staff workers from working with patients over 250 pounds. And really, it seems the vast majority of medical offices out there routinely handle patients of that size and much larger without any injuries to medical staff. One might question what these med techs were doing in a traditional doctor’s office to cause such problems. And to be frank, me thinks the doc doth protest too much. I’ve talked to a number of med techs who point out that the sort of routine care offered in a typical doctor’s office should not result in injuries to the staff of any kind, if the med techs were properly trained and following reasonable procedures.

While Dr. Carter may state that she is looking after her staff with this decision, I can’t help thinking that there are other motivations at work. Maybe Dr. Carter just doesn’t like fat people. Ida Davidson makes it clear that she felt outraged and humiliated about the way the whole thing was handled. She felt the doctor had engaged neither tact nor compassion, and I quote, “She didn’t care about my health that day. I think she just cared that I was a liability to her, maybe, and that I was too much work.”

But I also have to wonder if greed plays a part in Dr. Carter’s decision as well. Increasingly, doctors are seeing financial bonuses from insurance companies and medical groups for keeping their patients within certain metrics. In many cases, those metrics include BMI. So I have to wonder, is this decision really about protecting her staff or filling her bank account? And I also wonder, where will this end? Will doctors ultimately decide we are too expensive to treat? Will they stop seeing average-size or larger people at all? Will they only agree to treat people who they deem healthy and avoid those with expensive problems?

But perhaps most alarming to me is the question of whether or not fat people will be so humiliated and stigmatized by their doctors that they will stop going altogether. I’m far more frightened about the patients that Dr. Carter has turned away who are not brave enough to talk to CNN. What about the patients who simply internalize the shame, and don’t go to see the doctor at all any more. The Rudd Center has done a lot of work in documenting weight bias among medical professionals. It is real, and it has a profound effect on the health and well being of people of size. As the Rudd Center points out: people who are the victims of weight bias by medical professionals “are reluctant to seek medical care, cancel or delay medical appointments, and put off important preventative medical services.”

My dear Chicklettes. I have experienced weight bias from doctors in the past, and I have allowed it to keep me from going to the doctor. I have allowed myself to feel sad and worthless by men and women in white coats. I have suffered needlessly with medical conditions that would have been far less severe if I had gone to the doctor sooner. So learn from my mistakes. Make sure to find a doctor who treats you well. You deserve to be treated with respect. You deserve to receive competent, compassionate health care no matter what your size or shape or age or ability. Please remember you are not a liability. You are a unique and amazing person.

Love,

The Fat Chick

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