Public Health or Public Shaming? How Fatphobia is at the Core of our Health Care System

Imagine this: You’ve been experiencing pain in one of your knees, so you make an appointment with your GP. If you’re in a smaller body, your doctor will probably send you for some scans, prescribe pain medication and maybe refer you to a specialist or even a surgeon. If you’re in a larger body, however, there’s a good chance your doctor will attribute the pain to your body size and encourage you to lose some weight as a solution.

In other words, two people with the same problem will be treated differently depending on their physical appearance.

If this reminds you of your experiences with health professionals, you’re not alone! This is known as fatphobia and it’s causing a lot of harm in the medical industry.

At Embody Health London, we think this topic is extremely important to talk about because it shapes our clients’ experiences and expectations. By discussing this with our clients, we hope to create a more welcoming, compassionate and nurturing environment than what they may have experienced with other health professionals.

It is an indisputable fact that all people deserve access to safe and effective health care – it’s a basic human right! However, current research and anecdotal evidence show that most health care professionals just don’t have the tools required to provide care to people in larger bodies.

Let’s step back into the scenario and imagine that you need to be sent for scans to see what’s going on with your knee.

If you’re in a larger body, research shows that your GP is less likely to refer you on for further testing¹. Additionally, much of the equipment needed to assess or diagnose patients, such as MRI machines and CT scanners, are just not built with the technological or physical capabilities needed for use on people in larger bodies.

Next, the doctor may prescribe you with medication for the pain. The recommended doses for medication are usually only tested on people with an ‘ideal’ body weight, so most of the time, we have no idea how these drugs will affect larger bodies! As a result, people in larger bodies are often under-dosed and their medication is ineffective. This means your knee pain is going to be very difficult to manage pharmaceutically!

Maybe the problem with your knee can only be fixed surgically. Most operating tables are only designed for patients weighing up to 120kg and depending on the location, your hospital may not have access to more appropriate equipment. In addition, many surgeons will decline to operate on patients in larger bodies until they lose weight, suggesting that the risk of complications is too great. However, a study analysing postoperative complications of almost 7000 surgeries found that²:

1. There were very few significant differences in the rate of certain complications between obese and non-obese patients.
2. In some types of surgery, the likelihood of complications occurring was actually lower in obese patients.
3. There was also no difference in the mortality rate between obese and non-obese patients. In patients with a BMI greater than 35, the mortality rate was higher but only by 1%.
4. Postoperative complications in obese patients were less frequent following more complex surgeries compared to more simple procedures – this is thought to be related to the level of monitoring provided during post-operative care.

If these facts weren’t concerning enough, a study published in 2001 looked into GP attitudes towards people in larger bodies³. The findings were heartbreaking.

Many of the doctors that participated in the study reported that they perceived patients in larger bodies to be more annoying than patients in smaller bodies and that seeing larger patients was a waste of their time. Many also stated that they would enjoy their job less if their patients increased in size and that their patience diminished the heavier their patient was.

When thinking about why people in larger bodies may have poorer health outcomes than their smaller-bodied counterparts, we need to consider that it may be less to do with their body size and more to do with compromised medical care.

Fatphobia in the medical industry has the potential to lead to:

• Patients avoiding check-ups due to bias from their GP.
• Increased stress from shame and discrimination.
• Delayed diagnosis of illness due to failure to refer to further testing and/or inability to use diagnostic equipment.
• Medications and drug-based treatments being inappropriate for their weight.
• Refusal by surgeons to do life-changing surgery (for example, a knee replacement), which may cause difficulties with mobility and inability to exercise or access nutritious foods.

Data from the World Health Organisation estimates that around two-thirds of people in the Western world are classified as overweight or obese. This means that there’s a good chance that two-thirds of people are receiving sub-standard health care.

At Embody Health London, we make it a priority to do our part to counteract this by taking a weight-neutral approach to wellbeing. This means that we understand that weight is NOT a determinant of health. Instead of focusing on body size, we help our clients to become healthier by prioritising behaviours like nourishing their body with good nutrition, getting enough sleep and having an active lifestyle.

If you would like to learn more about our services email [email protected] and we will be thrilled to learn about your story and how we can support you!

Karli Battaglia MDiet, APD

EHL Team x

References

1. Phelan S, Burgess D, Yeazel M, Hellerstedt W, Griffin J, van Ryn M. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obesity Reviews. 2015;16(4):319-326.
2. Bamgbade O, Rutter T, Nafiu O, Dorje P. Postoperative Complications in Obese and Nonobese Patients. World Journal of Surgery. 2006;31(3):556-560.
3. Hebl M, Xu J. Weighing the care: physicians’ reactions to the size of a patient. International Journal of Obesity. 2001;25(8):1246-1252.