The Intersection of Fatness and the Healthcare System

Image Description: A blue and silver stethoscope lying on what appears to be a medical chart. The contents of the chart are mostly blurred because the only object in focus is the stethoscope. There is a blue pen in the background, also out of focus.

CONTENT WARNING: Eating Disorders, Body Image, Fatphobia

Fatphobia runs rampant in the medical industry — and with it, detrimental effects that go beyond decreased quality of care for those with bigger bodies. At a panel discussion hosted by UCLA’s Resilience In Your Student Experience (RISE) Center on Apr. 15, 2021, the speakers discussed these consequences, as well as how to combat body policing, tying in their personal experiences as clinicians, therapists, dieticians, and college students. The discussion, which was in collaboration with other campus resources including Counseling and Psychological Services (CAPS) and the Ashe Student Health Center, was the third event of RISE’s Body Liberation series. The series is running throughout the month of April, featuring various other events that strive to increase awareness surrounding the intersections between body size and discrimination, while also offering community for anyone on a body acceptance journey.  

Dr. Lola Martin, a postdoctoral fellow at UCLA CAPS, led Thursday’s discussion on fatness and healthcare. Considering medical systems are often used to police bigger bodies, she began by asking the panel about their personal encounters of weight and quality of care in both life and work. Dr. Nicole Hayes, a clinical psychologist at CAPS, pointed out that these people are often missed in the diagnosis of eating disorders. While they may be engaging in the same unhealthy habits as people in thinner bodies, clinicians often wrongfully assume they are “bettering their health.” In fact, many healthcare professionals actually praise those who lose weight through disordered eating or excessive exercise, completely ignoring the mental and physical detriment of eating disorders. Dr. Hayes acknowledged that, unfortunately, too many of her fellow professionals fail to recognize the gravity of their words and actions.

An undergraduate student on the panel echoed this sentiment, reflecting upon her personal experience at the doctor’s office while suffering from an eating disorder. She remembered always feeling a lack of trust between her and her physician, as she was commended for having the number on the scale drop. Ironically, she stated that the moments when she felt the most weak, sick, and isolated were when she felt the least judged at the doctor’s office. The student also stated that, while she knew this was wrong, she felt a sense of satisfaction because so many of their prior conversations had consisted of concerns about her body mass index (BMI), even if her weight wasn’t the original reason for the visit. 

This student’s experience is just one example of how medical institutions systemically provide a lower quality of care to fat people and consequently, weaken relationships between them and their clinicians. Carol Chen, a dietician at the Ashe Student Health Center, emphasized that although health does not equate to someone’s worth, BMI is an outdated and inaccurate way to assess patient health. She explained that many who are considered “healthy” by the BMI scale are actually unhealthy based on metabolic markers including blood work, which provide a more objective picture of one’s health. Others on the panel added that there is immense research that has not only proven that a higher weight does not correlate with poorer health, but also that harmful dieting practices — often recommended by doctors to larger patients — are not effective and are usually accompanied by dangerous health risks. 

Fat shaming in the medical system is also amplified by other marginalized identities a patient may have. Another undergraduate student spoke about her experience as a Latina woman, recalling how she dreaded seeing the doctor growing up because the conversation would always end up shifting toward her weight. She specifically stated that her doctor would try and refer her to a dietician and make racist remarks about cutting back on her family meals. She also emphasized that the language barrier forced her to worry about her weight alone, leading to disordered eating habits and body image issues that remain undiagnosed. Dr. Hayes added that men, trans women, and nonbinary people are also often denied treatment. This can all be traced back to the fact that eating disorder representation is extremely limited, and many healthcare professionals — along with the general public — still inherently believe that only thin, white women can suffer from eating disorders. 

At the conclusion of the discussion, the panelists agreed that while the frequency of body shaming in the medical industry is devastating, there are ways for fat people to advocate for the quality of care they deserve. Dr. Martin suggested that patients be as vocal about their needs as they possibly can. She acknowledged that while it’s unfortunate that some clinicians may not comply, finding professionals who respect a patient’s wishes to not discuss weight or diets in a triggering way is essential. One of the students also suggested reclaiming and redefining what it means to be healthy. She explained that she focuses on how her body feels, deliberately making space for joyful movement instead of focusing on the number on the scale. Ultimately, there is much more work to be done in establishing a more inclusive and equitable healthcare system. Holding these discussions and building these supportive communities for those who may be struggling is a powerful first step. 

For more information and ways to get involved with UCLA’s RISE Center, see here

National Eating Disorder Association’s (NEDA) Helpline: (800)-931-2237

You can find more resources and support services provided by NEDA here.

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