And Tips for What to do When it Does
Dealing with weight stigma or anti-fat bias at the doctor’s office is a common experience for people of higher weight. It can leave us feeling unheard and untreated and can even cause trauma that keeps us from returning to the doctor, even when we may really need to. The burden for changing this should be on the medical establishment, but as we know, that kind of systemic change doesn’t generally come easy. So, here are 5 common ways weight stigma shows up at the doctor’s office with some tips and ideas (for varying comfort levels) on how we, as the patient, can deal with it.
In The Waiting Room
Sometimes, for higher-weight folks, navigating the waiting room at a doctor’s office can be really daunting. Many times the only place to sit is those chairs with hard metal arms. If you are a higher-weight person, those metal arms may dig into your body painfully. Some people of higher weight might not fit in them at all or get stuck and have to embarrassingly maneuver themselves out of them. Even if they have different seating, it may still be too small or feel unsafe. The medical establishment could change this by making sure to have at least some bench seating or other types of sturdy, non-restricting seating available in their waiting rooms, but until that becomes a common thing, here are some ideas for ways in which you might think about handling this situation.
As fat people, it is sometimes even more embarrassing to speak up, but if you have that in you to do so, you could approach the office manager or your doctor and simply tell them that they are not accommodating ALL of their patients and their waiting room chairs leave you with no place to sit. If it is a possibility for you, you can tell them that unless they become more accommodating, you will not be able to return to their practice in the future. If you don’t feel comfortable doing this face to face, you could call in advance and let them know that they need to have an empty room available for you to sit in (on the table) until it is time for your appointment, as their waiting room will not accommodate you.
If all of that is too much for you to do for yourself, it might be helpful to find a non-fat phobic friend to take with you to the appointment and ask them to speak up on your behalf.
In addition to the seating, doctor’s waiting rooms can be filled with magazines, literature, and even programs or advertisements on the t.v. that focus on weight loss and shaming fat people. Chances are that you will not get the office to change this (especially as they get paid to have some of that literature and advertisements), but you can come prepared with headphones to listen to or watch something on your phone or bring your own reading material to distract you from the onslaught of weight stigmatizing materials.
The Weigh-In
For many people of higher weight and for anyone with an eating disorder, the weigh-in at the doctor’s office can be a traumatic and fraught experience. Doctors will often try to tell you that they must have your weight for medical reasons, but truthfully, that isn’t actually the case, more often than not. There are actually only a few conditions where it is important to keep a close track of one’s weight, and chances are, if you have one of those conditions, you already understand why tracking that might be important. If you are in doubt, you can certainly ask your doctor to carefully explain the evidence-based reason for them needing your weight so that you can give informed consent to be weighed.
Doctors and the medical assistant staff are fond of telling you that your insurance requires a weigh-in. If this is truly the case, it is typically only because the insurance company will pay the doctor slightly less without the weigh-in, according to Ragen Chastain of the Weight and Healthcare Newsletter. It is not our responsibility, as fat people, to make sure that the doctor gets every penny that they can from the insurance companies. Your mental health is more important than that.
I’ve learned to just say “no,” “no thank you,” or “I don’t do that” at my doctor’s office when asked to step on the scale. Sometimes the staff gets a little surprised or tries to be insistent, but I’ve learned that a firm “no” usually stops it. The same goes for if they tell me I can stand backwards on the scale and not look, or whatever, just saying “no” or “no thank you” typically stops them from trying further. If they tell me to “just guess,” I just shrug and say, “I have no idea.” I realize that this approach may not feel comfortable to some people, and that’s ok. There are some other ideas.
If you can’t just say “no,” you might consider having a private discussion with your doctor and explain that you have medical trauma and/or weight-associated trauma and that being asked to do the typical weigh-in triggers a trauma response in you. You can ask them to note it in your chart so that you won’t be asked in the future. If you have an eating disorder, be sure to include that in your discussion and let your doctor know that even being asked could trigger your eating disorder behaviors.
Another idea is to order “don’t weigh me” cards that you can hand to your doctor when you visit. I think these are a wonderful idea and may help some people who have a hard time finding their voice to let their doctor know that they won’t be doing the weigh-in. These cards can be found at More-Love.org, HERE.
The Blood Pressure Check
For higher-weight people, many times, even the “large” blood pressure cuff isn’t large enough. And a lot of times, the medical staff will insist that they “try” it, even though it literally can produce wildly inaccurate results to use a blood pressure cuff that isn’t large enough. For me, the automatic cuffs leave me bruised every single time. And typically, it is mainly because they don’t have a cuff that will fit me, and it has to inflate several times just to get any reading.
Also, taking blood pressure immediately after the stress of the waiting room and the weigh-in will typically result in an artificially high reading. Add to that the stress of the cuff-size issue, and it can really result in an elevated reading.
So, what are the options for us, as higher-weight people? Getting accurate blood pressure is actually pretty important to our healthcare.
Well, I can tell you what I do and offer a few other ideas, as well. I always ask to have my blood pressure taken on the lower part of my arm, between my elbow and my hand. This is usually just fine, and never, at any doctor’s office or hospital, have I been told that they can’t do it that way. Usually, they have an immediately accessible cuff that works on that area. I am being treated for high blood pressure, actually, so I’ve also gotten myself a wrist blood pressure machine, and I track my own blood pressure on an app on my phone. That way, I can show my doctor what my blood pressure typically is outside of the stress of the doctor’s office. When going to a new doctor, I’ll often take my wrist machine with me, just in case their staff can’t otherwise accommodate me.
Another option is to insist that your doctor keep a thigh cuff available for your visit. Ideally, these would be in every room, but you can ask your doctor to note it on your chart and to have one available at your next visit. You can remind the staff of this when you make your appointment, as well.
Regardless, it’s important to bring the issue of being accommodated in taking your blood pressure up to your doctor. One way or another, you have to be sure that accurate readings are being obtained, and trust me, your doctor will want this as well. If he or she doesn’t seem to care about it, it may be time to find a new doctor, if that is a possibility for you.
Gowns/Equipment Aren’t Big Enough
This is a really tough one. This one, more than any of these weight stigma problems, has to be righted by the doctor and their staff. As the patient, there is often little you can do to provide the right equipment, nor should that be your responsibility. Having said that, if it is something you can afford to do, you can always bring your own gown (you can also insist you stay in your own clothes), or even certain equipment. I’ve learned that you can buy your own large-size speculum, for instance. But truthfully, you should not have to. The doctor’s office should be prepared to accommodate you.
It’s very hard for us to advocate for ourselves a lot of the time. However, your health is too important to leave up to chance and to being too afraid to speak up. For some people, this might be a trauma issue and may be virtually impossible, however, if that is the case, it might be good if you bring a friend or other advocate with you to the doctor if you know that you’ll need to be accommodated. It’s important to let your doctor know that you need to be accommodated for size in equipment, especially in testing equipment, like MRI and CT scans. If your veins are hard to find because of your weight, you can request that an ultrasound tool be used to take blood or to insert an IV. Having a private and frank discussion with your doctor about these issues can help to make exams and tests a little easier.
You Just Have to Lose Weight
When your doctor tells you that the treatment for whatever your issue is, is that “you just have to lose weight,” it can result in feeling unheard, untreated, and it can even be traumatizing. This is a huge topic, and there are a lot of aspects of it that deserve to be discussed in greater detail, but for the purposes of this writing, we’re just going to skim the surface and talk about a few points that might be helpful to understand.
According to Scientific American, “Research suggests that roughly 80% of people who shed a significant portion of their body fat will not maintain that degree of weight loss for 12 months; and, according to one meta-analysis of intervention studies, dieters regain, on average, more than half of what they lose within two years.” Their article, “Unexpected Clues Emerge About Why Diets Fail,“ goes into greater detail, but the fact remains that diets really don’t work. I’ve read that the number of failures is even higher than the 80%, but 80% is still high enough of a failure rate to understand that the advice from doctors to “just lose weight” is not sound medical advice.
If your doctor suggests “just losing weight” will fix whatever health issue you have, a couple of key questions can help you to get real care. First of all, you can ask your doctor to provide you with research studies on your specific condition that show that losing weight changed or cured the condition. Chances are there are none that conclusively show a link between weight and your condition. They may show correlations, but that isn’t the same as causation. Also, asking your doctor what treatment they would prescribe to a thin person with the same issue can help you to get to the heart of the real treatment options.
The truth of the matter is that besides the diagnosis of “ob*sity” in and of itself (which isn’t a disease, but an attempt to pathologize fat bodies), there is simply no health condition or disease that fat people get that thin people don’t also get.
Advocating Around Weight Stigma
Ultimately, if you can do it, it’s really best to find a doctor that you trust or that is committed to Health At Every Size® (HAES®) and to talk openly with him or her about your own experiences of weight stigma and healthcare trauma. Sometimes working with a therapist or an anti-diet coach can help you to feel more able to talk to your doctor. Sometimes having an anti-fat bias health advocate with you to facilitate these conversations can be helpful. The advent of telehealth has made finding a doctor who practices HAES® a little more accessible, as well as in finding a therapist or coach to help you deal with these issues.
Ragen Chastain, who is an author, speaker, and educator in the weight and healthcare space, offers more detailed cards than the “don’t weigh” cards that you can print out to take to your doctor, which can either speak for you or help to facilitate a conversation. You can find these cards on her website, Dances with Fat, HERE.
Our health is too important to let weight stigma and anti-fat bias get in the way. Hopefully, some of these tips and ideas will help you to navigate weight stigma at the doctor’s office a little bit better.
*** Note on language. As a person living in a larger body, I personally prefer the term “fat” for many reasons, and so that is the term I use in my writing. Many in the body-positive movement use “higher-weight” person and other language like that. I use those terms interchangeably. Just like other groups of people, those of us living in larger bodies are not a monolith, and in the end, there are only various preferences and no “right or wrong” terminology. I write using my own preferred terms, and I accept that they might or might not be yours.