Larger people stop going to the doctor. They don’t get the treatments they need. Focusing on weight loss as treatment can also cause anxiety and stress, trigger eating disorders, and create trauma and other mental health issues.

Doctors focusing on a patient’s weight, either as a routine part of their patient care or as a treatment plan for specific disorders, can and does typically cause more harm than good. And that is not what doctors are supposed to do. Keep reading for a better understanding of how this happens.

First, Do No Harm

It always seems like doctors are rushing you in and out of their office. Well, that is, after they’ve made you wait in the waiting room for an hour. The actual time a doctor spends with you, individually, can seem like a hurried affair. We can talk about how our system facilitates this situation, but it’s the end result that really matters. And the end result is often that the doctor doesn’t have time to do a full medical and mental health history. When you combine that with medical weight stigma and the pathologizing of fat bodies, this can be a collision course of harm. This is especially true for a person who has a history of disordered eating, weight cycling due to chronic dieting, and other weight-related physical and mental health disorders.

When doctors so quickly “prescribe” weight loss without informed consent and without an understanding of the patient’s weight-related history, this can definitely result in long-term harm that is worse for the patient’s health, many times worse than the illness or ailment that the “prescription” was meant to treat. I’ve had friends who have had their eating disorders triggered with this type of advice by doctors who did not even know their full weight and weight-related mental health history. I have a mental health history of disordered eating. That same triggering has happened to me on more than one occasion.

I’ve had chronic pain for 30+ years. I’ve also been a chronic dieter for my whole adult life, so this pain has been with me as my weight has cycled up and down. I’ve tried to get help from doctors for it for years. I’ve been told so many different things about causes and treatments, but every single doctor I’ve been to, at one point or another, told me that if I lost weight, it would help. It never mattered what my actual weight was or whether I was thinner or fatter than the last time I was at the doctor’s office. It was just a thing I was told. A lot.

At one point in my life, I had just lost about 80 pounds, and because I was still in so much pain, I had made an appointment with a new, expensive doctor who was supposed to be really great at helping people with pain and other conditions that other doctors weren’t. This doctor did a whole battery of tests that I had to pay cash for (and weren’t cheap), and then when he got all the results back, his main conclusion was still that if I would lose weight, I wouldn’t hurt as much. I told him I had just lost 80 pounds. He said, “lose some more.” And then he proceeded to accuse me of binge eating (which I had never done and certainly hadn’t intimated to him that’s what I did) and told me to stop that, and I’d feel better.

After seeing that doctor, I finally just gave up. I didn’t go back to a medical doctor for more than 8 years after that. Which was really a terrible thing because when I finally did go back, it was to the ER. I had some weird symptoms that I ultimately found out were caused by the fact that I had had a small stroke due to high blood pressure. I suffered a second small stroke a month later. Then, after going to the neurologist, I finally found out that I had been having multiple small strokes due to high blood pressure for the past 3 to 4 years, based on the scarring in my brain that showed on the MRIs.

I don’t know, but maybe if I hadn’t learned from doctor after doctor that no matter what I went to the doctor for, I’d only leave with the shame and stress and anxiety of being told that I wouldn’t have health problems if I just weighed less, my high blood pressure would not have gone untreated and caused me to have multiple strokes.

Just Try It

As I’ve talked about in other posts (like this one), it really should be on the medical establishment to make sure that their medical equipment and supplies can accommodate people of all weights and sizes. But that is so often not the case. With so much talk about how high weight (ob*sity) has become an “epidemic” (another way medical anti-fat bias harms people, but one that deserves its own full discussion), you’d think medical offices would be more accommodating to such a large part of the population. But, so often, they aren’t.

So many times, people of higher weight are cajoled to “just try it.” This can be putting on 2 gowns instead of one properly fitting one (which doesn’t work and can be embarrassing for the patient). It can also be getting on a table or a chair that may not truly be made to hold higher weights (which is dangerous for so many reasons).

“Just try it” is something that I’ve mostly been confronted with when I’ve said I won’t step on the scale, when I tell them their blood pressure cuff is too small, or when I have explained that I’m a hard stick when it comes time for an IV or to draw blood. Getting on a scale at all triggers my disordered eating and can result in mental health harm for me. So, unless the doctor can explain a truly medically necessary reason for me to get on the scale, I don’t want to “just try it.” It’s not worth the harm and the months of hating myself.

Taking my blood pressure can be difficult in a medical setting because even the “large” cuff usually doesn’t fit me and because the automatic machines have to strangle my arm repeatedly because it can’t get a good reading. As far as my veins go, I’m hard to stick both because of genetics (my mom and sister both had/have the same problem) and because of my weight. I can’t tell you how many times I’ve “just tried” to let them take my blood pressure with a too-small cuff and an automatic machine or to let someone try to find a vein and come out black and blue up and down both arms.

Try this New Weight Loss Drug

This one has caused so many people so much harm over the years that it deserves its own full-blown treatment. Think about how many housewives were prescribed “uppers” or stimulants for weight loss between the 1940s and 1970s. The numbers were epidemic, according to the article, “America’s First Amphetamine Epidemic 1929–1971” found at the website. Some doctors still prescribe stimulants for “appetite suppression.” Stimulants can cause heart damage, and cause other health issues including issues with addiction. Getting your patients addicted to speed seems way more harmful than helping them with their actual health problems in other, weight-neutral ways.

There are too many diet drugs that have caused harm to too many people over the years to list. If you were around in the 90s, for instance, you probably remember that Fen-Phen killed enough people that the makers had to stop making it, and had to pay out a lot of settlements. There are others just like Fen-Phen. The current weight loss “magic pill” treatment, semaglutide, is actually a treatment for diabetes. There’s a great podcast called “Fad Camp” that recently did a deep dive into this new drug, which you can listen to here: Revolutionary Weight Loss Drug. From what I learned there, I’d be willing to bet that eventually, Novo Nordisk’s version of this medication, Wegovy, being pushed solely as a weight loss drug, will go the way of Fen-Phen, leaving countless lives forever damaged in its wake.

I, personally, have been prescribed different drugs, but mostly took them very short term and a very long time ago, so I don’t remember too much about what they were. I suspect I only took them short-term due to the side effects they caused. One thing that I did try was a prescription Lipotropic drug that I injected directly into the fat on my stomach every few days. I injected this drug for several months. It was expensive and I never lost more than a pound or two. I did get a stomach full of small bruises, though.

You Are Too Fat to Treat

This is harmful in pretty self-explanatory ways. I’ve known people who desperately needed some kind of back or joint surgery to solve excruciating pain issues but were refused this life-changing surgery until they “lost enough weight.” More than one person that I know had weight-loss surgery to lose weight, just so they could get a different surgery to solve the problem they went to the doctor for in the first place. I don’t know how a person can be too fat for one surgery but not too fat for a different surgery. It just doesn’t make sense. Plus, medical weight loss surgery has its own whole host of damage it can and does cause to people.

Much of the time, “you are too fat to treat” often comes in the form of “you just need to lose weight” to treat your problem, which we’ve already discussed above. The thing that is so harmful to people, aside from the fact that most weight loss doesn’t actually fix any problem, is that they go untreated for real issues because “just losing weight” is not necessarily easy (or probable in lots of cases) and they give up on getting help. I think one of the most valuable things a higher-weight person can learn to say to their doctor is “how would you treat a thin person with the same problem?”

Medical Weight Stigma Is Infinitely Harmful

There are so many ways that weight stigma and anti-fat bias from the medical community are harmful. And it is extremely prevalent in our world today. For me, personally, I’ve either been really lucky in recent years, or it is starting to change where I live (I live in a more progressive part of the country), or I’m just getting really good at advocating for myself, but I haven’t suffered with any weight-related trauma from a doctor since after that ER visit for my stroke (the ER visit itself was a horror show for me for many of the reasons I have talked about in this article). Likely it is a combination of all three of those things.

If I could give other higher-weight folks a gift, it would be the gift of self-advocacy. It takes courage, and it takes being able to work through some of the trauma of our past (therapists are great for this), but it is so worth it. I can hardly believe that I had to suffer multiple strokes before I finally found the courage to speak up and get the medical care I needed. My high blood pressure is now under control, and since the strokes, I’ve also had to have cervical surgery (which was terrifying for me, but I had an amazing doctor who really listened to me, even about my weight/medical trauma) and I am being treated for kidney disease, depression, and fibromyalgia.

I feel certain my life would be a lot different today if medical weight stigma had not been so prevalent throughout my entire adult life. I can’t really do anything to change the past, but I’m definitely doing everything I can to not allow it to impact me in my current health situations. Because of that, I do feel healthier than before, and I feel confident in the medical treatment I am getting.

*** 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.

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