Fat bias

When I started this blog, I had simple objectives. First of all I wanted to share my lived experience of recovering from anorexia nervosa. Blogs were a really instrumental source in my own recovery. Secondly I wanted to debunk myths and stigma attached to eating disorders, especially from a perspective of someone working within the healthcare profession. However as time has gone on, I still have these intentions, but I also wish to be a voice in the health at every size movement. It has become increasingly apparent how much fat bias exists within healthcare. Now I am more aware of it than ever, I do not intend to be quiet about weight stigma.

People are being harmed every day by weight stigma. The issue here is, weight stigma is not widely recognised yet. How can something change when it’s not recognised as a problem? We keep talking about it.

We aren’t even taking steps to reduce it within healthcare, because we don’t know it exists, even amongst ourselves.

Just yesterday a fellow doctor posted a question on social media asking for weight loss advice for her and her partner. The doctor went on to describe all the various diets both she and her partner had tried over the years. Further more she described her thin privilege but then “menopause occurred and I gained an unacceptable amount of weight”. Most of the responses to the post disappointingly were encouraging various other diets, only one of my colleagues responded encouraging her to explore HAES, discouraging dieting.

If those of us working within healthcare have such implicit biases, how can we expect to provide non discriminatory care to “fat patients”? I do not use the term obese as obese implies pathology, it’s a medical label for “fat” and fat is not a disorder or pathological problem in isolation. It’s a deep seated belief that has infected our entire society that fat is directly related to health. Though correlations can be present in certain conditions, it is not causation and not the sole indication of health. I repeat, correlation does not equate to causation.

I would be very hesitant to receive eating disorder treatment from a provider who was not health at every size aligned. I believe biases here potentially harm our recovery, comments such as, “we won’t let you get fat in recovery” this to me should be a red flag. You might get fat, if you are supposed to, if your body needs to and so harmful statements like this perpetuates the fear of weight gain and does not address the core beliefs that need to be rewired.

We need to be shifting the rhetoric of weight = health. If we move away from this paradigm healthcare becomes a lot more accessible and non discriminatory.

Why does it matter?

One of the fundamental lessons from medical school is to provide holistic care, individualised to every patient. Doing no harm to our patients. Yet, we try to treat every “fat person” like they are one person. There is a lack of individualised care. We are not providing holistic care when we have a “one size fits all approach” as long as that size fits within a certain range on the BMI chart. This in itself causes harm and is not practicing the fundamental principle “do no harm”. Patients do not receive the appropriate treatments to many conditions because of weight stigma, whether it is surgical procedures, access to eating disorder treatment it’s all discrimination.

What can we do?

Educate ourselves. If this is the first time you have even heard the concept of health at every size, or weight stigma I encourage you to check out some of the links below.

Leave weight out of the picture, not every patient needs to be weighed every visit, consider if it’s necessary. Ask if the patient wants to know the number before you do it, some people prefer or need this to be blind.

Address your own implicit anti fat bias.

Learn about the negative consequences of dieting.

Everyone has the right to weight inclusive care. I just want to say now, these are my own views and opinions. I’m a doctor sick and tired of hearing weight loss is the answer. I have had to work on my own biases in eating disorder recovery. I am fully aware many will not agree with my opinions, colleagues, peers and friends included and this is intended as a conversation starter.

Resources:

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