If you’ve ever felt like you were being discriminated against or that your health concerns were being ignored because of your weight, you’re certainly not alone. Up to 4 in every 10 adults with obesity report experiences with weight stigma or discrimination. Many others have experienced teasing or other forms of mistreatment based on their weight, too. The situation tends to get worse as your body mass index (BMI) goes up.
It tends to be worse for women than it is for men, says Rebecca Puhl, PhD, a clinical psychologist who studies weight-based bullying, bias, and discrimination at the University of Connecticut Rudd Center for Food Policy & Health in Hartford, Connecticut.
These realities are not lost on Latoya Shauntay Snell, a full-time fitness creative and founder of Running Fat Chef. “I know what it is to have to go through medical discrimination,” Snell says. “I know what it is to not be listened to with valid health issues and to be scared or have anxiety when you’re walking into a medical office.”
Weight Bias and Stigma in Health Care
Negative stereotypes, prejudice, and unfair treatment are widespread in society and in the media. While bias and stigma toward some groups has gotten better over time, weight bias and stigma has not. Unfortunately, it comes up not only in everyday life, but also too often in doctor’s offices. If you’ve felt this, you aren’t just imagining it.
“Medical professionals are not immune to the same negative societal stereotypes that we see in the general population — stereotypes that people with higher weight are lazy, lacking motivation, have poor self-control and no willpower, are at fault for their weight, and are less compliant with medication and treatment,” Puhl says. “These attitudes have been reported by a range of health care professionals, including doctors, nurses, dietitians, mental health professionals, physiotherapists, occupational therapists, exercise physiologists, and by students training in professional health disciplines.”
Puhl says the first step to addressing weight bias in health care settings is to recognize when it’s happening and understand just how common it is. That’s essential because these negative attitudes have real consequences for your health care experiences and your health. This is true even when doctors or other health professionals aren’t doing it on purpose.
“Even if it’s unintentional, [weight bias] can translate into stigmatizing communication with patients and reduced quality of health care delivery,” Puhl says.
What Are the Consequences of Weight Bias in Health Care?
Puhl says evidence suggests doctors and other care providers tend to treat their patients with a higher BMI differently than patients with a lower BMI in many ways. For example, providers may spend less time in appointments, show less positive rapport, and engage in less patient-centered communication. They may talk or intervene less while showing less respect as your BMI goes up. These trends can have lasting effects on your health. You may also find yourself avoiding doctors and the health care you need.
“We see that adults with higher weight, especially women, are avoiding health care because of weight stigma — because of experiences like disrespectful treatment and negative attitudes from providers, unsolicited advice to lose weight, medical equipment that was too small to be functional for their body size, and embarrassment at being weighed, and also from internalized weight stigma — blaming themselves for their weight,” Puhl says. “People who have experienced weight stigma in health care don’t want to repeat those experiences, and as a result they delay or avoid seeking care altogether.”
What Is Medical Gaslighting?
“People living with the disease of obesity have always felt like the medical community dismisses them or makes them feel like it’s their fault,” says Cristy Gallagher, associate director of research and policy at the STOP Obesity Alliance in Washington, D.C., who has had obesity and related health problems over the years herself. “Just one bad provider can make a person living with the disease of obesity feel like it’s their own fault and decide not to go back to a doctor ever again.”
People with higher weight often report feeling judged or shamed because of their weight. You may have gotten disrespectful or insulting comments, insensitive language about your weight, and a general lack of compassion during health care visits. Your valid health concerns may have been dismissed or attributed to your weight without the needed examination, tests, or care required to rule out other causes.
These experiences are increasingly being recognized as a form of medical “gaslighting.” Medical gaslighting occurs when your genuine concerns about your health are invalidated or ignored without steps to evaluate them. Most of the time, medical gaslighting isn’t done purposefully. It comes instead from a lack of awareness or understanding of disease and unconscious biases. Experts have identified medical gaslighting as a real problem that should be actively called out and addressed within the medical community.
Internalized Weight Bias
In the face of weight bias, stigma, and medical gaslighting, it’s likely you may have internalized weight bias yourself, which can make it difficult to challenge it in others. You may have a tendency to blame or devalue yourself. National studies have found that about 1 in 5 people have high levels of internalized weight bias, with estimates of over 50% among people who have obesity, Puhl says. It’s especially likely if you’re a woman and are trying to lose weight. The internalized weight bias is yet another barrier to your health and health care.
“Internalized weight bias can have negative consequences for psychological well-being, eating behaviors, weight-related health, weight management, and health care avoidance,” Puhl says.
Tips for Overcoming Weight Bias and Stigma
If you find that your provider is exhibiting weight bias and stigma or that they are gaslighting you, “they’re just not the right provider,” Gallagher says. “Find a provider who is willing to work with you and is willing to have that shared decision-making process with you about what they have available in their toolbox.”
Puhl recommends the following strategies to help you overcome weight bias, including internalized bias, and improve your own health:
Recognize you’re not alone. Many people experience weight stigma, and it’s important to remember that these feelings are shared. Practicing self-compassion can help deal with these difficult moments and avoid self-criticism or shame.
Shift the perspective. When encountering weight stigma, try to view it as a reflection of the other person’s bias — not a reflection of your worth. Emotional distress can be reduced by attributing stigmatizing behavior to others’ prejudices, rather than criticizing oneself.
Affirm your worth. Everyone deserves respect and dignity regardless of how others behave. Self-acceptance and recognizing your own strengths can help build confidence and self-esteem.
Seek support. Talking with trusted friends or family members who are understanding and supportive can help process emotions and move forward after a stigmatizing experience.
Take action. Stigma should not be passively accepted. Educate those around you about weight stigma and its harmful impact. When weight stigma goes unchallenged, it persists. Speak up and hold people accountable when they engage in fat shaming, weight stigma, or bullying. Support broader policies that aim to protect people from weight-based discrimination.
Give yourself grace, Snell advises. While there are many things outside your control, the needed changes can begin with you.
“We can’t live in regret about the things that we haven’t done,” Snell says. “We can only live in the present and then hope to map out things that we can do in the future. [We] have to acknowledge that these things are not going to happen overnight. … We didn’t get to a certain mindset overnight. We were spoon-fed certain ideologies, whether they were positive, negative, neutral, good, bad, or indifferent. We learned these things over time, and our bodies took the score for it. So now we have to get to a process of unlearning, undoing, and then re-examining how we can approach this in a different manner that’s conducive for us.”
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