In part 1 of this series, we examined the myriad ways in which weight bias and discrimination — also known as fatphobia1 — often show up in medical settings, the negative impact on patients, and recommendations for clinicians to address their own weight bias and embrace weight-inclusive care.
Part 2 of the series features a patient’s perspective and experience with this widespread issue in health care.2 Kennedy Inman is an associate professional counselor in Gainesville, Georgia. In an interview with Endocrinology Advisor, she shared several personal experiences with both fatphobia and weight-inclusive care in health care settings and offered tips for clinicians regarding effective and respectful care for patients in larger bodies.
What experiences have you had with fatphobia in health care?
I have had providers tell me that my endometriosis or polycystic ovarian syndrome (PCOS) would get better if I worked out, ate better, or lost weight. Had they asked me about my history, I would have told them I had my gallbladder removed because of sudden weight loss in high school due to disordered eating and over-exercising, mainly as a way to try and manage my PCOS because it was implied that only fat people have PCOS. My mother had ovarian and endometrial cancer, and when I would bring this up as a point of concern, as well as my own experiences with endometriosis and PCOS, the providers would not take my concerns seriously.
Additionally, I had a traumatic intrauterine device (IUD) insertion the second time I got an IUD. They held me down and inserted it despite me having an inflamed cervix, and it took a couple of tries to get it in — and there was a med student watching and trying to voice concerns, but the gynecologist kept saying I was struggling and making it worse. This experience made me very uncomfortable with getting any sort of penetrative ultrasound done. I have had doctors who did not understand that and just thought I “didn’t have a high enough pain tolerance” or was “being a baby” and tried to refuse me service because I requested an alternative way to look at my reproductive organs.
I have been told many times by providers that I should go on injectable weight loss medication to manage my PCOS and endometriosis, or that my mom might not have had endometrial cancer if she had been on these medications. When I told them that I do not feel comfortable taking those drugs, they told me I wasn’t trying hard enough or that I would do it if I was “really” struggling.
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I would like health care providers to know that if you mention weight loss as a strategy to mitigate or manage symptoms, chances are that people in bigger bodies have tried that already in many different ways.
I have also had providers tell me that I am prediabetic based off my body mass index (BMI) and weight — I am 6 feet tall and 300 pounds — without actually talking to me about my eating or exercise habits or family history. I have had providers tell me that my periods “weren’t really that bad” when I described them in appointments, choosing not to believe me because I am in a bigger body or negating my pain tolerance because of my weight despite my family history.
I had an open cyst for 3 months on my bikini line, and a doctor told me it was due to not maintaining good hygiene — implying that fat people are dirty and gross — when in reality, it was hidradenitis suppurativa, which is not caused by being unclean.3 When I was able to see a dermatologist who saw me past my weight, I was able to go on a month-long antibiotic to stop the bleeding.
How did those experiences affect your health and your relationship with health care providers? What were the eventual outcomes of those encounters?
These experiences severely affected my relationship with health care professionals. For a long time, I would only go to the doctor if I had been sick for prolonged periods of time because I didn’t want to hear that I got a sinus infection or something because I was fat. The eventual outcome was that it would take longer for me to get better because I had waited to go to the doctor until I could “prove” I was sick or had valid concerns.
I had terrible experiences with gynecologists except for the one I saw growing up, and I stopped going to them for a long time because they always concluded that any of my reproductive problems had to be because I was fat or that I would not have as bad of a time if I was skinny. I have struggled with losing weight as an adult despite going to the gym several times a week and working a more physically laborious job in grad school.
Have you had any health care encounters in which you received affirming, weight-inclusive care? What impact have those experiences had on your health?
When I had my hidradenitis suppurativa cyst, I was fortunate to work with a dermatologist in Cumming, Georgia [a city in metro Atlanta], who took my concerns seriously. I was able talk with her about my issue, and she heard the different ways I had tried to fix it as well as the impact it had on my life. She was able to see the impact of my hormones not being right, and she understood my concern about antibiotics affecting the medication I was on for gastrointestinal issues related to my gallbladder removal.
At my follow-up appointment, she prescribed a medicated wash to help prevent the issue from coming up again. I felt so validated that I cried in the parking lot after the appointment.
Additionally, I have found a gynecologist who has been very understanding and is working with me to manage my endometriosis and PCOS. She even did an external sonogram of my organs after I explained that I had a traumatic IUD insertion, and she was able to show me without penetrating me.
For the health care providers reading this article, what would you like for them to know about the kind of care you would like to receive at medical appointments? What do you wish they would and would not do or say when treating patients in larger bodies?
I would like health care providers to know that if you mention weight loss as a strategy to mitigate or manage symptoms, chances are that people in bigger bodies have tried that already in many different ways. It is harder to spot disordered eating habits among people in bigger bodies because weight loss is celebrated and often not questioned as much.
We may also like existing in our bigger bodies. Many bigger people do not see thinness as the goal or ideal and just want to live our lives in our authentic bodies. We want to be given the benefit of the doubt and for our concerns to be taken seriously, not just have providers imply that our concerns are lesser problems because of some moral deficit we have. It is morally neutral to live in a bigger body, just like it is to live in a skinny body.
Do not only look at our weight; also ask about our personal and family medical histories. You cannot just go with what you see. Plus, be aware that charts follow clients, and what is written in a medical file will follow someone for a long time, so please try not to write biased things.
Lastly, it’s not just what you say but how you say it. Use softer approaches when talking about sensitive topics. Understand why people may shut down or not want to talk about certain subjects. It may be the situation they are mad at, not the provider. Let them explore their anger around the issue, and it may reveal some more symptoms.
This article originally appeared on Endocrinology Advisor
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