This is the 2nd post in a 2-part series on weight stigma.  Check out the 1st post here.  

Weight stigma is the discriminatory words, actions, and ideologies targeted toward folks based on the size and/or shape of their body.  This can show up in judgments toward others, whether spoken or not.  Weight stigma also includes beliefs that only certain sizes/shapes of bodies are worthy of fun fashion or accessible areas.  

Internalized weight stigma occurs when someone turns these beliefs, judgments, and actions toward themselves.  For example, thinking “I deserve to be uncomfortable in this seat because my body is too large”, or believing that you are not allowed to wear certain clothing due to the size or shape of your body.  

In a society obsessed with thinness, such as the US, weight stigma is everywhere.  This includes in the offices of many medical providers.  

Medical Weight Stigma

Many medical professionals in the US have spent their entire lives amidst the diet culture that engulfs us all.  Diet culture includes the hierarchical view that some bodies (i.e. thin, white, abled) bodies are more worthy than others.  Diet culture also emphasizes things like “clean eating” and “lifestyle change”, as well moving your body with the intent to change shape/size.  

These individuals then attend years of school and training that reinforce the view that larger bodies are undesirable and unhealthy.  Health insurance utilizes BMI (Body Mass Index) as a metric to evaluate care and render payment to providers.  If you are unfamiliar with the reasons that this focus on BMI is absurd, I encourage you to check out this article or this video.  

This weight stigma then shows up in the office with patients.   A larger-bodied patient may seek care for an ear infection, and receive a reprimand about their weight (true story!).  For many fat individuals, any visit to a medical professional requires gearing up to defend our right to exist.  Having multiple negative and shaming experiences with doctors understandably leads to many fat people avoiding medical care, or at the very least, waiting longer to seek treatment for medical concerns.  

Then, if there are “poor health outcomes” – things like chronic illness or infection, or even death – they are attributed to the person’s size, with no consideration of the role that weight stigma may have played in that person not seeking medical care earlier or at all.  

Personal Experience

The only time in my adult life that I have not been mid-fat (more info at this link) was when I had an active eating disorder.  During that time, not a single medical provider asked me about my food intake or body-related behaviors.  They all acknowledged, and even encouraged, the weight loss.  Weight stigma meant that an eating disorder wasn’t even a consideration because I was still  “o*erw*ight” according to the BMI.  

My eating disorder years are certainly not my only experience with weight stigma in a medical office.  Following a car accident that totaled my vehicle, I had some pretty severe back pain that led to me seeking treatment.  Every visit included being advised to lose weight.  Do thin people not have car accidents or related injuries?  I’ve also had a similar experience when I had a sinus infection – being given a lecture about the size of my body when what I really needed was something to help me breathe.  

My most recent experience with medical weight stigma began when I sought out a new primary care provider in 2019.  Well, we all know what 2020 brought, and that led to me continuing to see this provider far longer than was beneficial.  Let me share a bit about my experience with Dr. P (not their real name or initial).  

During my first appointment with Dr. P, I made sure to include that I am in recovery from an eating disorder and that I have no interest in planning for intentional weight loss.  Yet, at every single appointment, Dr. P asked some version of, “What are we going to do about this weight?”  Both Dr. P and the other staff congratulated me when the numbers on the scale were lower, despite that being due to the tremendous stress of being a mental health provider in the midst of a pandemic.  

Dr. P prescribed me a particular medication that can have a side effect of dry cough.  Well, that side effect was pretty intense for me.  The continuous dry cough led to multiple respiratory infections, and I spent 8 months of 2023 sick with various respiratory issues.  I mentioned this issue to Dr. P multiple times, and was met with dismissal of my concerns.  

I was considering finding a new provider, but hesitant to go through the process again.  I also didn’t have much hope that things could be different.  

Then, weight loss injectables came on the scene.  I have done a lot of research around these medications.  I am informed about their uses and the side effects, and I choose not to utilize them personally with a goal of intential weight loss.  Dr. P mentioned one of the injectables and said, “What do you think? It could help with losing the weight.”  (Remember that I had explicitly told Dr. P that intentional weight loss was not one of my goals.)

I very clearly let Dr. P know that I am familiar with these medications and that I am not interested in taking them for weight loss. 

Yet, she brought it up at every subsequent visit!  

After the 4th time being told these injectables were the only option for progress (and still having the dry cough from the other medication Dr. P refused to change), I let Dr. P know that I was going in another direction and would no longer be seeking services at that office.  

I work in the medical field.  I am trained in understanding research.  I have specialized training in working on body image from a weight-inclusive perspective.  I’m in recovery from an eating disorder, and was clear about my history and current goals.  Yet, the weight stigma continued in every appointment.  What about the patient who doesn’t have access to all the information?  The person who trusts their medical provider based on their title?  The person who is so tired of fighting for adequate care that they just give up?  

Combatting Weight Stigma

My journey brought me to scheduling with a new provider at a practice that I had heard positive things about.  This practice does not weigh patients at every visit – in fact, I have never been weighed there.  They reserve that for instances when it is truly necessary for the inviduals treatment. The provider I see has listened to my history and personal goals, and has never once made weight the focus of care.  This provider was willing to make  a medication change and the dry cough that I had suffered with for nearly 3 years was gone within a week.  (This is a miracle when your job is talking.)  This provider also discovered that my thyroid levels were off and that was contributing to some concerns in ways that Dr. P never considered due to only seeing my weight.  

It’s so refreshing to have someone listen, to feel like they see me as a person and not as a fat body to be fixed!  Everyone deserves to have access to healthcare with providers who believe ALL bodies deserve respect and compassion, and that all individuals have the right to advocate for their personal health-related goals.  

Yet so many fat people never have the experience of being seen as a person by medical providers.  We are always seen as our weight first.  At most medical practices, the literal first piece of information they get about you is your weight!  

This is why so many fat people stop seeking medical care.  If you are told that your weight is the problem every time you see a medical professional, you stop wanting to see medical professionals.  Trust me – we fat people are aware of the size of our body.  There may be times when some of us want to focus on that with our providers.  However, it’s not the only thing about us.  If a fat person has a sinus infection, a dislocated finger, or tests positive for the flu, it is not helpful to focus on their weight.  It is helpful to treat the issue at-hand.  By always bringing the focus back to weight, providers increase the likelihood that an individual will put off seeking care the next time, leading to poorer overall health outcomes (which will then be attributed to weight and not lack of access to appropriate care).  

It would have been much less harmful if Dr. P had said from the start – at that first appointment when I shared my ED history and said I did not want to focus on weight – that we would not be a good fit because of how Dr. P practices.  A provider who knows they believe being fat is inherently bad and practices from a perspective of prescribing intentional weight loss should acknowledge that with patients so the patient can make an informed decision about continuing care.  

Combatting Weight Stigma

What can be done to help decrease the number of people who are being harmed by weight stigma when seeking medical care and beyond?  

Here are some ideas you may want to utilize to fight weight stigma in your life:

• Learn more about weight stigma.  Seek out resources, like those listed below, to learn more about weight stigma and how it impacts all of us (no matter the size of your body).
• Embrace the term “fat” as a neutral descriptor.  This has been empowering for me personally.  The very word that has been used by others throughout my life to bully and harass me has now become a simple adjective that does describe my body.  
• Look for medical providers who are weight-inclusive.  Many weight-inclusive providers advertise this because they know it’s not the norm in US medical care.  You can also ask a new-to-you provider if they are weight-inclusive – their reaction to the question is likely to tell you all you need to know.
• Bring a support person who can advocate for you.  If you have someone in your life who you feel comfortable bringing to your appointment, do so.  Have a conversation with your support person beforehand about how you would like for them to advocate and how you will let them know you need them to speak up.  Sometimes having an extra voice there can make a big difference.  

Here are some resources for further learning about weight stigma and its impacts: 

• Regan Chastain’s Weight and Healthcare Substack – Ragen examines all the research and breaks it down into digestible chunks, delivered straight to your inbox.
• Reclaiming Body Trust – This book is a great way to learn more about the impacts of weight stigma and the power of trusting your body.  
• Medical Students for Size Inclusivity – This group was created by medical students who recognized that the “business as usual” model of US healthcare causes harm to those in larger bodies.  This is a great option for anyone who may be pursuing a career in the medical field, as well as to share with any medical providers who are willing to learn about the impacts of weight stigma in the medical field.
• HAES Health Sheets – Downloadable info sheet that address the role of weight stigma in typical treatment of common medical concerns.  These can be helpful in feeling empowered to advocate for yourself, or to share with your provider.  This entire website has lots of helpful resources.  

If you are interested in working to improve your body image and unpacking the ways diet culture has impacted your life (or if you just want to work with a fat mental health provider who gets what it’s like to exist as a fat person in this world), I am currently accepting clients in North Carolina.  You can learn more about my approach to body image work here, and feel free to complete this contact form if you’d like to see if we may be a good fit for working together. 

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Michelle F. Moseley is a Licensed Mental Health Counselor in NC. She believes ALL people deserve respect, compassion, and access to mental and physical healthcare. Michelle specializes in working with survivors of religious trauma and with those who have body image concerns, finding there is frequent overlap in these areas. You can learn more about Michelle by visiting her website at MichelleFMoseley.com or following her on Instagram – @therapy_with_michelle 

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