Fat shaming doesn’t just hurt a person’s self-esteem. Studies show it can take a real toll on physical health too. And according to a new review of research presented this week the American Psychological Association annual convention, doctors are one of the biggest offenders when it comes to making people feel ashamed of the number on the scale.
That statement may come as a surprise if you think of fat-shaming as mainly something that happens in social situations or over the Internet—or something that women do to themselves. But it definitely resonates with those who’ve experienced it firsthand.
According to the review, this type of “medical fat shaming” can come in the form of disrespectful treatment, lectures about your weight, embarrassing comments, and a less thorough examination. Even well-meaning physicians, if they don’t approach the topic carefully, can ruin a patient’s experience at the doctor’s office—and potentially inflict long-term damage to their well being.
“Studies show that the most common source of fat shaming is family members, and after family comes doctors,” says Joan Chrisler, PhD, a professor of psychology at Connecticut College, who presented the review at the conference. “I find that kind of upsetting, because these are the people who should have your best interests at heart, and instead they’re making you feel the worst.”
Doctors need to be aware of this tendency for bias, says Chrisler, and should be making efforts to stop such behaviors in their offices. They may think that fat patients don’t know what’s best for them and need to be protected from their unhealthy behaviors, she says. “But really, most fat people know they’re fat—they don’t need to be told when they come in for a sore throat or a broken arm,” adds Chrisler.
Practices like weighing patients at every visit (especially in open areas where other people can see the number on the scale) can also make people hesitant to visit the doctor, says Chrisler, even when the have a problem unrelated to their weight. “They’re not going to want to come back for a follow-up visit after that,” she says, “and that could be seriously hurting their health.”
The medical community does a disservice to larger patients in other ways, says Chrisler. Overweight people are often excluded from clinical trials, which means that recommended medication doses might not be appropriate for them. Some studies have suggested this to be the case for certain antibiotics and chemotherapy drugs.
Other studies suggest that medical professionals tend to make assumptions about overweight people’s health and motivations. This means they might not take patients’ symptoms as seriously, and could miss or misdiagnose serious but treatable conditions. In one study of more than 300 autopsy reports, obese patients were 1.65 times more likely than others to have significant undiagnosed medical conditions, including bowel disease and lung cancer.
Chrisler says that patients need to stand up for themselves and object when they feel their doctor is unfairly or inappropriately calling out their weight. “They can also change doctors if they have a physician who is treating them disrespectfully,” she says.
She encourages patients to tell their doctors about the Health at Every Size movement, which advocates for compassionate self care, respect, and healthy behaviors for all people, no matter what their weight. She also recommends referring physicians to her 2016 article in the journal Fat Studies, “Sizeism Is a Health Hazard.”
And while sometimes it is appropriate for doctors to discuss weight and recommend weight loss to patients, Chrisler stresses that there’s a right and a wrong way to go about it.
“We know that dieting usually fails and we know that making people feel bad about their weight is not the way to go,” she says. “People should be focused on trying to eat a nutritious diet, being more physically active, getting enough sleep, things like that—not focused on what the scale says.”