Tom Cruise performed a spectacular daredevil stunt jump from the roof of the Stade de France during the closing ceremonies of the 2024 Olympics. Despite the 62-year-old actor’s brave and athletic feat, Internet trolls immediately criticized his “old man belly.” Lady Gaga has had to dispel rumors about her “looking pregnant” and even Taylor Swift has been asked about her perceived “weight gain” since finding love with Travis Kelce.
But bigtime celebrities aren’t the only ones who face body shaming, although they face it more publicly than most. Weight shaming is widespread and, unfortunately, widely prevalent in the healthcare field too.
Doctors often blame patients for excess weight, implicitly or explicitly, but experts say such behavior is not just impolite – it is bad medicine.
“Physicians and providers are not expected to contribute to weight shaming,” said Grettel Rodriguez Garcia, M.D., an internal medicine doctor with a certification in Obesity Management. “The World Obesity Federation defines weight stigma as [discrimination and judgment] targeted toward individuals because of their weight or size. It’s really a discrepancy, because these days our society embraces diversity, but there’s still a widespread bias against people with obesity and it looks like it’s socially acceptable.
“Obesity is often viewed as a result of ill-advised lifestyle choices or the patient choosing to be fat, or it’s seen as a lack of self-control.”
When physicians succumb to these attitudes, “it’s a barrier to really diagnose and treat obesity properly.”
Physician biases about weight can have negative consequences for patients. A 2009 study published in Basic and Applied Psychology explored the extent to which shame is elicited in physician-patient interactions, and examined the emotional and behavioral reactions of patients to those interactions.
Half of respondents recalled one or more interactions with a physician that left them feeling ashamed. Forty-five percent of those reporting such experiences terminated their treatment or lied to their physician to avoid experiencing further shame, and the interaction led to further negative emotional and behavioral consequences.
At the same time, 33 percent of the shamed respondents believed their shame provoked useful behavioral changes. The study concluded that inducing shame in medical contexts is widespread and may have both positive and negative effects.
“Fortunately, the medical world has come to recognize obesity as a chronic medical condition,” Dr. Rodriguez continued. “A chronic condition means it’s not the severity of the disease, but the length of the disease, which means you will always have it if it’s not controlled.
“Obesity is multifactorial and multidisciplinary, and it’s linked to a lot of comorbidities, so it takes more time to properly diagnose and treat. Physicians are highly specialized now in their chosen field and may lack the training to address the issue of obesity without offending the patient. With the high prevalence of obesity, I believe it should be included in the curriculum of all specialties because this chronic condition affects much of the endocrine system and other specialties like cardiology.”
When physicians become blind to their own biases, they fail to do their job and patients living with obesity who already have higher mortality can end up with substandard medical care.
Surprisingly, obese people are not necessarily included in U.S. clinical drug trials so drug dosing for larger bodies is basically unknown territory. In cases such as infections, blood clots and cancer this can be life threatening.
“First of all, physicians should make the patient feel comfortable in their environment,” Dr. Rodriguez said. “I think more attention is being paid to having the right equipment to accommodate larger-sized patients. Something as simple as a blood pressure cuff can be a challenge. If the patient is so large that the cuff doesn’t fit correctly, you are not going to get an accurate check. Scales should be located in a private area and able to weigh even the largest patients, and seating in the waiting room should accommodate larger bodies.”
Just this year the Association for Size Diversity and Health created a roadmap called “Health at Every Size” to combat the discrimination – intentional or unintentional – against overweight people in healthcare. It teaches physicians how to address weight issues in a non-judgmental manner. When discussing weight, the language should be non-blaming, respectful, evidence based and without assumptions. Compassionate care should incorporate empathy (not pity) about the patient’s health status.
The new thinking arises from the idea that healthcare is a human right for people of all sizes and the refusal to provide care until arbitrary weight loss is met could be a violation of the patient’s bodily autonomy. Fat people’s access to comprehensive healthcare should not depend on obtaining a certain BMI or weight loss – though there may be circumstances where excess weight makes it truly inadvisable to provide a specific treatment.
“What we do in our weight loss practice is dive into the patient’s medical history to find out what might be causing their weight gain and listen to everything the patient says,” Dr. Rodriguez said.
“They may have been struggling with weight loss for a long time and every doctor has told them to diet and exercise, but that is not working for them. We do the whole spectrum of treatment from the nutritional side of it, the behavioral therapy, and accountability with close follow-up.
“We monitor all medications our patient is taking because some of those can cause unexpected weight gain. Our focus is on the quality of life and sustainable changes. By trying to uncover the root of the problem our patients feel like they’ve been heard and have a different perspective when they have an individualized plan to follow.
“The good news for patients suffering from obesity is that there’s more training and more places targeting the disease itself,” Dr. Rodriguez added. “There’s plenty of research and better drugs coming out all the time to help manage this chronic condition.”
Just as importantly, it appears that anti-fat bias is finally being addressed in early medical training and weight stigmatizing is being replaced more often with compassionate care in an effort to give everybody an equal place in medicine and a right to the best possible care.
Dr. Grettel Rodriguez Garcia received her medical degree from the Universidad Iberoamericana UNIBE in Santo Domingo, Dominican Republic, and completed her residency in Internal Medicine at Lincoln Medical and Mental Health Center in Bronx, N.Y. Her office is located in Primary Care of the Treasure Coast, 1265 36th St., Vero Beach, adjacent to Cleveland Clinic Indian River Hospital. For more information, call 772-567-6340.