Episode Details

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Higher-weight patients can face tremendous weight stigma, including intrinsic, extrinsic, and structural stigma, within the healthcare system, with those at the highest weights and those who are multiply marginalized being the most impacted. Some of that isn’t something that can be solved by individual providers, but some of it is.

The part of the appointment from the time we enter the office to the time when we see the healthcare provider has the potential for a lot of occurrences of weight stigma. Here are some things the healthcare workers who see patients during this time can do (or stop doing) right now to improve fat* patients’ experiences.

I do want to point out that many of these things are done by healthcare workers who are under pressure from those who are higher up the hierarchy and/or the facility. It can be difficult to push back. I would suggest that you do whatever you possibly can with any power/privilege/leverage that you have, and then work to create allies so that you can work together to push for larger change.

Just as a note, if you find that you are doing some/all of the things mentioned here, know that you aren’t alone and that you can use any guilt/shame/embarrassment/defensiveness you might feel as a catalyst to do things differently moving forward, to share this information with others, and to advocate for change.

In situations that are a structural failure to accommodate the fat patient, I definitely recommend apologizing. Even if it’s not your fault, acknowledging that this patient’s healthcare is being compromised – that they aren’t receiving the same experience that a thinner person would – and apologizing for that can help the patient not to blame themselves for systemic failure and to feel cared for, which can be the difference between them coming back or disengaging in care.

You are too big for…

If a fat patient is not accommodated by a chair, a blood pressure cuff, an MRI machine or anything else, it’s not that the patient is too big, it’s that the equipment is too small. When you tell a fat patient that they are too big for something, you add insult to the (very real) injury of not being accommodated in a healthcare setting, with all the harm that can stem from that.

Just wear two gowns

It’s bad enough to find that a facility hasn’t bothered to purchase gowns that fit you, but this is often followed by a suggestion that you wear two gowns. If you aren’t sure why this isn’t a good idea, go find two shirts that are too small and try to wear them both at once.  It can be uncomfortable, othering, embarrassing, and it’s pretty unlikely to cover you effectively. The best solution would obviously be to order gowns in all sizes, including the largest possible, proactively. Failing that, can the patient wear their own clothes? I’ve had them bring in the big paper sheet which is definitely a subpar experience but, at least for me, better than trying to wrestle my way into two too-small gowns.

You should cut down on the snacks…

Many fat patients, myself included, have found ourselves on the receiving end of unsolicited food and/or movement advice from the person who was in charge of taking our vitals prior to our appointment. This is not appropriate and it can often be harmful. Typically, this advice is based on stereotypes and the person doling it out has little to no information about the patient’s possible history of disordered eating, request for weight-neutral care etc. let alone speciali