Episode Details

Happy 2024! I am ready for another year of writing about the intersections of weight science, weight stigma, and healthcare and I’m glad you are here reading! This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!

I received the following question from reader Lisa:

I notice that when you write about things that can hurt larger people’s health you usually mention weight cycling, weight stigma, and healthcare inequalities. I’ve read your posts for the first two – is there a post that describes the third one?

Thanks for asking Lisa, I’ve been meaning to write this and you’ve given me the perfect gentle push! For the record the piece for the harm of weight cycling is here and the one on the harm of weight stigma is here.

The idea of healthcare inequalities is difficult to quantify because it’s such a vast category. In terms of a definition, the one I’m going to use here is any way in which higher-weight people’s healthcare experiences differ from those of thin people to the detriment of higher-weight people.

It’s always important to remember that when we discuss these inequalities we are clear that they don’t impact everyone equally, as people’s weight becomes higher their experience of inequality typically increases as well and, utilizing Kimberlé Crenshaw’s framework of intersectionality, those who have multiple marginalized identities will also face greater inequality in their individual marginalizations and at the intersections of them.

Finally, I want to point out that thin people can face healthcare disparities as well based on things like marginalized identities and socioeconomic status. The comparisons I’m drawing here are about the typical experience of thin people and are not meant to indicate that thin people never face issues in accessing healthcare, just that as a group thin people are not systematically marginalized within the healthcare system because of their size.

I also want to be clear that this is not an exhaustive list and I welcome you to add other examples in the comment section. I’m going to divide these up into groups to help give this conversation some structure.

Practitioner Bias

This includes a lot of different things. Before I get into it, I want to point out that providers aren’t necessarily bad actors who just hate fat people (though, sadly, some absolutely are.) Many are simply a product of a healthcare system (including healthcare education) that is deeply rooted in weight stigma. Regardless of how they got to this place, these practitioners are responsible for the harm that they do.

Some practitioners are operating out of implicit bias, which is to say that the bias is subconscious. Others are operating from explicit bias, they are fully aware of their negative beliefs and stereotypes about higher-weight people and they are working with higher-weight patients based on those beliefs and feelings. This can lead to a lot of negative impacts. Some examples:

There is the classic (and far too prevalent) example of a practitioner who offers ethical, evidence-based treatments to thin patients for health issues, but sends higher-weight patients with the same symptoms/diagnoses/complaints away with a diet.

There’s the “Occam’s razor” mistake. Occam’s Razor states “plurality should not be posited without necessity.”  Said another way, when choosing between theories, the simplest one is usually correct