Talking to your doctor as a fat person is too often an exercise in hostility or futility. I have navigated this difficult situation many times over the years, with varying results. Like most fat people, I have avoided seeking medical care because I know or suspect I will be treated with bias or not treated at all. In many cases, I’ve had to convince a medical professional that I am competent, that I understand my body and my health, and/or that I can be trusted to understand and comply with directives.
This isn’t news to anyone. There is a wealth of research that proves over and over again that healthcare professionals routinely fail to provide adequate or value-neutral care to fat people because of their biased beliefs about fat lives and medical science itself. I decided sometime in my thirties that I wasn’t going to be meek about it, I wasn’t going to endure it or ignore it any longer. Here are some of the things I’ve learned to say to increase my chances of receiving decent care, or to weed out those who are truly incapable of giving it. You may find some of this useful.
Before treatment has begun:
- “I am not interested in being weighed today. My weight has no bearing on the purpose of this appointment.”
- Note: this will not always work. Some professionals will refuse the appointment if you will not be weighed. Some facilities weigh you on a digital scale beneath the exam chair or bed. Choose your battles.
- “Please record my weight if the doctor requires it, but I am not interested in hearing the resulting number, or discussing that information with you. Please refrain from describing any change in my recorded weight, or commenting on my body in any way.”
- “This blood pressure cuff is not an appropriate size to get an accurate reading. Please locate a larger one.”
- Note: this works with any equipment you know or suspect is inappropriate for your body. Most hospitals and offices have bigger ones, often they are a different color. I often request the ‘red cuff.’
- “Yes, I am aware that I am overweight. This is not news to me. Have we dispensed with your obligation to inform me of an obvious characterstic of my body? Can we resume the appointment, which has a specific purpose unrelated to my weight?”
- “My diet and exercise habits have nothing to do with the purpose of this visit, and dicussing that instead of my current and pressing medical complaint is a waste of both of our valuable time.”
- “Can you tell me about any bias training you have attended to enable you to treat fat bodies without discrimination? Was it offered by your medical school? Have you pursued it in seminar or as a part of your continuing education?”
- Note: a professional will often dodge this question, by insisting that they provide value-neutral care, or that they have a number of fat patients, or fat people in their life. Do not accept these answers. This is a documented problem among both doctors and nurses and you’re asking specifically about their professional education as it pertains to your care. You can accept ‘no I have not had any bias training’ as an answer, but you should indicate that they need to pursue it. You can say “that is disappointing to hear'”or “I hope we can proceed without your being adequately prepared, but I am not encouraged by this news.” It is your doctor’s job to have the necessary education to treat you, full stop.
- “I would like to encourage you to seek out anti-fat bias training for yourself and your staff. Studies have shown that even a single class that addresses this bias can help professionals like you to provide adequate and value-neutral care to fat bodies.”
- “The BMI is a non-medical tool, created and popularized for actuarials to sell insurance. It has no application to the health of an individual, and has complicated implications with respect to race and gender. I’m not interested in it as a metric, and I’m concerned that you’re continuing its use despite the proven harm it has done in the hands of medical professionals.”
After the problems begin:
- “I fail to see how my weight could possibly affect my broken arm/blepharitis/bone cancer. Can you explain to me in detail how one is connected to the other?”
- Note: you’re likely to get an an answer about your overall health. You may respond with something like “I appreciate your concern for my overall health, but our time is limited today. I am here specifically seeking treatment for my broken arm/blepharitis/bone cancer. Are you prepared to focus on the matter at hand?”
- “I am interested in evidence-based medicine. Can you tell me about the success rate of that diet/medical weight loss program you’re recommending?”
- This is a trick. No diet or medical weight loss program has a success rate of more than ten percent. Most of them are around 2%, especially if measured two years out. Expect doctors to be defensive about this. Follow up with “I am not interested in a program of restrictive eating that results in a minor reduction in body weight for such a short length of time, and I don’t think it is for my benefit that you’re bringing it up. Is it a requirement of your position that you suggest this to me? Ok, then you’ve fulfilled you requirement. Continuing this conversation strikes me as unproductive.”
- “I am interested in evidence-based medicine” is the phrase that has physically rocked medical professionals with the greatest regularity in my experience. Don’t be shy. Science always offers proof. If nothing else, it lets them know that you’re not a passive patient. You are engaged with the information necessary to safeguard your own health, and you’re prepared to seek research and actually read it before making a decision. This should not shock them, but it often does.
- “I want to assure you that the weight loss methods you’re suggesting have been offered to me many times. I have examined the evidence of their failure, and I have determined that I am not interested at this time.”
- “I appreciate your advice about my diet and exercise regimen, but I am curious as to why you assume this information is new to me. It is readily available, taught in public schools, and reinforced in all media. Do you understand the lack of a simple causal relationship between diet, exercise, and sustained weight loss? Do you have access to journals and studies that might help to further your understanding?”
- “What are the side effects of that weight loss drug? What percentage of those who take it maintain their weight loss over time?”
- “I am aware of the existence of bariatric surgery. I am not interested in a surgical solution at this time.”
- “Are you aware of the short and long-term side effects of bariatric surgery? Are you aware that the common complications often lower a patient’s quality of life rather than improving it?”
- “Are you aware of the documented increase in substance abuse and suicidality in bariatric weight loss surgery patients?”
- “Are you aware of the correlation between bariatric surgery and premature death?” (Do not skim this and then complain that I’ve misunderstood it— look at the seven year mark.)
- “It concerns me that you are recommending this surgery to me without first informing me about these risks.”
- “It concerns me that you seem to value weight loss over the significant health problems caused by an invasive, elective surgery.”
- “I understand that you feel unqualified to perform this procedure on a person of my size. Can you recommend another doctor or office where they have received adequate training?”
- “Can you explain to me specifically how my body size makes me an unacceptable candidate for this procedure, but not for bariatric surgery?”
- They’re not gonna answer this. This is probably the end of this conversation.
- “I acknowledge that you have the right to refuse to treat my illness/injury on the basis of my current weight, but I must insist that you record exactly that in my chart. Please record my request, your refusal, and your exact reasoning for saying no. I require that my medical records be as complete and accurate as possible, due to the documented bias of medical professionals against bodies like mine.”
- They may very well refuse to do this. If so, say: “I will document it for my own records, in that case.” It’s an empty threat, but boy do doctors hate to see you write things down.
- “How would you treat a thin person with with these exact same symptoms?”
- This does not ensure you will receive this treatment. It may just be something to keep in your back pocket until you can find a weight-neutral provider.
If problems persist:
- “I don’t feel comfortable continuing this exam/treatment/procedure/conversation. It is evident to me that you are incapable of providing value-neutral care to a person of my size.”
- The doctor or nurse will likely become extremely defensive, if not hostile. Try to remain calm, but remember this is a relationship built on trust. If you cannot trust them, they cannot treat you. It’s as simple as it is awful.
- “I hereby revoke my consent. Stop what you are doing immediately. Do not touch me further. Leave the room. You are dismissed from my care.”
- This is like throwing a grenade. Use it when you don’t feel safe, but know that there’s no coming back from it. This relationship is over.
- “I intend to bring a complaint against you/your office/your staff based on the experience I have had. Nothing may come of it, but I want you to understand you have failed to provide value-neutral care on the basis of a well-documented bias in your profession. This is unacceptable, and I do not accept.”
- You don’t have to say this, or anything. You can just leave. They can bill you. Put your clothes on and leave.
- Nothing will come of a complaint you make about this, usually not even an apology.
- This is not advice for a medical emergency. In an emergency, do what you need to do to survive.
- Doctors are assholes with a lot of power. Many of them will resist discussions of this type, dismiss you, and/or refuse to treat you. They are accustomed to deference and compliance, so many of them receive a statement of fact about their inadequacy or failure as though it were an attack. Be ready for them to become defensive or hostile to you for simply stating the truth.
- These scripts assume that you have access to medical care, that you have the ability to advocate for yourself, that you have enough options that you can refuse substandard care, and that you’re prepared to be a cunt like me on your own behalf. None this may be true, and I’m sorry. This is really hard to do, and the deck is stacked against us. This is the advice I have to share. I’m not a doctor, not a lawyer, not a social worker, not an expert in anything but living in a fat body.
- Don’t resort to threats or insults. Don’t say the word ‘malpractice.’ This is a professional service interaction that YOU are paying for THEM to provide. I hate the word ‘customer’ in a healthcare setting, but this is a for-profit industry, so that’s what you are. Be polite, but be firm. You are not their friend. You are paying for a service that keeps you alive and healthy, and you deserve to get it.
- The words “value-neutral care” are not used accidentally, and I did not invent this phrase. It is drilled into medical professionals during their education and in their practice. It is their guideline. Feel free to make these scripts your own, but this phrase is important, and you should keep it in mind.
- Nurses are often the bigger problem. Nursing culture is rife with fatphobia and dehumanizing behaviors towards fat patients. They need anti-fat bias education as much as doctors do, but they’re less likely to get it. It is my habit to be sightly warmer and more polite to nurses; they work a lot harder for less money, and are more likely to be from marginalized backgrounds. That’s my choice and you certainly don’t have to do it, but I find that it works better to gently remind nurses and to curtly inform doctors. YMMV.
- There is nothing fair about this interaction. Doctors are less likely to listen or value your opinion (or your life) because you’re not white, because you’re not male, because you’re not straight, because you’re not cis, because you have chronic health problems, because you’re disabled, AND because you’re fat. You might cry the first time you try this, or every time. Fighting back with facts while sounding both educated and uncompromising is the best strategy I’ve got, but I know it won’t solve any of the above problems.
- You do not have to apologize for being direct. You do not have to apologize for advocating for yourself. You are literally fighting for your life.
- You do not owe anyone an explanation of or an apology for your body. You do not have to thank someone for providing inadequate care. You do not work for them. Your body belongs to you and only you. This is work you do with yourself, and it is hard. But you’re worth it.
Our healthcare system is fucked. These scripts haven’t always gotten me the results that I’ve wanted, and they haven’t caused any policy changes at big places like Kaiser where I’ve had to use them. But learning to speak up has helped me feel more powerful, more able to advocate for myself, and to overcome my fear of interacting with medical professionals. It has occasionally resulted in a doctor or a nurse changing their mind or their habits. It has made being fat in a paper gown a little more bearable. I hope something in this is useful to you, too.