Numbers Don’t Tell the Full Story: Medical Weight Bias
Blog post by Adwoa Asante
My heart drops these days as I’m called back for a routine appointment. Not only is my name mispronounced but the scale awaits me. I look up as if to avoid eye contact with the scale and mutter “I don’t need to know what the scale says” and usually the nurse will honor my request with a simple “Got it. No worries.” and quietly document the number in my file.
It Wasn’t Always This Way
Up until my late twenties, I would’ve described my body as stout, muscular, and fat in “all the right places”. I wasn’t afraid to go to the doctor because I was “healthy”, and active, bloodwork always came back normal, and besides the abnormal period or consistent acne, my health issues were pretty minimal. Doctors would often suggest that I get more sleep, relax, find ways to destress, and keep up the good work.
The pandemic really introduced a period of my life, our lives, where we were forced to slow down and really pay attention to what was going on in our bodies. We noticed our breathing, wondering if it was labored because of COVID symptoms or if we were having a panic attack. We noticed aches and pains from the hours we spent sitting in a now work-from-home environment, headaches that wouldn’t quit because our eyes were focused on screens, and the occasional sneeze or cough that made us think twice about whether we were socially distanced or not.
I too, noticed ALL the issues I had ignored. While I love to sleep, I wasn’t rested. The acne was getting worse. New floaters were forming in my eyes. But my trust in doctors had not changed. In fact, I relied on them even more. They were my heroes in this scary time – until “being overweight and having a high BMI” was now considered a risk factor for COVID.
The Lack of Curiosity and Critical Thinking Grieves Me
As a friend recently stated in her commencement address to graduates of social work and nursing programs, “[the helpers] see people on their worst days”. I had hoped that the doctor’s office could be a safe place for me to be unwell and in need of help. Instead, it became a place where I was scolded and reminded of how my body was wrong.
The last year has been full of incidents and encounters with providers who just can’t help themselves when it comes to my body weight. The most egregious appointment happened in early March. I had finally built up the courage to visit a gynecologist to discuss a potential PCOS diagnosis due to some symptoms I was experiencing. She spent about 60% of the appointment discussing the need for me to lose weight making various offensive comments about my body without ever inquiring about my health or lifestyle. Finally, I interrupted. Our exchange went a little something like this:
Me: If it’s okay with you, I’d like to offer a comment and a question.
Provider: Sure, go ahead.
Me: *Voice shaking. Palms sweaty. Thinking about mom’s spaghetti* I’ll start with my comment. I have to say that I am aware my body is bigger. I’m probably at my largest size. That is probably the result of finally treating my depression. I’m eating three meals a day. My job is remote but I’m transitioning to another job soon that will get me out of the house. And we disagree about BMI but I’m the healthiest I’ve ever been.
Provider: *silence*
Me: And my question is, what would you do for someone who had a “normal” BMI? *I actually used finger quotes* Where would you start?
Provider: Well, then it becomes medical….
My mouth dropped open in my mask and my mind went blank for a moment. I was aghast. What would we label this setting that we are in currently? Is this not medical?
This is why medical weight bias grieves me so much. The doctor had not looked at my chart, had not touched me, had not asked me any questions about myself. She came in and immediately began her lecture about my size and need to lose weight. This approach lacks curiosity. This approach assumes that the body, the person, in front of them is unhealthy simply because of its size. This approach skips the questions because fatphobic providers think the number on the scale provides the whole story. But as we know, for most issues, context matters! We are whole people, with whole lives and stories beyond the scale.
How to Prepare and Care
We may not be able to avoid all fatphobic providers, but we have some options for how we cope.
Before the appointment: Consider taking a support person with you who is pro-body liberation and a safe person to process with. If you’re anything like me, write down your questions and concerns. When I get nervous, I lose my train of thought. My notes can serve as a reminder of what I’d like to share. For extra support, share this note with your support person!
During the appointment: BREATHE. BREATHE DEEPLY. Our anxiety may be heightened by the presenting issue and doctors’ offices might make that worse. Perhaps, queue up a breathing/meditation on your phone to regulate your breathing. Also, if you’re feeling up for the challenge, have a list of responses and comebacks when/if the provider says something that is unhelpful. Try “well, what would you do for someone in a smaller body?” “What led you to that conclusion?”
After the appointment: If you can, take the rest of the day off! Journal, eat your favorite meal, go to a yoga class or move your body in a way that helps to diffuse the emotion from the appointment. Document your experiences. You never know what patterns or revelations appear. Maybe it’s time to find a new provider or even submit a complaint if your doctor has a history of making hurtful comments.
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Adwoa Asante is a Body Liberation Ambassador with Current Wellness. Outside of Current Wellness, she serves as the Director of Operations at the Southeast Raleigh Table. You can find Adwoa spending her downtime making breakfast for her friends, tending to her plant babies, or listening to a podcast.
If you are looking for a size-inclusive healthcare provider, visit the Health At Every Size® Healthcare Provider Listing created by the Association for Size Diversity and Health
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