Forgive me. Until I struggled with weight myself, I didn’t have the vaguest idea of how to be helpful to my patients. In fact, I was harmful. If your doctor tells you to eat less and exercise more, that implies that you don’t already know that. It implies that you just need to try harder. Maybe it implies that you’re undisciplined or unmotivated. Are you ever again going to trust that doctor as a person who might be able to really help you with your challenges? Why should you, when all she has done is to pile on even more shame?
Until I gained weight, I just didn’t get it. But boy, did that ever change! I’m grateful to my patients for letting me enter a dialogue with them about strategies as well as science. With each of my patients, we look at her individual challenges and create an individual set of goals and strategies. My suggestions may work, or maybe they won’t. Goals change. Strategies change. The important things, however, do not change: there is no judgment or blame or failure. There are only difficulties that are followed by new opportunities. It is all positive.
Clearly, I’m not the only doctor who was clueless. Doctors are merely educated members of a fat-shaming culture — admittedly members who see the health consequences of obesity and who are troubled and frustrated and, often, patient-blaming. In fact, most physicians think that obesity is mostly a behavioral problem related to nothing more complicated than eating too much and exercising too little (1). So they tell you to just change your behavior. Simple, right? Oh please — give me a break! In Roxane Gay's astonishingly powerful and moving memoir, "Hunger," she makes an observation that is all too true of doctors: "...when people use the word 'obese,' they aren't merely being literal. They are offering forth an accusation" (p. 12).
Many studies have shown the pervasiveness of weight bias among physicians and even medical students (3, 4). They commonly characterize obese people as “noncompliant, lacking in motivation and self-indulgent” (4). Listen to what Jay has to say about this:
Jay—After I became a healthy weight, I wasn't embarrassed to go to the doctor. I used to absolutely dread stepping on the scale and seeing the little shake of the head from my nurse as she filled out my chart:
"Oh, just a little higher up from last time, dear."
Like I wasn't aware. Once I got in to the exam room, I felt like I was dehumanized - the only thing that my doctor saw was my fat. She just saw the obesity and it became the automatic explanatory mechanism for why I was in that day. Then she would lecture me on the importance of diet and exercise.
Of course I knew I was fat — I'm not stupid. I knew my weight was a significant problem because I was the one living with it. I knew how shitty I felt, how sluggish and tired I always felt. She didn't have to tell me that. It's so demoralizing and hurtful when you go in to see someone who has sworn to heal you; and instead, she makes you feel as if you are being judged or viewed as "lesser" just for your weight status. All I wanted was for her to see beyond my fat, to not devalue me as a human being, and to genuinely try to help me.
I, Janice, apologize on behalf of my colleagues and ask you for suggestions for getting us to stop being yet another source of shame. Have you found a way to “help” your doctor change his or her approach?
(1) Foster GD et al. Primary care physicians’ attitudes about obesity and its treatment. Obes Res 2003.
(2) Gay, R. (2017). Hunger. New York: Harper Collins.
(3) Puhl RM et al. Obesity bias in training attitudes, beliefs, and observations among advanced trainees in professional health disciplines. Obesity 2014.
(4) Phelan SM et al. The mixed impact of medical school on medical students' implicit and explicit weight bias. Med Educ. 2015.