Size Discrimination at the Doctor's Office

Research shows that many physicians are biased against their heavier patients. Here's what you need to know

Does your doctor make you feel bad about your weight? If you're a woman who is even just 13 pounds overweight (with a BMI of around 27) watch out: Your doctor is more likely to assume that you're "lazy," "weak-willed," "awkward" and "sloppy," according to several university studies cited in this fantastic article, out now in Prevention magazine. And this translates to a lower standard of care -- think undiagnosed broken bones, asthma confused with depression (what?!), and a general reluctance to deal with any other aspect of your health besides your weight. 

The best part? Doctors don't start to discriminate against male patients until they're at least 75 pounds overweight. Oh hello, it's our old friend, Double Standard.

The article (written by the amazing Harriet Brown, author of Brave Girl Eating) doesn't have time to explain why doctors discriminate against overweight women more than men, but I think it boils down to the fact that men have a much broader standard of beauty. Yes, chubby guys are subjected to tons of "fat guy in a little coat" jokes and that's not pretty. But a man can be big -- broad, hulking, insert your descriptor of choice here -- in a way that women never get to pull off. Anything big about a woman's body (boobs, butt, hips, nose) must be balanced by an equal-but-opposite something small (a teensy waist, bird bone wrists, baby doll feet). Fashion editors all over New York City devote countless hours to strategizing how to dress you to make the most of those tiny parts.

I guess (naivety alert!) I just thought that people with a medical degree were above all that business.

When I read Dances With Fat's "So My Doctor Tried to Kill Me," the bloom was pretty much off that rose. And Brown does a terrific job of laying out why obesity freaks doctors out so much. For starters, the obesity-health connection isn't as rock solid as we like to think. Some studies show that overweight people may live longer than lighter folk, especially those who do a lot of crash dieting. Then there's the pesky reality that diet and exercise don't impact every body in the same way. "One of the key factors underlying this stereotyping is the notion that nobody would be obese if they were eating healthy and exercising," says Arya Sharma, MD, PhD, chair of obesity research and management at the University of Alberta in Brown's story. "But for every obese person I see who doesn't exercise two hours a day or who's drinking gallons of soda pop, I'll treat ten thin people doing exactly the same thing."

And when overweight patients do try to lose weight, most of them fail. Writes Brown: "Ninety-five percent of people who lose weight gain it back within 3 to 5 years -- which may leave physicians feeling frustrated and helpless and perhaps inclined to blame patients." But is it really the patient's fault when most diets demand unrealistic lifestyle changes and set up unattainable goals -- like the idea you'll lose the weight and keep it off for all eternity?

Mad props to Brown and Prevention for shedding light on this often invisible problem. As for the medical community? You can do better. Check out the Yale Rudd Center for Food Policy & Obesity for ideas on how to combat size bias, for doctors and patients alike.

PS. I'll be on vacation for two weeks starting tomorrow but you'll be in good hands with the amazing Charlotte Anderson, who will be subbing for me here until July 12. Thanks, Charlotte!


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