How Doctors Dismiss Overweight Patients

If you go to the doctor for a health issue or concern, or because you are in pain, you would expect a thorough examination to get to the root cause. This does not always happen for those who doctors may consider "overweight" or "obese," because many doctors have a bias against individuals in larger bodies.

About 2 out of every 3 of Americans are considered "overweight" or "obese." According to doctors who use the BMI measurement, those who are overweight have a body mass index (BMI) of 25 or greater, and those who are obese have a BMI of 30 or greater (it's important to note that BMI has received a lot of criticism, and to remember that BMI is merely one number that does not tell your health story). This means that a large number of people going to the doctor for a concern might face unnecessary biases due to their body shape or size.¹

Body size and bias in healthcare

Weight bias in medicine may stem from a variety of factors, including the minimal education about obesity that doctors get in college and in medical school. There is also little to no education about weight bias, stigma, and their impact on larger bodied individuals. If there is no education or discussion about these issues, doctors tend not to see it as a problem or even recognize the issue exists.¹

A person's weight is complex, and not a result of merely “eating too much.” Factors can include:¹

• Genetics
• Hormonal changes
• A history of trauma
• A history of dieting
• Environment

A strictly medical approach sees obesity as only an issue of weight gain and the idea of fatness as a disease, with weight loss as the cure. This way of thinking influences how doctors approach health concerns or complaints: the excess weight must be the culprit.²

This kind of thinking can also lead to doctors or healthcare providers unconsciously viewing overweight or obese people as having poor health habits or lacking self-control when in reality, weight does not tell the story of a person's health. This might influence their attitudes toward the person in a negative way, and cause unnecessary judgment and stigma.²

How do these biases affect people in pain or those with health conditions?

If a person in a larger body has had negative interactions with their doctor because of fat-shaming or being made to feel bad about their size, they may be less likely to go to the doctor, especially when there is a problem.²

The health impacts of weight bias in healthcare are widespread and can include:^1,2

• Exclusion from medical studies
• Under-dosing of antibiotics, chemotherapy, or other medications
• Not taking health complaints seriously
• Assuming any health complaints or symptoms are due to being overweight
• Failing to run the right tests to make an accurate diagnosis
• Negative effects on mental health, including depression, anxiety, substance abuse, and suicidal tendency
• Reduced trust in the healthcare system, leading to less engagement with it
• Physiological reactions like increased blood pressure and blood sugar

In a study of more than 300 autopsies, obese people were 1.65 times more likely than non-obese people to have significant undiagnosed medical conditions. This suggests that they were misdiagnosed or did not have access to appropriate care.²

For larger-bodied people with undiagnosed axial spondyloarthritis who are experiencing pain, this might be brushed off as stress on joints or bones from excess weight. For women especially, whose complaints about pain may be more likely to be dismissed, this exacerbates the problem.

Doctors may suggest diets or exercise instead of ordering the right screening or diagnostic tests that would find signs of axial spondyloarthritis. All of this leads to delays in diagnosis and treatment, worsening of symptoms, and reduced quality of life.

Things to consider

It is worth it (although can be difficult) to find a doctor you like and trust. Talk with them about your health concerns, and if you experience weight bias or inappropriate treatment, ask to speak with the office staff about your experience there. They might not be aware of how their biases show up in their treatment.

If you are overweight or obese and experiencing pain, any other health symptoms, or have concerns, see your doctor. Let them know what you are experiencing. If need be, bring a friend or family member for support. If the doctor recommends a certain treatment, ask them if they would recommend the same treatment for a person with a BMI they consider "normal." If the focus remains on your weight, redirect it to your symptoms and concerns. ² You can also decline to get weighed - if anyone insists, ask, "Will my weight change my medical treatment?" If not, there is often no reason to be weighed.

You deserve relief from your symptoms and an accurate diagnosis. Weight is just one aspect of a person's health - there are more important things to consider, like a person's stress levels, sleep, and social support. All of these things play an integral role in your health, independent of your weight. Find a doctor who will work with you to find out the underlying cause for your symptoms so you can get proper treatment.