Welcome back to Chief Complaint! It’s wonderful to have you here. For newcomers, this is where we delve into the intersections of medicine, body image, and patient experiences – all from your friendly primary care physician.
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The question that stopped me in my tracks came from Cassie Krajewski, a therapist who hosted me on her insightful podcast, (fabulous!) podcast, to discuss size-inclusive healthcare. She asked point-blank: “Why are doctors so bad at being nice to fat people?”
The simplicity and profundity of this question were striking. Despite my extensive work over the past year addressing fatphobia in medicine – even taking my message on the road as seen on CBS News – this fundamental question had never been posed to me so directly. It highlighted a critical issue: why do healthcare professionals, capable of incredible feats, struggle with basic human compassion when it comes to patients in larger bodies? It’s a question that gets to the heart of patient experience and the often-fraught doctor-patient relationship. It’s about understanding why, sometimes, in the eyes of a patient, the doctor, you’re huge – not in stature, but in perceived judgment and inaccessible empathy.
yellow car toy on white surface
Understanding Patient Perspectives: Sometimes, the journey to compassionate care feels like navigating a complex road, especially when addressing sensitive issues like weight stigma in healthcare.
Cassie astutely pointed out that doctors perform incredibly complex tasks daily. We navigate rigorous medical training, make critical decisions under immense pressure, and some even conduct intricate surgeries. Neurosurgeons, for example, are renowned for their demanding profession. Yet, the very individuals capable of such intricate procedures often falter at demonstrating fundamental interpersonal skills: creating a welcoming and comfortable environment for fat patients. It shouldn’t be harder than brain surgery to make someone feel respected and heard, to alleviate their anxiety about visiting a doctor, or to avoid triggering self-loathing simply by being in their presence. These are the very principles of kindness and respect we teach toddlers: be gentle, treat others with the same consideration you expect. So why are these seemingly simple behaviors so challenging for some doctors when interacting with fat patients?
Numerous studies and reports consistently reveal that doctors and nurses, those entrusted with care, are often among the primary sources of stigma and discomfort for individuals in larger bodies. This isn’t just about bedside manner; it’s about the pervasive issue of weight bias deeply embedded within the healthcare system, impacting patient experience and health outcomes.
Over the past days, reflecting on Cassie’s question and discussing it with fellow physicians committed to size-inclusive care, several key theories have emerged to explain this disconnect. These theories aren’t excuses, but rather attempts to dissect the complex reasons behind this harmful reality and pave the way for meaningful change in how healthcare professionals approach and treat patients of all sizes.
Here are some potential explanations for why, in the eyes of many patients, doctor, you’re huge – a barrier rather than a support:
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Doctors are Products of a Fatphobic Culture: Despite the scientific nature of medicine, doctors are fundamentally human, shaped by the same cultural biases as everyone else. We like to believe in our objectivity, guided purely by data. However, the overwhelming data is clear: fatphobia actively hinders health and well-being. If rationality truly reigned, fatphobia within healthcare would have been dismantled long ago. The reality is, we live in a deeply fatphobic society. This bias is so ingrained it often becomes invisible unless consciously challenged. As one anthropologist aptly put it, “Culture is everything!” and healthcare is not immune to its pervasive influence. This cultural context shapes perceptions, often leading to unintentional yet harmful biases in medical practice.
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The Misguided Belief that Stigma Motivates Health: Thankfully, this perspective seems to be held by a minority within healthcare, but it’s a damagingly loud minority. This is the medical equivalent of online trolls who police fat bodies with misguided “concerns” about “glorifying obesity.” These healthcare providers mistakenly believe that stigmatizing larger bodies is a necessary tool for motivating patients towards healthier behaviors. For instance, some prominent bioethicists writing in respected medical journals have even advocated for a confrontational approach with parents of children deemed overweight, comparing it to “a diplomat dealing with a recalcitrant political regime.” This tone-deaf approach, completely detached from the realities of patient care and family dynamics, highlights the dangerous extreme of this stigmatizing mindset. It’s a stark example of how a doctor can appear huge and out of touch, creating distance and mistrust.
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Weight Loss as the Default “Good”: While the overtly aggressive stance mentioned above might be less common, a more subtle yet pervasive issue is the assumption that weight loss is always beneficial and the primary goal in healthcare, especially for fat patients. Many doctors, while not intentionally discriminatory, operate under the ingrained belief that addressing “obesity” head-on – meaning pushing weight loss – is inherently helpful. They see themselves as tackling a “disease,” and in this framework, any mention of weight, even in unrelated contexts, feels justified. My recent interview with the Washington Post highlighted this perfectly. The segment preceding mine featured a reporter who, upon seeking medical attention for a broken wrist, was immediately advised to consider Ozempic for weight loss. Every fat person has similar stories. While such anecdotes seem egregious, it’s likely the doctor genuinely believed they were offering helpful, compassionate advice. This ingrained weight-centric approach makes the doctor, you’re huge in their focus on weight, overshadowing the actual health concern.
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Weight as a Tangible Metric, a False Sense of Control: In situations of diagnostic uncertainty, doctors may overemphasize weight because it’s easily observable and quantifiable. A friend recounted his experience as an “underweight” teen struggling with undiagnosed Crohn’s disease. Despite his deteriorating health, doctors fixated on his weight, repeatedly advising him to “just eat more.” This illustrates how, when faced with complex or ambiguous medical issues, healthcare providers may default to focusing on weight – a “problem” they feel they can address – even when it’s irrelevant or even detrimental. Medicine’s training often prioritizes definitive answers and solutions. Uncertainty is uncomfortable. Focusing on weight provides a semblance of control in situations that feel overwhelming and ambiguous. In these moments of uncertainty, the doctor, you’re huge in their perceived confidence, even if it’s misplaced, and the patient feels dismissed and unheard.
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Fatphobia as a Defense Against Mortality: The culture of medicine often perpetuates a false dichotomy between physician and patient, health and illness, creating an illusion of separation and control. We categorize behaviors as “healthy” or “noncompliant,” constructing a narrative that suggests disease prevention is solely within our control, rather than acknowledging the interplay of genetics, environment, and chance. Fatphobia fits neatly into this comforting but ultimately false worldview. By blaming fat patients for their health issues, doctors maintain a sense of control and distance from their own vulnerability and mortality. It’s easier to attribute health problems to weight, placing responsibility squarely on the patient, than to confront the inherent uncertainties and limitations of medicine and the randomness of health outcomes. This defensive mechanism can make the doctor, you’re huge in their perceived invulnerability and judgment, creating a barrier to genuine empathy and connection.
grayscale photo of hospital bed
Creating a Welcoming Healthcare Environment: Moving away from judgment and stigma towards creating spaces where all patients feel seen, heard, and respected is crucial for improving healthcare experiences and outcomes.
These explanations are not justifications for fatphobia in medicine. Weight bias causes demonstrable harm, and dismantling it is imperative. Understanding the roots of this problem is the first step towards developing effective solutions. This exploration is a starting point, an attempt to understand the complex factors that perpetuate widespread and deeply damaging fatphobia within healthcare.
I am eager to hear your perspectives. Why do you think healthcare providers struggle to provide truly compassionate and effective care for patients in larger bodies? Please share your thoughts in the comments below. Let’s begin a crucial conversation towards a more inclusive and equitable healthcare system.
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I was recently featured in Ragen Chastain’s newsletter, Weight and Healthcare! It was a true honor, as her work has profoundly shaped my approach to medicine. I encourage you to read the interview.
A note on language: I frequently use the word “fat.” I understand it can be jarring, given its history as an insult. I myself spent years avoiding it. However, following the lead of courageous fat activists, I am reclaiming the word as a neutral descriptor, akin to “tall” or “brunette.”
I use “fat” to describe bodies generally and specifically when referring to individuals who embrace the term. However, I only use it with patients who have indicated their comfort with it. For many, it remains a hurtful word, and I respect that.
If you are someone in a larger body, I invite you to consider using “fat” to describe yourself. You might find it empowering. A world of body liberation awaits.
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