Patients call out fat-shaming doctors for hurting their health: ‘I always go in with my guard up’

The first time Patty Nece can remember experiencing weight stigma was in third grade. A nurse wheeled a scale into her classroom, then proceeded to weigh every child in front of the entire class.

“I didn’t want to get on that scale,” Nece tells Fortune. “She said to me, ‘You’re fat, you need to lose weight,’ in front of everybody in the class.”

Nece adds, “Incidents like that just cut you to the core. It still stings.”

Liz Paul had a similar experience as an adult, at a visit with her OB/GYN for an intrauterine device (IUD) insertion procedure. The doctor spent 20 minutes trying to insert it, while Paul writhed in pain and discomfort on the table. Then he gave up, telling her she was “too fat” and that he “can’t work with people like you,” she recalls.

“I always go in with my guard up, because I'm always expecting something from a health care setting,” Paul tells Fortune. “It’s exhausting to have to do that, and not know if health care is going to have your back.”

For their entire lives, Nece and Paul have felt stigmatized for being in larger bodies, something that has impacted their quality of health care and trust in doctors. And they are not alone—a study published in the International Journal of Obesity in 2021 found that over 40% of American adults experience weight bias at some point in their lives. Up to 80% have experienced weight stigma in medical settings, according to recent findings. And TikTok is full of people sharing such experiences.

“Stigma ranges from how someone feels in the appointment to how the doctors are talking to them about their weight,” says Mckinzie Burrows, a spokesperson at the non-profit Obesity Action Coalition. “It’s pervasive.”

And weight-based discrimination in a medical setting can be harmful to obese patients’ health, explains an article published through StatPearls, making them “more likely to cancel appointments and avoid future preventative health care, ultimately increasing their medical risks and healthcare costs.”

But even for patients who do not technically have obesity—defined as a body mass index (BMI) of 30 or higher—there is evidence that facing weight stigma in a doctor’s office may lead to a 60% increase in mortality, according to one study. Other research has found that weight stigma pushes patients to avoid screenings that can “lead to delayed cancer diagnoses, increasing morbidity and mortality.”

Says Lisa Howley, a senior director in the American Association of Medical Colleges’ Department of Medical Education, “Weight is one of the most stigmatized aspects of patient care.”

Reasons for weight-bias in the medical world

Weight bias is pervasive in medical settings, say experts, both because of the lack of education doctors receive around the topic and because weight is wrongfully utilized as the best indicator of a patient’s health.

“Health and weight are not the same thing but people treat them like they are,” says Katherine Flegal, epidemiologist and former senior scientist at the Centers for Disease Control and Prevention's National Center for Health Statistics. In fact, she says, “evidence is limited that weight loss will benefit you.”

Researchers behind a 2024 meta-analysis published in the British Journal of Sports Medicine found that cardiovascular fitness is a much stronger indicator of someone’s health than their weight. “Compared with normal weight-fit individuals, overweight-fit and obese-fit had no significant increase in risk of all-cause mortality,” the study noted.

“There are a number of misconceptions over how your body regulates weight,” Dr. Francesco Rubino, a renowned bariatric surgeon, previously told Fortune. He says our body weight is just as regulated as our red blood cells—which is largely out of our control.

Doctors receive minimal education about weight stigma and obesity and can carry their own internalized weight bias into appointments—especially given the focus on BMI, which throws patients into categories of “overweight” and “obese,” says Burrows. “A lot of schooling does not focus on stigma.”

A study from October 2023 found that 40% of resident physicians agreed with the statement, “Fat people tend to be fat pretty much through their own fault,” while almost half agreed with the statement, “Some people are fat because they have no willpower.”

But things may be changing. Dr. Lydia Alexander, president of the Obesity Medicine Association (OMA), says that the OMA works to educate doctors about proper obesity care as well as weight stigma. And Howley of the AAMC points out that some medical schools have made weight-bias education a priority, including Rutgers University and Johns Hopkins University. She adds that while the AAMC has addressed the issue directly, it does not control the curricula at U.S. medical schools.

The American Medical Association (AMA) also recognized, in 2023, the various issues with BMI, suggesting it be used only in conjunction with other risk factors to make medical assessments.

Fallout of patients avoiding necessary care

Nece says that she always hesitates to go to a doctor. “I’ve felt like they’ll just blame everything on my weight, it’ll be embarrassing, and a waste of time,” she admits.

Paul, who was embarrassed by her school nurse so many years ago, worries not only about the quality of care she’ll receive, but also the shame she’ll feel based on what they say about her weight. “I always feel like it’s a successful doctor appointment if I don’t go cry in my car afterwards, which unfortunately doesn’t happen all that often,” Paul says.

Such hesitation to seek care can lead to dangerous repercussions for higher-weight people.

“[Weight stigma] drives patients to not get preventative care and to wait until something they’re experiencing—a symptom or a health issue—is advanced, so they miss out on early treatment and early detection,” says Ragen Chastain, a patient advocate and health coach who has personally battled weight stigma. One study, for example, found that people with higher BMI tend to delay care and switch doctors more frequently in an attempt to avoid stigma.

“It has real implications,” says Chastain, who has also authored two books about living in a larger body.

And that, in turn, can lead to having lowered trust in medical professionals. Nece says doctors assume larger-bodied people like herself lie about their food intake and exercise if the providers don’t see the results they urged.

In one case, a dietitian was disappointed that Nece didn’t lose weight after a month of being on her diet plan, deciding she no longer wanted to work with Nece—who, in turn, “internalized it all.”

While numerous studies have linked higher weight to comorbidities such as Type 2 diabetes, high blood pressure, and heart disease, solely focusing on weight loss is likely not the right answer for everyone, and can further perpetuate stigma, says registered dietitian Marlena Tanner.

“I think we’re so used to prescribing weight loss without really looking at the whole picture,” she says.

Doctor’s office weight stigma could even spark or retrigger eating disorders for those who are susceptible, experts say. A study in the International Journal of Obesity found that weight stigma is “significantly associated with greater disordered eating.”

That resonates with patient Karen Graves. She has long lived with a diagnosis of atypical anorexia, an eating disorder often missed because it is diagnosed in people of higher weights.

She recently told a friend she thinks she’d be healthier if she didn’t see doctors at all.

“It’s just very disconcerting to try and get healthcare,” Graves, 72, says, noting she is often disbelieved about having an eating disorder. “It makes me feel disregarded, that my health doesn’t matter.”

Vivian Lee, an eating disorder therapist, believes those most at risk of engaging in unhealthy weight loss behaviors are those who struggle with body dysmorphia—having a preoccupation with perceived flaws in physical appearance that others don’t see. But she doesn’t entirely blame physicians, noting that most weren’t given the tools to discuss weight loss and diet in more inclusive, sensitive ways.

How to talk to your doctor

As the medical community catches up to the latest research, experts advise anyone struggling with weight stigma to advocate for themselves at the doctor.

“As the patient, you have more power than people sometimes think you do,” Lee says.

Here are tips from Tanner and Lee about how to handle conversations about weight, both wanted and unwanted:

• You don’t have to step on that scale. “You can decline getting weighed. You have that right as a patient,” Tanner says

• Have an upfront discussion with your doctor. Lee suggests asking your provider not to make comments about your weight, dieting, or weight loss.

• Provide your doctor with resources. Organizations such as the Obesity Action Coalition and articles in the National Library of Medicine are helpful places to start.

• Shift the conversation. Tanner says doctors should be asking, “Do you feel healthy in your lifestyle? How do you feel about your eating?” rather than prescribing weight loss, she says. And you can take the lead.

• Work with a dietitian. Try it, if it’s financially feasible. Then see if the dietitian and your doctor can communicate about your care.

• Switch doctors. Don’t be afraid to move on.

“If you’re leaving the appointment feeling any type of shame or discomfort or guilt about eating or your body, that’s a clue that something went wrong,” Tanner says. “You never have to continue with a provider that is damaging.”

This story was originally featured on Fortune.com