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  • Writer's pictureSasha Borissenko

EPISODE 6. A dose of fat and health

Why is it so hard to digest that you can be fat and healthy? And why is weight seen as a prerequisite at the doctor’s office? For a dose of health and fat, medical prejudice, and more, check out episode 6 of Chewing the Facts.

When Kylie* received her childhood medical records, she was shocked to learn her doctor said she wasn’t honest about revealing her food diary details as an 8-year-old.

“Even as a child, I wasn’t believed and I always had the worst thought about me by medical professionals.

“The thing is, if he had just talked to me about it, he’d know that at home there was no access to food, especially ‘unhealthy food’.”

Even though the food in question was locked away in a filing cabinet, Kylie’s doctor encouraged her to go to weight-loss programme Jenny Craig when she was just 10.

Her case is not unusual. In 2021, almost 60 per cent of 14,000 adults in weight-loss programmes in Australia, Canada, France, Germany, the UK and US reported weight bias, with two-thirds of it coming from doctors.

A 2021 meta-analysis looked at 41 studies highlighting negative attitudes among health professionals towards fat people. Fat patients experienced patronising and disrespectful treatment and all their health issues were attributed to weight. More than half of patients avoided, delayed or cancelled appointments as a result.

Research shows weight stigma undermines health behaviours and preventative care, causing disordered eating, decreased physical activity, healthcare avoidance, weight gain and increased risk of early death.

Although Kylie has a family history of bowel cancer and has been losing weight dramatically for a year, her doctor has not pursued further testing.

“Because of my size, [my doctor says] it obviously can’t be that. It’s probably just ‘all the bad food that I eat’. I think my GP is just happy that I’m losing weight.”

One doctor, Florence*, told Chewing the Facts that telling people to lose weight even when it might be irrelevant was embedded in the healthcare system.

“It’s interesting the degree of defensiveness doctors have when any suggestion that they personally could be biased comes up.

“I wonder if some of the reluctance around doctors really getting on board with addressing weight stigma is [there’s] cognitive dissonance that ‘I can’t be biased because I’m a good doctor and I’m caring and you know I want the best for all my patients and so I couldn’t be contributing to poor [health outcomes]’.”

As a medical professional, she has witnessed colleagues openly mocking fat people by suggesting they be sent to the zoo for MRI scans, for example.

It was not only dehumanising and factually incorrect, it also meant the person needing an MRI went untested, she said.

Doctors in Aotearoa are required to follow Ministry of Health clinical guidelines to promote weight management.

Director-general of health Diana Sarfati said monitoring weight over time was important from an individual health outcome perspective, regardless of a person’s weight status.

“I’ll start by saying the Ministry of Health is very much against any kind of prejudice or discrimination against anybody on any basis, including how much they weigh.

“People with a higher BMI feel unwelcome, they’re unable to access the services they need, and that is a real problem and would absolutely be something that would be of concern to us.”

*Not their real names

Chewing the Facts - new episodes every Sunday. Produced with the NZ Herald, with support from NZ On Air.

You can follow the podcast at iHeartRadio, Apple Podcasts, Spotify, or wherever you get your podcasts.

This post originally featured on the NZHerald, here.


- The prevalence and practice impact of weight bias among New Zealand registered dieticians

- 'Fitness and fatness': Not all obese people have the same prognosis; second study sheds light on 'obesity paradox'

- Obesity paradox in caucasian seniors: results of the PolSenior Study

- Obesity or BMI paradox? Beneath the tip of the iceberg

- 'Obesity paradox' debunked in new research

- Impact of obesity on bone metabolism

- Weighing up weight loss advice

- Obesity stigma: Important considerations for public health

- Individual and aggregate years-of-life-lost associated with overweight and obesity

- Does being overweight really reduce mortality?

- Obesity and its relation to health and disease

- Obesity: An overblown epidemic

- Flawed methods and inappropriate conclusions for health policy on overweight and obesity: the Global BMI Mortality Collaboration meta-analysis

- The obesity wars and the education of a researcher: A personal account

- Dissonance in naming adiposity: a quantitative survey of naming preferences from a convenience sample of health professional and lay population in Aotearoa New Zealand

- The violence of fat hatred in the “obesity epidemic” discourse

- Weight stigma in the COVID-19 pandemic: a scoping review

- Weight bias during the COVID-19 pandemic

- The metabolically obese, normal-weight individual revisited

- Metabolic and body composition factors in subgroups of obesity: what do we know?

- The obese without cardiometabolic risk factor clustering and the normal weight with cardiometabolic risk factor clustering: prevalence and correlates of 2 phenotypes among the US population (NHANES 1999-2004)

- Cardiometabolic disease risk in metabolically healthy and unhealthy obesity: Stability of metabolic health status in adults

- Healthy eating index and obesity

- Fitness vs. fatness on all-cause mortality: A meta-analysis

- Medical Council of New Zealand: Conduct & professionalism

- “Best Practice” for patient-centered communication: A narrative review

- The HONDA patient population- Hypertensive, Obese, Non-Compliant, Diabetic and Asthmatics- in the U.S. is a significant driver of healthcare costs

- The New Zealand medical workforce 2022

- Peer victimization, psychosocial adjustment, and physical activity in overweight and at-risk-for-overweight youth

- The burden of weight stigma

- How do weight bias and stigma affect patients with obesity?

- A nationwide study of discrimination and chronic health conditions among Asian Americans

- A multilevel analysis of the relationship between institutional and individual racial discrimination and health status

- Perceived racism and cardiovascular reactivity and recovery to personally relevant stress

- Disentangling the effects of racial and weight discrimination on body mass index and obesity among Asian Americans

- Perceived stress following race-based discrimination at work is associated with hypertension in African-Americans. The metro Atlanta heart disease study, 1999-2001

- Chronic exposure to everyday discrimination and coronary artery calcification in African-American women: the SWAN Heart Study

- Unfairness and health: evidence from the Whitehall II Study

- Weight discrimination and risk of mortality

- Impact of weight stigma on physiological and psychological health outcomes for overweight and obese adults: A systematic review

- The stress of stigma: exploring the effect of weight stigma on cortisol reactivity

- Associations between perceived weight discrimination and the prevalence of psychiatric disorders in the general population

- Self-reported racial discrimination and substance use in the Coronary Artery Risk Development in Adults Study

- Recent experiences of weight-based stigmatization in a weight loss surgery population: psychological and behavioral correlates

- Psychosocial variables associated with binge eating in obese males and females

- Weight-based stigmatization, psychological distress, & binge eating behavior among obese treatment-seeking adults

- Body image and psychosocial differences among stable average weight, currently overweight, and formerly overweight women: the role of stigmatizing experiences

- Risk factors for bulimia nervosa. A community-based case-control study

- Abuse, bullying, and discrimination as risk factors for binge eating disorder

- Teasing history, onset of obesity, current eating disorder psychopathology, body dissatisfaction, and psychological functioning in binge eating disorder

- Clinical Guidelines for Weight Management in New Zealand Adults

- Economic impact of excess weight in Aotearoa

- Weight bias among health care professionals: A systematic review and meta-analysis

- The roles of experienced and internalized weight stigma in healthcare experiences: Perspectives of adults engaged in weight management across six countries

- Obesity stigma: Important considerations for public health.

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