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.
This post originally featured on the NZHerald, here.
RESEARCH AND SHOW-NOTES
- 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)