How would you know?

When someone in a marginalized body shares a deep fear with you and your first answer is, “Well, I work in that field and I’ve never seen that,” you are in the wrong.

Especially if you do not share that marginalization.

Especially if you are a healthcare provider.

Especially if that fear is well-founded, well-documented and likely.

Two times recently I have seen thin healthcare providers insisting that they have never seen weight stigma in action at their workplaces. Ever. (In the context of hospital care and eating disorder treatment, respectively.)

Dear healthcare providers in smaller bodies:

How.
Would.
You.
Know?

Do you think weight stigma only happens when doctors rub their hands together, cackle evilly and decide to kill a fat patient? Of course not.

It happens when you don’t glance quite as carefully at a fat patient’s chart.

It happens when you’re slightly more skeptical of a fat person’s pain.

It happens when you prescribe weight loss.

It happens when you assume a fat client is noncompliant.

And it happens in ways that are documented in both a thousand thousand lived experiences and in actual studies. For instance, we know that during the H1N1 flu pandemic, fat patients were systematically treated later with anti-virals. (And had worse health outcomes.) And we know that fat people with eating disorders can’t get diagnosed, can’t access treatment, and even get different diagnoses (see: atypical anorexia).

If your first response to fears of or discussion of weight stigma is to defensively announce that YOU have never seen any of that, you are actively doing harm, you are gaslighting fat people, and you’re part of the problem.
Because if you don’t see weight stigma in action all around you, you’re not looking.

Even those people

I had a conversation this week with a healthcare provider who presented me with a rather startling claim: that both she and the hospital for which she works are not only entirely free of weight stigma or bias, but perfect in their handling of patients. Even patients with a very high BMI, to use her wording.

I’d like to explore that word “even” for a moment, since we see it used a lot in regards to fat people. 

“Even” fat people.
“Even” people who need mobility assistance.
“Even” people with very dark skin.

Have you ever heard “even” used to refer to people with significant amounts of body privilege? Me neither. In a similar vein, no one ever gripes about the need to accommodate children and their unusually small (when compared to thin adult) body sizes, because children are valued in our culture (particularly the thin, white, abled ones).

The word “even” positions people in fat bodies as removed from “normal” patients and presents them as an aberration, a population that requires effort and sacrifice to accommodate. Rather than it being assumed that it’s equally important and necessary to serve bodies of all sizes, some bodies are considered optional, an extra burden.

Hunting for an MRI

A friend recently traveled 175 miles for an appointment at the only MRI machine that would accommodate her body. Not long after, a second friend mentioned to me that they had used the same machine. Is it the only MRI machine within two U.S. states that will hold fat bodies and is patient-accessible outside hospitals and bariatric centers? It seems so. And that only goes so far: I’m not sure what folks over a size 32 or so do for MRIs, because that machine won’t hold them.

(It’s both ironic and informative that much of the equipment build to accommodate fat bodies is only available in bariatric centers, which are devoted to quite literally erasing fat bodies. They may want to delete us, but they’re willing to serve “even” people like us.)

Perfection and bias

To come back to the initial claim of perfection, and to give the claimant a small amount of credit, her claim only extended to her, the specific part of the hospital in which she works, and that portion of the hospitals in which she’d previously worked. But the claim is still ludicrous on its face.

You were steeped in weight bias from the time you could first understand language. So was I. So is everyone in most areas of the planet. It is not possible to be perfect in our understanding of fat oppression and weight stigma, and it is not possible to be completely free of fatphobia. Consequently, it’s just not possible to be perfect in how we treat people in fat (and other marginalized) bodies, though of course it’s something we can work every day to improve.

And yes, we can have fatphobic thoughts and act in fatphobic ways even when we don’t intend to. Part of what’s so insidious about weight stigma is that it can happen even when someone is a well-meaning good person. It doesn’t have to be planned or even intentional. And often it’s not noticeable to people who aren’t subject to it. So when people ask you to consider that environments in which you were comfortable and in which you liked all the people around you may not have been good for people in marginalized bodies, it’s not an insult. It’s just another area where you may not have been aware of every dynamic present.

If you are a healthcare provider who wants to be good to fat people, here’s a start:

Stop talking about fat people like we’re some enormous (pun ever so intended) burden to manage. Then sit with your defensiveness around the fact that you probably have some weight stigma kicking around in your brain.

I could give you a generic list of ways to improve your workplace as a provider, but getting past your defensiveness and some of your internalized weight stigma is the first step, since it provides the foundation for action. When you fully believe that fat people are equally worthy, you’ll begin to see areas for improvement in both yourself and your hospital or office or clinic or practice, from having large blood pressure cuffs available to advocating for more inclusive medical equipment or sturdier massage tables.

If you want more specific guidance, I and a number of other fat folks are happy to guide you. Now is a good time to start.

Let’s dig deep.

Every Monday, I send out my Body Liberation Guide, a thoughtful email jam-packed with resources for changing the way you see your own body and the bodies you see around you. And it’s free. Let’s change the world together.