Weight Stigma Is the Deadly Problem Keeping Patients From Getting the Care They Need

Ellen Maud Bennett, 64, a Canadian costume designer with a penchant for fresh lobster, peonies, and the “perfect shrimp-wonton soup,” spent years feeling unwell. But when she sought medical intervention, no one offered suggestions beyond weight-loss treatments. When her cancer was finally discovered, she had only days to live. “Ellen’s dying wish was that women of size make her death matter by advocating strongly for their health and not accepting that fat is the only relevant health issue,” her obituary read.

Bennett’s case may be extreme, but when it comes to weight, doctors often have a big blind spot. When a heavier patient comes in with symptoms but a doctor sees only fat, it can mean treatment will fail to help her get healthier or, worse, will add to her health issues. Weight stigma may even be part of what causes the laundry list of risks we typically hear linked to being heavier. Studies show weight shaming can cause spikes in levels of cortisol, the stress hormone that can contribute to high blood pressure, diabetes, and heart disease—“the very conditions that doctors blame on an individual’s weight,” says Louise Metz, M.D., a board-certified internal medicine physician. And the stress of constantly being judged for your size? Ironically, it’s been linked to weight gain—a 2018 academic opinion paper that examined nearly 70 studies on weight stigma found that it led people to eat more.

Making matters more complicated, the stigmas and biases associated with being fat are almost impossible to escape: “Weight stigma affects so many life experiences—from the size of chairs to the pace of exercise classes to the availability of good medical care,” says Deb Burgard, Ph.D., a fellow of the Academy for Eating Disorders. Even the terminology used to describe larger bodies can be shaming. Overweight reinforces the idea that larger bodies are somehow wrong, and obese pathologizes the ratio of weight to height, even though it’s not always a great indicator of health. (That’s why fat advocates like me prefer terms like fat, larger, heavier, and plus-size.)

Jessica, a 31-year-old who works in retail, had a history of eating disorders that started when she was 10 and was bullied about her weight at school. As an adult, she started to get a foothold on healthier habits, but fat-shaming encounters with a doctor can still trigger destructive behaviors around food. “Recently I went to a gastroenterologist who insisted I [must have] a fatty liver due to my size,” she says. Blood work and an ultrasound revealed her liver was perfectly healthy, but the episode triggered a relapse of her eating disorder. Even though her liver was healthy, her doctor didn’t look beyond her size.

Stories like Jessica’s aren’t uncommon—women dealing with weight stigma are actually at a greater risk for eating disorders, says Chevese Turner, chief policy and strategy officer at the National Eating Disorders Association. “Often the same behaviors that would be considered red flags in thin people”—obsessively counting calories, going overboard at the gym, developing a preoccupation with the scale or with food—“are seen as positive behaviors for ‘weight management’ in plus-size people,” Turner says. “In some cases they’re even celebrated by doctors.”

But that’s not the only way weight stigma can affect patient care. After injuring herself in a fall, Gretchen, a woman in her 40s, made an appointment with an orthopedist. Instead of discussing her options for hip surgery, she was told it was “too dangerous” given her weight and her diabetes. When she pressed for further evaluation, it was suggested she wouldn’t be able to fit into an MRI machine. (She’d had an MRI a few weeks before and fit in the machine just fine.) Instead, another risky procedure was recommended: weight loss surgery. “I was left with the feeling that I was fat, it was my fault due to a lack of character, and I only had one option: permanent life-altering surgery that came with not only gigantic physical trauma but more than likely emotional distress,” she says.