Doctors are ‘fat shaming’ patients and discriminating based on size

A professor of psychology has told a conference of top experts that "disrespectful treatment and medical fat shaming" could be costing lives.

Dr Joan Chrisler, a professor of psychology has told the 125th Annual Convention of the American Psychological Association that medical 'fat shaming' is taking a toll on people's health. The health and social psychologist says that doctors are discriminating against people based on their size and negative stereotypes of overweight people:

"Disrespectful treatment and medical fat shaming, in an attempt to motivate people to change their behaviour, is stressful and can cause patients to delay health care seeking or avoid interacting with providers."

Professor Chrisler also said that size discrimination can mean people receive inappropriate care from their doctors:

"Sizeism can also have an effect on how doctors medically treat patients, as overweight people are often excluded from medical research based on assumptions about their health status - meaning the standard dosage for drugs may not be appropriate for larger body sizes."

Indeed, recent studies have shown frequent under-dosing of overweight patients who were prescribed antibiotics and chemotherapy. Worryingly, another review of over 300 postmortem reports showed obese patients were 1.65 times more likely than others to have significant undiagnosed medical conditions (such as endocarditis, ischemic bowel disease or lung carcinoma), indicating misdiagnosis or inadequate access to health care.

"Recommending different treatments for patients with the same condition based on their weight is unethical and a form of malpractice. Research has shown that doctors repeatedly advise weight loss for fat patients while recommending CAT scans, blood work or physical therapy for other, average weight patients. In some cases, providers might not take fat patients' complaints seriously or might assume that their weight is the cause of any symptoms they experience. Thus, they could jump to conclusions or fail to run appropriate tests, which results in misdiagnosis."

Chrisler also told the world-renowned conference that negative attitudes amongst doctors can also cause psychological stress in patients:

"Implicit attitudes might be experienced by patients as microaggressions. For example, a doctor's apparent reluctance to touch a fat patient, or a headshake, wince or 'tsk' while noting the patient's weight in the chart. Microaggressions are stressful over time and can contribute to the felt experience of stigmatisation."

A medicalised view of weight conceptualises fatness as a disease and weight loss as a cure, says Dr Maureen McHugh, a psychologist who also presented research on fat shaming to the APA conference. Dr McHugh says that fat shaming on social media has become prevalent and weight is the most common reason children are bullied in school with 85 percent of surveyed adolescents reportedly seeing overweight classmates being teased:

"Stigmatisation of obese individuals poses serious risks to their psychological health. Research demonstrates that weight stigma leads to psychological stress, which can lead to poor physical and psychological health outcomes for obese people."

Both Chrisler and McHugh argue that it is essential for weight stigma to be addressed in psychology and the medical profession - in training, in theory and research, and in working with overweight clients. But, warns Dr McHugh, treatments should focus on mental and physical health as the desired outcomes for therapy - not on weight.