Your Doctor Is Probably Not Fat-Shaming You

Last week, the Washington Post published one doctor's remembrance of the emotions associated with treating a morbidly obese patient. The doctor was condemned for purported "fat-shaming." Is your doctor really fat-shaming you?

The Washington Post piece, by Edward Thompson, is meant to evoke in the reader a sense of "there but for the grace of god go I" towards a man that weighs 600 pounds. If read with an ungenerous spirit, its tone in some places could be seen as harsh. Yet the backlash is not unique to this story; stories abound online of "fat shaming" experiences in doctor's offices across the country. Among some of the more prominent proponents of the fat acceptance movement, the idea that doctors routinely fat-shame their obese patients has reached the status of conventional wisdom.

Common sense tells us that there are most certainly some doctors with poor bedside manner. There are most certainly doctors who have made rude remarks and acted callously towards their obese patients. There is most certainly a need for doctors to be trained to act and speak with sensitivity, both to avoid turning off their own patients, and for the sake of manners. And it is most certainly a fact that it is not easy being an obese person. Empathy for those who face serious challenges in life is a hallmark of common human decency.

That said: the fact that some doctors may at times be rude to obese patients is something very different from the supposition that virtually any suggestion by a doctor that an obese person should diet, exercise, and lose weight amounts to "fat shaming." We can all agree that doctors should not be rude; likewise, (I hope) we can all agree that doctors are medical professionals whose task it is to advise patients on their health issues. Obesity is a serious health issue. It is a doctor's duty to do what they can to help an obese patient to lose weight—which includes pointing out to them, in a polite and constructive way, that they are obese, that losing weight would be good for their health, and how to best accomplish that.

I am only saying all this because it often seems that those who speak out most publicly against the idea of fat shaming by doctors have a rather expansive view of what "fat shaming" is. A few examples—first, from an October 2011 essay about an overweight woman's visit to the gynecologist, published on XO Jane:

"I'm not concerned about it," I said tightly [when the doctor advised her to lose weight], "and if it comes up again I'm going to have to find another doctor."

"Any other doctor would tell you the same," he said, as though I hadn't been coming to him, just as fat as now, for several years.

"Well, I prefer a doctor who at least waits to hear what I eat before telling me to eat less."

He looked exasperated. "There's no possible way you're not eating too much."

After that, I was sort of blinded by a fine mist of fury particles for a little while

From a November 2011 essay on XO Jane:

Last Tuesday, I went to my gynecologist for my annual. My doctor is a cool lady, and even gave me a recommendation for her favorite sex toy shop, so I have a lot of respect for her. I was not so cool with what happened after the exam, however.

"So, I've noticed that you've gained 19 pounds in the past six months. Maybe you should think about changing your lifestyle habits."

Given that I am aggressively working on dealing with the stress-related eating and lack of exercise that led to this weight gain, I was predictably pissed.

And a January 2014 essay on XO Jane:

"You should really be watching your weight," [the doctor] said, which created a momentary vision in my mind of being asked to watch a friend's luggage at the airport while she darts to the bathroom to take a pee, but I know that's not what she meant.

"Watch your weight" is code for "get less fat."

The thing is, I know that the science behind "fat=unhealthy" is bad. I've read numerous studies on the subject and I've written about it. I could have countered her on purely medical grounds with discussions about set points and health as a complex issue, and how fat hatred and the diet industry drive mainstream medical approaches to weight. And I could have said, too, that people have a right to be treated like human beings regardless as to their weight and health risks.

What these essays have in common are a knee-jerk sense of being insulted when a doctor advised the writer—all of whom were, in fact, significantly overweight or obese—to lose weight. In all three cases, trained medical professionals gave their patients the entirely unremarkable advice that they should lose weight. And in all cases, the patients responded by getting angry at a perceived insult, rather than by taking what they were they were being told to heart. (We will not get into the discussion here of the last writer's dubious assertion that "the science behind 'fat=unhealthy' is bad.")

If you meet someone at a party, it is not appropriate to remark upon their weight. If you meet someone at the gym, it is not appropriate to remark upon their weight. As a matter of fact, the inside of a doctor's office is one of the only places in the entire world where it is appropriate to remark upon someone's weight. We go to our doctors for the hard medical truth. "You drink too much," they tell us. "You have erectile dysfunction." "You have too much stress." "You don't sleep enough." "Your diet is terrible." "You need to stop smoking." "You need to stop having unsafe sex." And, yes, "You need to lose weight."

This is a doctor's job. Of course many things that doctors tell us are uncomfortable. That is why our interactions with our doctors are confidential (until we write an essay about them). Still, we listen to our doctors, because—though we might wish we did not have to heed their advice—we know that their advice is given with the goal of improving our health. It may not be pleasant to answer in-depth questions about exactly what we're eating, drinking, smoking, and fucking. It may not be fun to hear stern words of warning about our poor lifestyle choices. But we listen, because it is for our own good. Even if we already know that some of these things are bad for us, our doctors still tell us, because hearing these things from a doctor can often instill us with the fear-based motivation we could not find within ourselves. It is irresponsible to tell people that they should ignore a doctor's valid medical advice simply because it is unpleasant to hear.

Shame is a natural feeling. Obesity is a challenging condition. Losing weight is hard work. There are countless obstacles to doing so. Your doctor is probably not one of them.

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