Going to the doctors office as a person in a larger body can be a scary, frustrating, and discouraging experience. We’ve heard from clients who have had doctors, nurses, and other health professionals use their weight or their BMI to explain away pain and illness, even when they turn out to be utterly unrelated. Weight loss is prescribed in lieu of learning more about family history, running diagnostic tests, or providing a referral to a specialist. There’s nothing more disheartening than feeling like you aren’t being heard– or worse, like your voice doesn’t matter because of the number on the scale.
Weight stigma in healthcare is sadly very common. Weight stigma keeps individuals from getting the help and care they deserve. In doing so, weight stigma contributes to poorer health outcomes, more so than the weight itself. It also perpetuates the cultural belief that people in larger bodies are less deserving of care and respect– at least not until they lose the weight– which is absolutely not true.
Here at RBA, we believe in Health at Every Size (HAES). HAES celebrates body diversity, recognizing that health doesn’t have a “look” and that healthy bodies come in lots of different shapes and sizes. HAES also challenges scientific and cultural assumptions about weight and health– the very assumptions that lead healthcare providers to blame weight for medical conditions. As HAES-aligned dietitians, we work with our clients to achieve optimal health without harmful dieting or weight loss prescriptions.
We also work to empower our clients to advocate for themselves and their health with their healthcare team when faced with weight stigma. It’s important to us that our clients know that their voice deserves to be heard. Many people aren’t aware that they have a choice when it comes to their provider and the type of treatment they receive. Read on for 4 key ways to start advocating for yourself at your doctors (or other healthcare providers) office.
Read on to learn more about how you can start advocating for yourself at a doctor’s (or other health care provider’s) office.
1. Do your research
Take a look at your physicians website before setting up an appointment. It would be a lot to ask if they had HAES based information on their website- if they do BOOK THAT APPOINTMENT NOW! But the pessimist in me finds that unlikely to find someone already educated on HAES. On the HAES provider finder you can find professionals that have been added to the list, however, I have not been able to find any in my particular area. Even if they do not advertise their HAES beliefs that doesn’t mean they are not open or in agreement of it. Things to look for that are less promising… Do they have weight loss plastered across their site or “weight management” certifications listed in their provider bios. Do they have products and tools for diet plans/weight loss advertised? Do they speak about nutrition without having a Registered Dietitian on their staff? These are huge red flags. Not that it can speak for the entire group of physicians but it is certainly something to consider.
Lay the groundwork
Let’s say you are not seeing any red flags, you make an appointment. You can write a letter to your doctor explaining your views on nutrition and weight and how you would like it addressed in your appointments. You can ask that this be added to your chart. Here is an example of what to include. Here is a great letter to use if you are writing to your pediatrician on behalf of your child. Another option if you are working with a HAES aligned provider already you can have your dietitian or therapist reach out to coordinate your care with your physician to lay the groundwork for discussions around food and weight. You may want to consider having the conversation at the start of your appointment. Another option is to bring a support person with you to your appointment whether it be a spouse, partner, or friend that can back you up if you need it.
Know your rights
Did you know that you can refuse to be weighed at the doctors office. Most of the time this is their regular procedure and there might be some push back. But know that insurance does not require it, the physician has the ability to check off weight refusal in the case the insurance requests that information.
There are very few reasons that your physician would need a current weight value. Such exclusions may be that you have Congestive Heart Failure- in that case daily weights checking for fluid retention are needed, in eating disorder treatment and it is part of medical stability assessment, certain medications, certain procedures/surgeries involving anesthesia, perhaps others that I am unaware of but you have the right to ask WHY they need it! If they do need a weight or you don’t mind that they weigh you you can ask for a blind weight- that is back to scale so you don’t see the number. However, it is important to know that sometimes that weight will end up in your electronic chart you access online, on lab slips, or in a summary of your visit print out. It is important to know this in the case you have decided not to see the weight and then it pops up unexpectedly.
Weight has been brought up as a treatment or problem, what to say
First, weight and health are not one in the same. You cannot tell a person’s health by the number on the scale. There is an immense amount of weight bias that occurs that can lead to dismissing symptoms chalking up to weight or withholding treatment options and expecting “diet and exercise” to suffice. For example someone with knee issues in a larger body may be prescribed weight loss. VS> someone in a smaller body being offered cortisone shots, physical therapy, pain management etc. Many times medical recommendations are made with little knowledge of a person’s actual health behaviors such as a suggestion to “eliminate red meat” when speaking to a vegetarian or “exercise 30 minutes a day” to a training runner. I urge you not to accept weight loss as a “treatment” for a medical condition. I know it is what we are taught in our culture and what physicians are taught in school- it doesn’t make it right or helpful! Here are some questions to ask as written by Ragen Chastain in her blog Dances with Fat…
What are the interventions available perhaps that you would recommend to those in smaller bodies?
The research shows that 95% of those who lose weight by dieting will regain the weight by 2-5 years. Do you have any research based recommendations that are safe and sustainable?
Weight stigma is associated with decreased health outcomes, I would prefer we do not focus on my weight.
Give them the research!
|Weight Neutral Approach Outcomes||Weight Focused Approach Outcomes|
Improved lab levels of blood lipids and blood pressure
Improved psychosocial outcomes such as mood, self esteem, body image, and depression
Which were maintained at the 2-year follow up.
Increase risk for osteoporosis
Increased chronic psychological stress & cortisol production
Increased anxiety about weight
Eating disorder behaviors
After the appointment
If you are not at peace with how your appointment went you have every right to change providers. Maybe the appointment was triggering to past experiences. It is important to check in with your therapist and/or dietitian after these types of appointments to process through the events, challenge beliefs and stigma, and reaffirm your intentions and goals. Providers that discriminate based on body size are effectively doing harm. It is important that you have a provider that supports your health, not diminishes it. You may also decide to write a letter at this point giving your reason for leaving the practice with the hope that this is an opportunity to educate them and for you to speak out and have your voice heard.
Advocating for yourself (or as a support person or for your child) can be intimidating and uncomfortable. It is awful that you would even have to consider fighting for your right to respectful healthcare. Yet in our diet culture and medical environment is it often necessary. Please know that your body does not have to be the one to change, our system is.
If you want any support or to talk more about advocating for yourself in the doctor’s office, email us! Or call us! We would love to speak with you, about going to the doctor or anything else. Email us at [email protected] and call us at 301-474-2499. We also have resources about Health at Every Size.
Blog contributions by Kristin Jenkins, RBA Nutrition Intern
Dana uses her advanced training in functional nutrition and food sensitivities to help her clients love and trust food again as they heal from years of painful symptoms that have dominated their lives. Co-author of Nourished: 10 Ingredients to Happy, Healthy Eating and Cooking with Food Sensitivities Survival Guide.