Weight Stigma Awareness: Advocating For Yourself at the Doctor

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 unrelated. 

Weight loss is often prescribed in lieu of learning more about a patient’s 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.

What is weight stigma?

Weight stigma awareness is essential for understanding how biases in healthcare settings can negatively impact patient care, particularly when doctors focus solely on weight loss rather than addressing specific health concerns. Weight stigma refers to the discrimination of a person for being in a larger body. Weight stigma at the doctor’s office might look like a person in a larger body being prescribed weight loss to address knee pain, while a person in a smaller body with the same knee pain being prescribed physical therapy, cortisone shots, or surgery.

Weight stigma at the doctor’s office 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.

What does weight-inclusive care look like?

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. By promoting weight stigma awareness, we can encourage patients to advocate for themselves, asking for alternative treatments when weight loss is suggested as a universal solution.

How to confront weight stigma and advocate for yourself at the doctor’s office

1. Do your research and find a quality provider

Take a look at your physician’s website before setting up an appointment. If you see any mention of Health At Every Size or weight inclusive care– BOOK THAT APPOINTMENT NOW! You may also be able to use the HAES provider list to locate providers in your area. Even if they do not advertise their HAES beliefs that doesn’t mean they are not open or in agreement with it. 

Be on the lookout for these red flags when searching for a provider: Do they have weight loss plastered across their site or “weight management” certifications listed in their provider bios? Do they endorse bariatric surgery or GLP-1’s for weight loss? Do they have supplements, meal plans, or other dieting “tools” advertised for purchase? Do they speak about nutrition or meal plans without having a Registered Dietitian on their staff? 

These could indicate the provider or practice is more interested in changing the shape of your body than addressing your holistic health concerns. Increasing weight stigma awareness helps patients recognize and challenge the unfair practices they may encounter at the doctor’s office, such as assumptions that all health issues stem from their weight.

2. Be proactive about discussing your healthcare goals and boundaries

Once you’ve found a provider, you might find it helpful to write a letter to your doctor explaining your views on nutrition and weight and how you would like it addressed in your appointments. You may also write a letter on behalf of your child or loved one. You can ask that this letter be added to your chart for future reference. 

At your first appointment, consider making your wishes about your care, and how you would like nutrition and weight discussed, known at the beginning of your visit. You may say something as simple as “I would prefer not to discuss my weight in our appointments, and only discuss treatment for my [insert condition] that does not include weight loss or dieting.” You may also say “I am working with a dietitian on my nutrition plan. If you have any concerns about my diet or eating, you have my permission to contact her directly.” If you feel uncomfortable having this conversation, you might consider bringing a support person with you, like a spouse, partner, parent, or friend. 

If you are already working with a HAES provider, you can have your dietitian or therapist reach out to coordinate your care and assist you in laying the groundwork for discussions around food and weight.

3. Know your rights as a patient

Advocating for yourself starts with cultivating weight stigma awareness, empowering you to ask for evidence-based treatments and to remind healthcare providers that health is not defined solely by body size.

Did you know that you can refuse to be weighed at the doctor’s office? Many offices treat stepping on the scale as a routine and mandatory part of your visit– but insurance does not require it. Your physician has the ability to check off “weight refusal” on your chart in the event your insurance requests that information.

With few exceptions, there is no need for your physician to know your weight or BMI. Those few exceptions might include congestive heart failure (where your weight is monitored to measure fluid build up around your heart), or eating disorder treatment (where your weight is monitored to assess medical stability). Your provider may also need to know your weight to prescribe the proper dose of medication or anesthesia. In any case, you have the right to ask WHY your provider needs your weight. This is called providing “informed consent.”

If your provider does require a weight for medical reasons, you may request they take a blind weight, where you stand with your back to the scale to avoid seeing the number. Please note that even if your weight is performed blind, the number may show up on your visit summary or in your online patient portal.

4. Know what to say when your weight has been brought up in an appointment

It’s important to understand that weight and health are not one in the same. You cannot tell a person’s health by the number on the scale. There are many conditions that are blamed on weight as the cause, yet research indicates that weight does not cause conditions like diabetes, heart disease, hypertension, PCOS, and more. How do we know? Because people in smaller bodies get these conditions as well. 

Being told to lose weight to treat your condition when someone in a smaller body is offered medication, surgery, or specialist referrals is an example of weight stigma. Being told to change your diet and exercise routine without first being asked what you eat or how you exercise is an example of weight stigma. Being told that you are unhealthy based solely on your BMI when all your other health markers are fine is an example of weight stigma. Having a provider spend less time with you or be openly rude to you because of your weight is an example of weight stigma. Being denied medical care as a result of your weight or BMI is an example of weight stigma. 

If you find yourself in any of these situations, you have the right to challenge the provider’s recommendations and advocate for better care. Ragen Chastain suggests these talking points 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 evidence-based recommendations for my treatment 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 (we love an evidence-based approach)

If you’re feeling on the fence about how a HAES approach to your healthcare could be beneficial, consider the differences in outcomes between a weight-inclusive versus a weight-focused approach: 

5. Processing your thoughts after your appointment

If you are not at peace with how your appointment went, you are not obligated to stay with this provider. Yes, it is discouraging to have to go back to the drawing board, but your physical and mental health are worth trying to find someone you can work with long term. 

If your appointment has brought up thoughts or feelings of guilt, shame, or embarrassment, be sure to check in with your therapist and/or dietitian to process your emotions. Your support system can help you process events, challenge internalized 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.

Summary

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, it is often necessary. Please know that your body does not have to be the one to change, our system is.  

Taking the following steps can bring weight stigma awareness to your health care appointments and help you advocate for better care for yourself or your loved one:

1. Research quality providers who practice within the Health At Every Size framework
2. Have conversations and set boundaries early about weight and diet talk
3. Know your rights as a patient and advocate for informed consent
4. Have talking points ready if you are confronted with BMI or weight loss talk
5. Take time to process your thoughts and emotions after your appointment

By fostering weight stigma awareness, we can shift the narrative in medical settings to prioritize patient health and respect over weight-centric approaches that may do more harm than good.